HIPAA 837 document splitting basis

Question

Hi,
In HIPAA 837P schemas we have two schemas single and multi,..I know that Multi is used when a hipaa splitting is needed. This particular document splitting case, when do the business might need the document to be split ? Is there any scenario's which require the document to be split? Are there different ways in which a document can be split?

Thanks,

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Ram

Answer 1

Ram,

There are a number of reasons that you might want to split an 837.

837 messages can be very large, so large that mapping them can consume more memory than you can allocate. By breaking down the messages into individual claims, each mapping exercise only requires memory for that single claim's work.

Breaking down the messages also allows you to scale out. So instead of having a single thread doing all the mapping work, Biztalk will spread the mapping load across multiple threads (and perhaps processes depending on configuration).

If you are doing any front end edits, breaking down the 837 allows you to individually route each claim through the appropriate logic. For instance, claims of type X might go through rules Y, or be routed to location Z. So - you can independently work on each claim - rather than working on the entire batch.

I am sure there are other reasons - but those are the ones that come to mind.

---Chris

Answer 2

Does splitting the document means, sending individual claims? does this means one edi file created for each and every claim submitted?

Thanks,

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Ram

Answer 3

Splitting means you will get one XML file out of the pipeline for each claim(instance of a 2300 loop) - rather than one big XML file for the entire 837.

Answer 4

Finally, how is it sent?

Thanks,

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Ram

Answer 5

Typically, splitting occurs in the EDI receive pipeline. After splitting - all the individual single claim messages hit the message box.

Messages are sent to ports/orchestrations/etc based on subscriptions to the messages that hit the message box.

So - I guess the correct but cryptic answer is: That depends on your configuration.

Answer 6

So can the claims that were split for easy handling be bundled out and send in a single EDI file with some amount of Claims?

Thanks,

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Ram