Hi,
We have scripted Medicare, Medicaid, BlueCross and Tricare. We first parse the 835 into an Access table. Once the Access table is updated the Meditech batch is created from this table. We also create exception reports by writing status' (ie Entered, Bad Account Number) back into the Access table and then querying the table. Tom McManus Tuomey Healthcare System Sumter, SC 803.774.8645 From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Parish, Jared R. Sent: Monday, June 09, 2008 2:40 PM To: [email protected]; Sexton, Kevin Subject: RE: [Talk] 835 files I am currently building remit scripts using the X12 835 file into meditech magic. I originally quoted this project to take me 50 hours, however, I have spent probably 175 hours to date and I'm not done. I have found it extremely difficult to script from the 835. I think my major hurtle is that I am a mediocre programmer at best, and I have no financial background. I have found that when I ask the claim posters what values they want entered in to what field in meditech I have two issues. 1. Translating what they want into something logical (i.e. If this then do that), 2. Finding the values that they want in the 835 file. (This is probably the bigger issues). I have purchased the WPC document explaining the 835 and this helped tremendously to decode the segments and fields. If I was asked to do this again, I would NOT. If your hospital will spring for the 90,000 claims module go for it. ...we might be buying the magic version in years to come. I will also note, as the poster below me did, I first convert the 835 to a comma-delimited file to make the actual script easier. We are using Quadax as our clearinghouse. If anyone decides to script the 835 and need help finding values please let me know. I might be able to help. Thanks, Jared Parish Business Analyst Blanchard Valley Health System 1900 South Main Street Findlay, Ohio 45840 Voice: 419.429.6476 Fax: 419.423.5540 Email: [EMAIL PROTECTED] CareTech Solutions, Inc. ________________________________ From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Sexton, Kevin Sent: Monday, June 09, 2008 2:12 PM To: [email protected] Subject: [Talk] 835 files BWS'ers, Is anyone scripting in all of their 835 files to Meditech Client Server (our HIS)? We are debating buying Meditech's Claims module ($90K+) or going to the trouble of scripting all of them and then having to support the scripts on a daily basis. I'm hoping to find someone who has been down that road. Thanks, Kevin J. Sexton 540-316-5504 Manager- Business Information Systems Fauquier Hospital -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Scaccia, Kimberly Sent: Monday, October 01, 2007 11:54 AM To: [email protected] Subject: RE: [Talk] Aetna 835 file Thanks Mary: However, I am able to extract all the codes from the raw 835 file from Meditech. My problem is that the payer legacy codes are more specific than the ANSI codes; therefore, as a fictitious example: Aetna sends me an 835 with reason code 16 which means: Claim/service lacks information which is needed for adjudication. The paper EOB would provide me with specifics on what is truly needed. I.E. Patient needs to provide Form XYZ, or patient needs to update information, or clinical documentation necessary, etc. This is what we have seen in trying to take our commercial remits live. Since we have an extensive denial/underpay department already in place, the 835s and lack of specificity has made it very difficult to move forward... it is like we are actually loosing data in most circumstances. Kim Scaccia, System Admin Recovery Reimbursement Patient Business & Financial Services Halifax Medical Center 386-226-4590 opt 1 ext 2018 ________________________________ From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Thompson, Mary Sent: Monday, October 01, 2007 11:44 AM To: [email protected] Subject: RE: [Talk] Aetna 835 file Loading the data into tables / SQL including the Claim Adjustment Reason codes, RA remark codes and the Claim Status codes and then query out of the tables to get the information regarding payment, denials, etc.. This will enable you to manage your 835 data and work your denials far more quickly then you ever did with paper RA's as well as trend these items. There is a lot of data in the 835 file and the most important thing you can do is load it all into something that you can then extract the information from for posting payments, ra codes, trending, denial management, etc. The codes and the definitions can be gotten from the Washington Publishing Company web site. I check it monthly for updates and keep our system current. www.wpc-edi.com/products/codelists Best of luck! Mary -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Scaccia, Kimberly Sent: Monday, October 01, 2007 10:22 AM To: [email protected] Subject: RE: [Talk] Aetna 835 file Kevin / Tom: I see you are having the same experience with the commercial 835s that I am... The reason codes from the payer are more specific than the ANSI Code... A Few Questions: Are you live with the 835 commercial? If so, how do you work around these reason code differences? (Specifically for payers who will discontinue sending the hard copy remits after ERA Go live)? Do you have a denials / underpay department? If so, how did they deal with the differences? Also, Kevin: Where were you on the Meditech L List? I have been asking these questions on the L for a long time (with no responses) J Kim Scaccia, System Admin Recovery Reimbursement Patient Business & Financial Services Halifax Medical Center 386-226-4590 opt 1 ext 2018 ________________________________ From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Thomas McManus Sent: Friday, September 28, 2007 3:35 PM To: [email protected] Subject: RE: [Talk] aetna 835 file Hi, I have experience with this. The paper copy and the electronic copy are different. Claims are indexed on account number. Another big difference is the Reason Codes. The paper copy uses a more specific reason code the electronic uses the Ansi standard codes which can be vague. Tom McManus Tuomey Healthcare System Sumter, SC 803.774.8645 ________________________________ From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Sexton, Kevin Sent: Friday, September 28, 2007 2:55 PM To: [email protected] Subject: [Talk] aetna 835 file This isn't really a BWS question.... The Aetna 835 file I am loading into Meditech doesn't match the hard copy they have been sending us. Has anyone else run into this. I was expecting patients A-Z but those patients are scattered all over various electronic files. -Kevin
