Validating Claims in 837 file RRS feed

  • General discussion

  • Hi,

    My company receives 837 p/i and we use biztalk to upload claims to our sytem. I want to put some custom validation for the claims and send the invalid claims for error processing and keep the 837 with all valid claims from the input 837.

    The validations are prity strate for comparing claim elements e.g service end date should not be after claim receive date etc

    What is the best way to do this?

    Note - There is map that converts input 837 to a canonical schema. I need these validation before the map is excecuted.

    • Edited by BuildSystem Thursday, December 11, 2014 5:09 PM
    Thursday, December 11, 2014 5:05 PM

All replies

  • The Business Rules Engine would be the most appropriate choice for this though certainly not the only one.

    I would do this in an Orchestration.  Apply the 837 Policy and if the number or type of errors exceed a certain threshold, route the message to the error queue.  Otherwise, forward for processing.

    I have done exactly that many times.

    Thursday, December 11, 2014 5:14 PM
  • do I have to split the 837 at claim leve for orchestrationl? I tried to use the bre i face 2 issues- 1. There is one validation using date base. I used db lookup but couldn't find how to handle if the member doesn't exist in data base. 2. I split the 837 at claim level.the map expect all the claims in one 837.

    I would apriciate if you guide me with some sample of orchestration.

    Thursday, December 11, 2014 6:19 PM