none
5010 - 837I Transactions, 24 "Other Diagnosis Codes"

    Question

  • We are mapping the additional 12 "Other" Diagnosis Codes to the 5010 schema for 837I transactions and I am wondering if Biztalk will allow a straight mapping to the additional HI segments in the lower level supplemental 2300 loop or if it will require other (repeated)segments (e.g. HL, CLM and PAT, etc.)to be mapped in addition? If so... is this the true 837I-5010 structure...to repeat elements at the lower level just to get the additional diag codes mapped? My understanding is that the HI segment is repeatable one time but the additional segments are not repeatable so that the HL, PAT and CLM segments are not required at that supplemental level.

    I have not had to map these other diag codes prior to the 5010 so I am concerned about repeating segments with the same data in the same transaction in two separate areas of the claim.

    Thanks!



    • Edited by Chrystap123 Wednesday, January 25, 2012 3:53 PM
    Wednesday, January 25, 2012 3:39 PM

Answers

  • you can change the Max occur of HI segment and other dignosis codes to unbounded so that you can directly add "Other" Diagnosis Codes to the HI segment wihout adding . HL, CLM and PAT...........
    • Edited by sriaug Wednesday, January 25, 2012 4:47 PM
    • Marked as answer by Chrystap123 Wednesday, January 25, 2012 5:39 PM
    Wednesday, January 25, 2012 4:35 PM
  • Yes it wont be compliant............and also you need to make sure to make Min Occur of those segment(HL, PAT, CLM) as '0'

    • Marked as answer by Chrystap123 Wednesday, January 25, 2012 5:39 PM
    Wednesday, January 25, 2012 5:11 PM

All replies

  • you can change the Max occur of HI segment and other dignosis codes to unbounded so that you can directly add "Other" Diagnosis Codes to the HI segment wihout adding . HL, CLM and PAT...........
    • Edited by sriaug Wednesday, January 25, 2012 4:47 PM
    • Marked as answer by Chrystap123 Wednesday, January 25, 2012 5:39 PM
    Wednesday, January 25, 2012 4:35 PM
  • Will this still be a compliant 5010 - 837I transaction without those segments (HL, PAT, CLM) or does the 5010 require them if those additional diag codes are present? My understanding is "no" but I just need to make sure.

    I can always test the output format on our ANSI validator to make sure the file is syntactically correct but just wanted to get your take on it. Thanks so much for your response!

    Wednesday, January 25, 2012 5:08 PM
  • Yes it wont be compliant............and also you need to make sure to make Min Occur of those segment(HL, PAT, CLM) as '0'

    • Marked as answer by Chrystap123 Wednesday, January 25, 2012 5:39 PM
    Wednesday, January 25, 2012 5:11 PM
  • You mean to say make the HL, PAT and CLM segments in the supplemental 2300 loop set to Min Occur = '0'? Not the hierarchical (Original top level) 2300 loop? I just want to make sure I am clear. Those would still be set to Min Occur = '1'?

    Wednesday, January 25, 2012 5:13 PM
  • yes in the supplemental 2300 loop(CLM , DTP and CL1) should be set to Min Occur = '0'......

     


    As per my understanding you are going to add other diagnosis codes to the 2300 HI segment....
    • Edited by sriaug Wednesday, January 25, 2012 5:21 PM
    Wednesday, January 25, 2012 5:17 PM
  • Last question...when you say 'you can change the Max occur of HI segment and other dignosis codes to unbounded ' ...what does that mean when I am looking at the properties of each segment? How do I get to 'Unbounded' as the property? I haven't done this before. And do I do this at the hierarchical 2300 loop? I assume yes if i am changing the Min Occur to '0' on the lower level supp 2300 loop.

    Thanks again... you truly are a huge help!

    Wednesday, January 25, 2012 5:23 PM
  • when you look at the property window....just change Maxoccur from 1 to unbounded . delete 1 and type unbounded..
    Wednesday, January 25, 2012 5:28 PM
  • that's what I thought you were getting at... haha. Thank you!

     

    I wil mark your reply as "ANSWER".

     

    Thanks again. You rock!

    Wednesday, January 25, 2012 5:31 PM
  • Thanks. :)
    Wednesday, January 25, 2012 5:36 PM