16 Replies Latest reply: Jan 5, 2017 8:37 AM by Joe Berry RSS

    Parsing 835

    fhosea _

      Has anyone been able to parse an 835 to capture acct number, patient name, rev code, amt billed, amt allowed, amt paid, reason / remark and adj rsn. This would need to be rolled by rev code without losing the association between patient and their corresponding line items.

       

      I'm not sure what the limitations are since I am relatively new to this product.

       

      Also we are 9.0 so if anyone has writeen anything similar to this is it possible to send me the template?

       

       

      Thanks,

       

      Frank

        • Parsing 835
          Olly Bond

          Hello Frank,

           

          There's a couple of users here with expertise in US healthcare forms, of which I guess an 835 is an example.

           

          If you hear back from the experts, please feel to post some anonymised sample data and I'll help you through the modelling.

           

          To try it yourself, start with the line items and trap them using a Detail template, then trap the data for the patient using an Append template (or templates).

           

          Best wishes,

           

          Olly

            • Parsing 835
              KeyserSoze _

              Using [URL="http://www.google.com/cse/home?cx=017979669301925061066:c4v8ksw-llg"]Custom Monarch Forum Google Search Engine[/URL], I was able to find a couple of [URL="http://www.monarchforums.com/showthread.php?2297-Healthcare-835-Files-and-Monarch&"]past discussions[/URL] that [URL="http://www.monarchforums.com/showthread.php?394-One-Field-in-Report-View-Changes-in-Table-View&"]may help[/URL] you to get started.

                • Parsing 835
                  Joe Berry

                  There are two free programs that may help with 835's.  One is a program that no longer is supported, but still works for most 835's.  It is PCPrint and was created for printing Medicare 835's/  They have since created Medicare Easy Print.  I have not found any 835's that this program will not print.  I print my data to a pdf file and use Monarch to create useful reports.  I have used this technique in one form or another since Monarch v7. 

                   

                  What type of report are you looking to create?  If I have anything similar, I would be happy to share.

                    • Parsing 835
                      tcallahan _

                      Frank,

                       

                      Sorry for the late reply.   My name is Tom Callahan and I am the Healthcare Product Manager at Datawatch.  We have been receiving a lot of interest in the 835 in the past couple of years.   So, we have a built an 835 solution via our Monarch Report Analytics technology that uses the 835 EDI file directly.

                       

                      We are having a webinar on Tuesday (20th) at 12pm EST, where we will walk thru our 835 solution.   If you're interested in attending, send me your email address and I can forward over the invite. 

                       

                      Or if you want to directly about the 835 and some of the challenges you are running into, please feel free to call me at 978-275-8268 .

                       

                      Thanks,

                       

                      Tom

                        • Parsing 835
                          chicagodiceman _

                          Tom,

                           

                          Will there be a repeat of this forum? I'm sure this is of interest to me and I'm sure other users.  Just came across this post but it is very much of interest.

                          • Re: Parsing 835
                            ricklesgolf _

                            Any update on this 835 solution?  I am interested in mining the 835 data.  Thanks.

                              • Re: Parsing 835
                                Chris Porthouse

                                Does this come from an 835 EDI datastream/file?  Depending on the version of Monarch you are using, there is a program that is provided that is called Monarch Utility that can parse/format your EDI file into something Monarch can handle.  For example, here is a 835 Sample (Professional Claims Only- With Payment...pre-utiltity)

                                And after running through Monarch Utililty:

                                ISA|00|      |00|      |ZZ|EMEDNYBAT  |ZZ|ETIN       |100101|1000|^|00501|006000600|0|T|+~

                                GS|HP|EMEDNYBAT|ETIN|20100101|1050|6000600|X|005010X221A1~

                                ST|835|1740~

                                BPR|I|45.75|C|ACH|CCP|01|111|DA|33|1234567890| |01|111|DA|22|20100101~

                                TRN|1|10100000000|1000000000~

                                REF|EV|ETIN~

                                DTM|405|20100101~

                                N1|PR|NYSDOH~

                                N3|OFFICE OF HEALTH INSURANCE PROGRAMS|CORNING TOWER, EMPIRE STATE PLAZA~

                                N4|ALBANY|NY|122370080~

                                PER|BL|PROVIDER SERVICES|TE|8003439000|UR|www.emedny.org~

                                N1|PE|MAJOR MEDICAL PROVIDER|XX|9999999995~

                                REF|TJ|000000000~

                                LX|1~

                                CLP|PATIENT ACCOUNT NUMBER|1|34.25|34.25| |MC|1000210000000030|11~

                                NM1|QC|1|SUBMITTED LAST|SUBMITTED FIRST| | | |MI|LL99999L~

                                NM1|74|1|CORRECTED LAST|CORRECTED FIRST~

                                REF|EA|PATIENT ACCOUNT NUMBER~

                                DTM|232|20100101~

                                DTM|233|20100101~

                                AMT|AU|34.25~

                                SVC|HC+V2020+RB|6|6| |1~

                                DTM|472|20100101~

                                AMT|B6|6~

                                SVC|HC+V2700+RB|2.75|2.75| |1~

                                DTM|472|20100101~

                                AMT|B6|2.75~

                                SVC|HC+V2103+RB|5.5|5.5| |1~

                                DTM|472|20100101~

                                AMT|B6|5.5~

                                SVC|HC+S0580|20|20| |2~

                                DTM|472|20100101~

                                AMT|B6|20~

                                CLP|PATIENT ACCOUNT NUMBER|2|34|0| |MC|1000220000000020|11~

                                NM1|QC|1|SUBMITTED LAST|SUBMITTED FIRST| | | |MI|LL88888L~

                                NM1|74|1|CORRECTED LAST|CORRECTED FIRST~

                                REF|EA|PATIENT ACCOUNT NUMBER~

                                DTM|232|20100101~

                                DTM|233|20100101~

                                SVC|HC+V2020|12|0| |0~

                                DTM|472|20100101~

                                CAS|CO|29|12~

                                SVC|HC+V2103|22|0| |0~

                                DTM|472|20100101~

                                CAS|CO|29|22~

                                CLP|PATIENT ACCOUNT NUMBER|2|34.25|11.5| |MC|1000230000000020|11~

                                NM1|QC|1|SUBMITTED LAST|SUBMITTED FIRST| | | |MI|LL77777L~

                                NM1|74|1|CORRECTED LAST|CORRECTED FIRST~

                                REF|EA|PATIENT ACCOUNT NUMBER~

                                DTM|232|20100101~

                                DTM|233|20100101~

                                AMT|AU|11.5~

                                SVC|HC+V2020+RB|6|6| |1~

                                DTM|472|20100101~

                                AMT|B6|6~

                                SVC|HC+V2103+RB|5.5|5.5| |1~

                                DTM|472|20130917~

                                AMT|B6|5.5~

                                SVC|HC+V2700+RB|2.75|0| |0~

                                DTM|472|20100101~

                                CAS|CO|251|2.75~

                                LQ|HE|N206~

                                SVC|HC+S0580|20|0| |0~

                                DTM|472|20100101~

                                CAS|CO|251|20~

                                LQ|HE|N206~

                                SE|65|1740~

                                GE|1|6000600~

                                IEA|1|006000600~

                                 

                                 

                                HTH

                      • Re: Parsing 835
                        Joe Berry

                        Before I retired a couple of years ago, I did a lot of reporting for healthcare, including data from 835's.  I found it much easier, for most data, to use a free program to convert the 835 data into a PDF file that can be modeled easier than the format produced by the Monarch Utility.  There are two different free programs that will do this.  Medicare Remit Easy Print and PC Print - both were created by CMS for Medicare remittances. Since HIPAA, it works for all 835's since they all must follow the same standard.  Your mileage may vary, but I found it much more intuitive.

                          • Re: Parsing 835
                            ricklesgolf _

                            Thanks for all the input.  My problem has been capturing the multiple and varying fields for each record such as the reject or adjustment reasons.

                              • Re: Parsing 835
                                Joe Berry

                                Medicare Remit Easy Print has two different reports that can be created to accomplish your goal.  The first is Adjusted Service Lines and the other is Denied Service Lines.  These reports give the data necessary for management or the billing staff to understand the reasons for each.  I was the Director of Patient Accounts and used the data obtained from these reports to determine what improvements our billing staff could implement to reduce the amount of errors.  I originally attempted to get the data directly from the 835 files; however, this approach is much easier and in reality does not add much labor to the process.

                                  • Re: Parsing 835
                                    ricklesgolf _

                                    Thanks so much.  I will give this a try.  I really appreciate all of the vast knowledge!

                                    • Re: Parsing 835
                                      ricklesgolf _

                                      Joe,

                                      I have downloaded the Medicare software.  Is there a trick to selecting all of the records that are brought in on the 835?  When I go to reports, it only shows records by check number.  It would be very time consuming to select records by check number.  I am going to read the guide to see if I find anything there.  Thanks Again.

                                        • Re: Parsing 835
                                          Austin Perkins

                                          ricklesgolf -

                                           

                                          I've worked a lot with 835 files and have struggled with being able to convert the files to essentially a flat file that can be analyzed. The biggest issue when trying to convert them is the fact that you have several things working against you. One being that for each individual claim, the CAS detail line can be simply one line with one PR, CO, OA, or IA adjustment type, there can be multiple CAS lines, or there can be multiple CAS lines with multiple adjustment types and codes on a single row of data. Where this gets more tricky is that each insurance company has the potential to use different codes and different segments of the 835 because there are parts that are optional.

                                           

                                          To create a usable tool, you will have to find a way to create one file that has strictly 835 information (EFT number, EFT date, Payer, Payee, etc.). Then an additional demographic table would need to be created which would be unique by patient control number and contain patient information (name, charges, amount paid by insurance, admit date, discharge date, claim date, internal control number, other IDs, DRG, etc.). Once that was created, an adjustment level detail table would need to be created that too had the unique patient control number but also had each PR, CO, OA, and IA adjustment type, reason code (there are lots), and amount.

                                           

                                          Once those tables were created, the 835 information and patient demographic information could be flowed down to the adjustment detail lines. This is all possible using Data Prep Studio, just takes some work to get it right.

                                          • Re: Parsing 835
                                            Joe Berry

                                            Unfortunately the 835 data is specific to a specific remit file.  I had the posting folks create a pdf file for each remit and concatenated them together, then used Monarch to parse them.  Another thought is that the electronic billing system used by the healthcare entity may well import all of the remits and be able to produce a flat file of multiple remits.  If I was asked to create reports from 835 data, I would become friends with the person in charge of billing or one of the senior billing staff.  They can help you with understanding the data that is housed in both the electronic billing system and in the healthcare information system.  This may well provide the data needed for the reports requested.  hth