CMS form 1500 has been released for ICD-10 testing

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CMS has released form 1500 for the professional claim  for  providers using a paper claims. This new form has a ICD indicator for ICD-9 and ICD-10 claims.

The timeline is:

• January 6, 2014: Payers begin receiving and processing paper claims submitted on the revised 1500 Claim Form (version 02/12).
• January 6 through March 31, 2014: Dual use period during which payers continue to receive and process paper claims submitted on the old 1500 Claim Form (version 08/05).
• April 1, 2014: Payers receive and process paper claims submitted only on the revised 1500 Claim Form (version 02/12).

Please use the below URL to download the form and sample example.

http://www.nucc.org/%5Cimages%5Cstories%5CPDF%5C1500_claim_form_2012_02.pdf

visit - NUCC site  for more deatils.http://nucc.org/

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Automation tool- converts ICD-9 edi claim file to ICD-10 edi claim file.

http://urtesting.blogspot.com/

One of my friend has developed a automation tool that takes the icd9 claims as input and generates icd-10 brand new claims.The tool does the GEMs X-walk for icd 9 to icd 10 codes and also changes the date of service to service to a void the duplicate claim. I tested this and worked perfect for my testing.He is soon going to checkin the code in girth hub as open source.
Any one is interested please let me know.
This is a fantastic tool that also has the x-walk ability .
Urtesting.blogspot.com

HIPAA Transaction impacted by ICD-10 codes

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There are many transaction that are going to be impacted by ICD-10 diagnosis and procedure codes. Offcousre the 837 insutional and professional claims has a huge impact but almost all the most used HIPAA transaction has impact except the 835 transaction.
834 has a impactd when enrolling a member for pre-existing condition where Diagnosis code comes in 834 edi files.There is an impact on 270 and 271 transaction for claims status and also for 278 for referral when provider is referring for a condtion that has a diagnosis code.

837 - Profession - has a impact
837 - Instuitional - has a impact
837 - Dental - has a impact

270 - has a impact
271- has a impact

278 - has a impact.

835 - No impact .. but there need to a testing of 835 for the ICD-10 claims for making sure that 835 generates as expected for ICD-10 837 edi files.

Please feel free to comments ..and ask any question if you have..

How to prepare ICD-10 EDI claims file from existing ICD-9 files or convert ICD-9 files to ICD-10 files( Part-2)

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This is in continuation of part-1...
HIPAA 5010 ICD-9 claims with conversion to ICD-10 claims. This example has a ICD-9 diagnois code 0340 that has 2 ICD-10 X-walk .. so 2 ICD-10 EDI files has been created for testing.

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ICD-9 Professional Claim example

ISA*00* *00* *ZZ*Sender *ZZ*Receiver *130915*1025*^*00501*201309150*1*T*:~
GS*HC*Sender*Receiver*20130915*1020*123456*X*005010X222A1~
ST*837*2013*005010X222A1~
BHT*0019*00*23456*20130915*1023*CH~
NM1*41*2*Sender Name*****46*Senderid~
PER*IC*ContactPersonName*TE*TelephoneNumberofContactperson*FX*FaxNumber~
NM1*40*2*ReceiverName*****46*ReceiverID~
HL*1**20*1~
NM1*85*2*Billing provider name*****XX*NPI~
N3*Billing Provider Address~
N4*Billing provider city*Billing provider State*Billing Provider Zipcode~
HL*2*1*22*0~
SBR*P*18*Subscriber group ID******BL~
NM1*IL*1*Subscriber Last Name*First Name*Middle Name***IL*subscriberid~
N3*Subscriber address~
N4*Subscriber city*state*zipcode~
DMG*D8*SubscriberDOB*SubscriberSEX~
NM1*PR*2*PayerName *****PI*payerID~
N3*PayerAddress~
N4*PayerCity*PayerState*Payerzipcode~
CLM*claimNumber*100***13:B:1*Y*A*Y*Y*P~
HI*BK:0340~
NM1*82*1*rendering provider name*****XX*NPI~
LX*1~
SV1*HC:99214*100*UN*1***1**N~
DTP*472*RD8*20130910-20130910~
SE*30*2013~
GE*1*123456~
IEA*1*201309150~

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First ICD-10 claim for the above ICD-9 claim
ISA*00* *00* *ZZ*Sender *ZZ*Receiver *130915*1025*^*00501*201309150*1*T*:~
GS*HC*Sender*Receiver*20130915*1020*123456*X*005010X222A1~
ST*837*2013*005010X222A1~
BHT*0019*00*23456*20130915*1023*CH~
NM1*41*2*Sender Name*****46*Senderid~
PER*IC*ContactPersonName*TE*TelephoneNumberofContactperson*FX*FaxNumber~
NM1*40*2*ReceiverName*****46*ReceiverID~
HL*1**20*1~
NM1*85*2*Billing provider name*****XX*NPI~
N3*Billing Provider Address~
N4*Billing provider city*Billing provider State*Billing Provider Zipcode~
HL*2*1*22*0~
SBR*P*18*Subscriber group ID******BL~
NM1*IL*1*Subscriber Last Name*First Name*Middle Name***IL*subscriberid~
N3*Subscriber address~
N4*Subscriber city*state*zipcode~
DMG*D8*SubscriberDOB*SubscriberSEX~
NM1*PR*2*PayerName *****PI*payerID~
N3*PayerAddress~
N4*PayerCity*PayerState*Payerzipcode~
CLM*claimNumber*100***13:B:1*Y*A*Y*Y*P~
HI*ABK:J020~
NM1*82*1*rendering provider name*****XX*NPI~
LX*1~
SV1*HC:99214*100*UN*1***1**N~
DTP*472*RD8*20130910-20130910~
SE*30*2013~
GE*1*123456~
IEA*1*201309150~

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Second ICD-10 claim for the above ICD-9 claim

ISA*00* *00* *ZZ*Sender *ZZ*Receiver *130915*1025*^*00501*201309150*1*T*:~
GS*HC*Sender*Receiver*20130915*1020*123456*X*005010X222A1~
ST*837*2013*005010X222A1~
BHT*0019*00*23456*20130915*1023*CH~
NM1*41*2*Sender Name*****46*Senderid~
PER*IC*ContactPersonName*TE*TelephoneNumberofContactperson*FX*FaxNumber~
NM1*40*2*ReceiverName*****46*ReceiverID~
HL*1**20*1~
NM1*85*2*Billing provider name*****XX*NPI~
N3*Billing Provider Address~
N4*Billing provider city*Billing provider State*Billing Provider Zipcode~
HL*2*1*22*0~
SBR*P*18*Subscriber group ID******BL~
NM1*IL*1*Subscriber Last Name*First Name*Middle Name***IL*subscriberid~
N3*Subscriber address~
N4*Subscriber city*state*zipcode~
DMG*D8*SubscriberDOB*SubscriberSEX~
NM1*PR*2*PayerName *****PI*payerID~
N3*PayerAddress~
N4*PayerCity*PayerState*Payerzipcode~
CLM*claimNumber*100***13:B:1*Y*A*Y*Y*P~
HI*ABK:J0300~
NM1*82*1*rendering provider name*****XX*NPI~
LX*1~
SV1*HC:99214*100*UN*1***1**N~
DTP*472*RD8*20130910-20130910~
SE*30*2013~
GE*1*123456~
IEA*1*201309150~

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in the above example of ICD-9 to ICD-10 conversion .. everything is remains same except the HI qualifiers and X-walk.
I have created a utility that takes the ICD-9 claims and creates all possible ICD-10 claims. Please let me know if someone is interested. Next post I will give some examples of Institutional claims with Diagnosis and procedure codes.

Disclaimer - The post is for educational purposes and help to prepare well for the ICD-9 to ICD-10 conversion. Above example just help to understand the 837 changes for ICD-10 claims. Please do not use this claims in your testing as it will not work as data has been masked for security and confidentiality.

Learn SQL

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LEARN SQL:

To Know all the table in the database

1. How to get all the tables name of the database:

Select  *  from tab  -- This will give you  all the table name of the database.

when we are not sure the exact name of table use like keyword  to get the table name

Select * from tab where tname like 'A%'

give me the table name that starts with A

desc tab – this will describe the tab table of database.

TNAME                          NOT NULL VARCHAR2(30)                                                                                                                                                                          

TABTYPE                                 VARCHAR2(7)                                                                                                                                                                                  

CLUSTERID                 NUMBER      

2. How to get all the column name of the table:

Desc  tablename

Use desc  to get  all the column name and data types of the column

Or

Select * from tablename where rownum <1

1.       How to get records of the table

By using select statements

Select statements :

Select  * from  tablename

Select * from (Select * from tablename)

Or

Select  *  from tablename where column1 =’…’

Select  column1, column2, column3 from tablename where column1=’’ and column2=’’

3.       How to sort the displayed data ( ascending or descending)

By using order by keyword – default sort is ascending

Select  column1, column2, column3 from tablename where column1=’’ and column2=’’

Order by column1 asc ( asc is default even we don’t put it will work)

Select  column1, column2, column3 from tablename where column1=’’ and column2=’’

Order by 1

Select  column1, column2, column3 from tablename where column1=’…’ and column2=’…’

Order by column1  desc

Select  column1, column2, column3 from tablename where column1=’’ and column2=’’

Order by Lower(column1) asc

Or

Select  column1, column2, column3 from tablename where column1=’’ and column2=’’

Order by Upper (column1) asc

4.       How  do we do primary sort , secondary sort and tertiary sort:

Select  column1, column2, column3 from tablename where column1=’’ and column2=’’

Order by Upper (column1) asc, column2 desc , column3

Or

Select  column1, column2, column3 from tablename where column1=’’ and column2=’’

Order by 1,2,3

( here 1 means first column that we specified in select statements, 2 means second column that we specified in select statement i.e- column2)

5.       How to count the records:

Bu using count key words:

Just add the select count(*) from ( before your query and a

Select  count(*) from (

Put your sql query here

)

i.e

select count(* ) from (

select * from tablename where columnname=’’

)

Or

Select count(*) from table where columnname=’’

Or

Select count(;