Identifying Your Errors on the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Format

View your HIPAA 837 Files by Adding Line Numbers to each Segment and Breaking the Segments into Separate Lines

We've been looking for a good solution for our customers to help you locate the segment that is in error on your Daily Log report. An example of the file name on your Daily Log report is: ga001230.20031013. One method is to provide line numbers for each segment within the file that is already broken line by line. The other method is to break each segment within the file that is not already broken line by line into separate lines and to provide line numbers. We have found a way to do both of these methods using Microsoft Word.

IMPORTANT NOTE: The count on the Daily Log starts at the ST segment, which is really the 3^rdsegment. So when you are looking at the error, you will need to add 2 to the line count. Example: SEGMENT NM1 POSITION 1318 ELEMENT 4 IS MISSING

The position 1318 is the line number. After following the directions below, you would find the error on line number 1320.

Submitters whose Segments are already broken line by line

Here is an example of a file already broken line by line:

Open up Microsoft Word (Go to Start | Programs | Microsoft Word)

Click on File | Open

Locate the path of your file. By default our FTP Scripts use the "C" drive and our example will be for PC-ACE Pro32 users, the folder is "WINPCACE", and the file name is "TRANS.DAT". The file will be located in i.e. (C:\winpcace\trans.dat). This does not mean this is where your file is located. If you are not sure where your file is located, ask your in house Technical Support or contact your software vendor for the answer.

Click on the down arrow to the right of the "Files of type" box and Click on "All Files (*.*)"

Click on the down arrow to the right of the "Look in" box and Select your "C" drive

Double Click on your "WINPCACE" folder

Highlight the "TRANS.DAT" file and Click on "Open"

When the "File Conversion" screen appears, Select "Plain Text" and Click on "OK" (If this screen does not appear, skip this step)

Click on "Edit" and Click on "Select All" which will highlight your file

Click on "Format" and Click on "Bullets and Numbering"

The Bullets and Numbering Screen will appear, Click on the "Numbered" tab, Pick a numbering scheme, click on the numbering scheme and Click on "OK"

On your keyboard, Press the "Ctrl & F" keys at the same time, a Find and Replace Screen will appear, Click on the "Go To" tab, Under the "Go to what" box, Select "Line", Put your "Cursor" in the "Enter line number" box, Enter the Segment number in error, Click on "Go To" and it will go to that line. Click on "Close"

If you had entered 11, it takes you to the 10th line because the ISA segment is 2 lines (some ISA segments are only 1 line) and our count from your Daily Log report starts counting on the ST segment, so you would have to add 3 lines to get to the segment line in error. If your ISA segment were 1 line, you would add 2 lines to get to the segment line in error.

After locating your segment line in error, you would go back to your software, correct the error, and rebatch your claims to send to Cahaba GBA. We can't stress enough the importance of NOT SAVING the file you view. Our front-end system will not accept the line numbers at all.

NOTE: When you close the file DO NOT say "Yes" to save changes, Click on "No".

Submitters whose Segments are not already broken line by line

Here is an example of a file not already broken line by line:

Open up Microsoft Word (Go to Start | Programs | Microsoft Word)

Click on File | Open

Locate the path of your file. By default our FTP Scripts use the "C" drive and our example will be for PC-ACE Pro32 users, the folder is "WINPCACE", and the file name is "TRANS.DAT". The file will be located in i.e. (C:\winpcace\trans.dat). This does not mean this is where your file is located. If you are not sure where your file is located, ask your in house Technical Support or contact your software vendor for the answer.

Click on the down arrow to the right of the "Files of type" box and Click on "All Files (*.*)"

Click on the down arrow to the right of the "Look in" box and Select your "C" drive

Double Click on your "WINPCACE" folder

Highlight the "TRANS.DAT" file and Click on "Open"

When the "File Conversion" screen appears, Select "Plain Text" and Click on "OK" (If this screen does not appear, skip this step)

Click on "Edit" and Click on "Replace"

The Find and Replace Screen will appear, Click on the "Replace" tab and Click on the "More" button at the bottom of the screen

You will still be on the Find and Replace Screen. In the "Find what" field, key your delimiter (Segment Terminator) used in your file (It is usually a "~" (Tilde) and will be the last character in your ISA segment, your first segment), Tab to "Replace with" field (cursor must be here), Click on the "Special" button, Select "Paragraph Mark" from drop box, and Click on the "Replace All " button.

A Microsoft Word message will appear, Click on "OK"

The Find and Replace screen will appear again, Click on "Close"

Click on "Edit" and Click on "Select All " which will highlight your file

Click on "Format" and Click on "Bullets and Numbering"

The Bullets and Numbering Screen will appear, Click on the "Numbered" tab, Pick a numbering scheme, Click on the numbering scheme and Click on "OK".

On your keyboard, Press the "Ctrl & F" keys at the same time, the Find and Replace Screen will appear. Click on the "Go To" tab, Under the "Go to what" box, Select "Line", Put your "Cursor" in the "Enter line number" box, Enter the Segment number in error, Click on "Go To" and it will go to that line, Click on "Close"

If you had entered 11, it takes you to the 10th line because the ISA segment is 2 lines (some ISA segments are only 1 line) and our count from your Daily Log report starts counting on the ST segment, so you would have to add 3 lines to get to the segment line in error. If your ISA segment were 1 line, you would add 2 lines to get to the segment line in error.

After locating your segment line in error, you would go back to your software, correct the error, and rebatch your claims to send to Cahaba GBA. We can't stress enough the importance of NOT SAVING the file you view. Our front-end system will not accept the line numbers at all.

NOTE: When you close the file DO NOT say "Yes" to save changes, Click on "No".

You may find that after the first time you have gone through the instructions and are going through them an additional time, some of the information may already appear on the screens. Just skip that step and continue on to the next step.

To Determine Which Beneficiary's Claim Contains the Error

When determining which beneficiary's claim is in error, remember these two things:

1. Each claim begins with an HL segment.

2. The beneficiary's name is found in an NM1*IL segment.

So once you have found the error, you will want to scroll up or down to find the NM1*IL segment to determine whose claim the error is in. Remember that each new segment begins with an HL segment.

10. NM1*85*2*SAMPLE HOME HEALTH*****24*123456789

11. N3*400 E COURT

12. N4*DES MOINES*GA*50309

13. REF*1C*167999

14. PER*IC*KATHY*TE*5155551212

15. HL*2*1*22*0

16. SBR*P*18**UNKNOWN*****MA

17. NM1*IL*1*SMITH*DENNY****MI*123456789A

18. N3*100 MAIN ST

19. N4*ANYWHERE*GA*50309

20. DMG*D8*19100428*F

21. NM1*PR*2*MEDICARE PART A*****PI*00011

22. CLM*SAMPLE CLAIM*0***32>A>2*Y**Y*Y*********Y

23. DTP*434*RD8*20030116-20030116

24. DTP*435*DT*200301160001

25. CL1**4*30

26. REF*G1*011620030116200301

27. HI*BK>4280*BJ>4280

28. HI*BE>61>>>9946

29. NM1*71*1*GREEN*MARK****24*123456789

30. REF*1G*A12345

31. LX*1

32. SV2*0023*ZZ>HAEJ1*0*UN*1

33. DTP*472*D8*20030116

If you need assistance, please call our EDI Services Department at 866-582-3253.

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