8 Replies Latest reply: May 15, 2014 10:00 AM by jfrank _ RSS

    Healthcare 835 Files and Monarch

    jfrank _

      Hello All! I recently inherit a position where Monarch was one of the tools in my arsenal, I admit that I am mostly self-taught but very exciteb about the possibilities I see in Monarch. I was especially excited to find the prep tool that will allow delimiters to be replaced with spaces so I've started looking at our Insurance Remits (835) files to see what information I can pull from them and I've run into a (small?) problem.

       

      Each 835 file is comprised of several claims, each claim has at least one CPT code but might have several CPT code sections assigned to it (Easy enough to handle with detail/append models) but here's where it gets tricky: Each CPT code CAN have up to four group/reason codes. I was trying to make the CPT section the detail because it is consistently there, but those rascally group/reason codes are screwing things up!

       

      CLP XXXXXXXXX                1                                 97            81                  12              XXXXXXXXXX 23                             

      NM1 QC                       1                                 ANDERSON      X          H                                   MI              XXXXXXXXXXXX     

      NM1 IL                       1                                 ANDERSON      XXXXX      M                                   MI              XXXXXXXXXXXX   

      NM1 74                       1                                                          H                       

      DTM 232                      20071225                                       

      DTM 233                      20071225                                       

      SVC HC>99283                 97                                81                       1                       

      DTM 472                      20071225                                       

      CAS CO                       45                                16                      

      REF LU                       51537953                                       

       

      CLP XXXXXXXXX                1                                 97            71         10       12              XXXXXXXXXX 23                             

      NM1 QC                       1                                 ARRAMDAN      X          Y                                   MI              XXXXXXXXXXXX     

      NM1 IL                       1                                 ARRAMDAN      XXXX                                           MI              XXXXXXXXXXXX     

      NM1 74                       1                                                          I                       

      DTM 232                      20071225                                       

      DTM 233                      20071225                                       

      SVC HC>99283                 97                                71                       1                       

      DTM 472                      20071225                                       

      CAS CO                       45                                16                      

      CAS PR                       3                                 10                      

      REF LU                       51537953                                       

       

      CLP XXXXXXXXX                1                                 146           97         25       12              XXXXXXXXXX 23                             

      NM1 QC                       1                                 BOUTWELL      X          A                                   MI              XXXXXXXXXXXX     

      NM1 IL                       1                                 BOUTWELL      XXXXXXX    K                                   MI              XXXXXXXXXXXX     

      NM1 74                       1                                               MICHAE             

      DTM 232                      20071223                                       

      DTM 233                      20071223                                       

      SVC HC>99284                 146                               97                       1                       

      DTM 472                      20071223                                       

      CAS CO                       45                                24                      

      CAS PR                       3                                 25                      

      REF LU                       51537953                                       

      /CODE

       

      I have stripped the example above of any private information but you can see that CLP is the line where the new claim starts, the SVC is where the CPT information is, and the CAS is the GRP/RC in just the few I've attached here you can see that one CPT has two GRP/RC while the others have two. They can have none at all or up to four.

       

      I thought about making the GRP/RC the detail but since it isn't always there, I don't think that would work.

       

      Anyone seen this before or have any guidance?

       

      Thanks!

      Julie

        • Healthcare 835 Files and Monarch
          Bruce _

          Hi Julie

           

          I don't know which version of Monarch you have, but you have at least on footer that you can use.

           

          From Ver 9 you can have several footers that you can use.

           

          Footors are details that come after the main body and you set them up very much like the details template. They may or may not be on each report detail, so I think this is exactly what you need.

           

          Let us know if this helps or if you need more help.

           

          Bruce

           

            • Healthcare 835 Files and Monarch
              jfrank _

              Hmmm, I think I misunderstood what Footers were - I thought there were at the end of a page?

               

              I have Version 8.02, but Version 9 sounds interesting - I may have to see if I can justify a need for an upgrade.

                • Healthcare 835 Files and Monarch
                  RalphB _

                  You don't say if you have the Standard or Pro version of Monarch, but if you have the Standard version, I'd highly recommend you upgrade to the Pro version.  The extra functionality is well worth the extra cost. 

                   

                  I don't know what we'd do if we didn't have the Pro version at work.

                    • Healthcare 835 Files and Monarch
                      Olly Bond

                      Dear Julie,

                       

                      You've hit upon a surprisingly common problem - what to do when there's a record (in your case a CPL / SVC entry - which has sometimes none, sometimes one, two or more detail entries.

                       

                      If your report looks a bit like this:

                       

                      Header A

                      Detail 1

                      Detail 2

                      Detail 3

                       

                      Header B

                      Detail 4

                       

                      Header C

                       

                      Header D

                      Detail 5

                      Detail 6

                       

                      ... and you want a table that looks like this:

                       

                      Header A, Detail 1, Detail 2, Detail 3,

                      Header B, Detail 4 , , ,

                      Header C, ,

                      Header D, Detail 5,

                      Header D, Detail 6,

                       

                      then you need to use a multi-pass process - extracting the details, with appended headers, in one model (this won't get you the line with Header C as this has no detail) and extracting the headers alone in a second model, then combining the two data sets using either an external lookup or sometimes appending data from one project export to the bottom of the table created in the first project, and then bringing this data in to a third model and creating a summary from it.

                       

                      I think you'd definitely need Monarch Pro for this sort of work, but once you've set up one collection of models & projects, it's an easy, powerful and quick way of handling tricky data. The advanced Monarch training course should cover enough topics to help you handle this, or there's the model-building service.

                       

                      HTH,

                       

                      Olly

                      obond(at)avanquest.co.uk

                    • Healthcare 835 Files and Monarch
                      Grant Perkins

                      Hmmm, I think I misunderstood what Footers were - I thought there were at the end of a page?

                       

                      /quote

                       

                      At the end of a section of a report - but the section can be pretty much whatever you want it to be so long as it exhibits the characteristics you use to identify it.

                       

                      For example you could think of a single record as being a virtual 'page' of, potentially, variable length.

                       

                      Many Monarch features can, with a little experience and certain amount of imagination, be made to work of you in a number of ways beyond their obvious purpose.  I recommend experimenting. It doesn't take long and can't do any harm if you use copies of things to experiment on!

                       

                      HTH.

                       

                       

                      Grant

                        • Healthcare 835 Files and Monarch
                          Grant Perkins

                          Julie,

                           

                          There is another approach to this which you might be able to use.

                           

                          How many possible CAS codes are there in total? Not the number of them per record but the total number of possible codes?

                           

                          If it is a reasonable number you could set up a template that looks for the specific codes rather than listing what codes may be found. The format of the report is a potential constraint - I will try to explain.

                           

                          If you are using the SVC line for your detail trap and an SVC line is always followed by a DTM line then we aseem to have 2 lines to play with. If it is always followed by a and a REF line we have 3 lines to play with. If there is always a space before the next CLP line we may have 4 lines to play with. Lets start assuming we have just 2 lines.

                           

                          In you model define an APPEND template that uses EXACTLY THE SAME TRAP as your DETAIL template. Make the sample 2 lines long. The data in the sample does not matter much but a CAS line would maybe help.

                           

                          Paint a field (or fields) on the first line where CAS data field columns would be. (Ignore the first column - we will use this to select the other fields.) Go to the advanced field properties and set the 'Start Field on' value to a preceding string of, say, "CAS CO".

                           

                          On the second line do the same but make the preceding string, say, "CAS PR".

                           

                          Save the template and see what you get. Probably best if you name the fields for "CAS" type and value - CAS PR Values 1, CAS PR value 2, etc.

                           

                          If you need 4 different possible CAS codes then you would need two templates like this. If you need 6 total possible CAS codes you would need 3 templates and so on.

                           

                          If you need 40 CAS codes there is a problem because you will run over the maximum number of templates possible, especially since you will need at least 3 other templates by the looks of it to get the rest of the data.

                           

                          If it is possible to provide the template with more 'sample' lines without compromising how Monarch reads subsequent record sections that would help - you can get more possible CAS codes into a single template BUT you will not get the correct results if you allocate the template more lines then the minimum number of lines between SVC records (Ie Detail templates) found anywhere in the report. So if you ever get or could get a section which looks like:

                           

                          SVC HC>99283                 97                                71                       1                       

                          DTM 472                      20071225

                          SVC HC>99283                 97                                71                       1                       

                          DTM 472                      20071225                                        /code

                                                                  

                          You will be limited to 2 lines per template.

                           

                          This is a very useful technique PROVIDED the report format and the potential, pre-definable data content for the pre-ceding strings do not prevent its use. So I recommend spending a few minutes experimenting with it whilst someone finds out how many possible CAS codes might appear in the report.

                           

                          One benefit is that if there are no CAS codes nothing is reported. By making the Append Template trap the same as the DETAIL trap the Append values are always reset for each detail record.

                           

                          If you find that the number of possible CAS codes will make life difficult let us know. We have not yet run out of techniques to help us outwit the report author! 

                           

                          HTH.

                           

                          Grant

                           

                          PS. Despite my previous post I don't think footers offer much here unless you also tie the trap into the detail trap line but ensure it (the trap) ends AFTER the last identifer for the detail trap yet will always be reset by the detail trap line because the additional trap information will always be populated in a detail line.

                            • Healthcare 835 Files and Monarch
                              jfrank _

                              Thanks for all the advice! I haven't been able to really roll up my sleeves and get back into this project since last week because of other activities. However, yesterday I did try using the footer model which looked like it was going to work. I also talked to my supervisor about a possible upgrade and the annual conference and she said both are possibilities!

                               

                              I'll keep you posted once I take another serious crack at this.

                               

                              Thanks again!

                              Julie