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# | Location | File | Last Modified |
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1 | CCRS.zip\CCRS\CCRS-BUSRULES-v1.5.3.zip\CCRS-BUSRULES-v1.5.3-436e6fff1115001d614ccd45b469ad60a9bdb27b\docs\ETL_Mapping | 837P_Professional.xlsx | Tue Apr 10 06:18:41 2018 UTC |
2 | CCRS.zip\CCRS\CCRS-BUSRULES-v1.5.3.zip\CCRS-BUSRULES-v1.5.3-436e6fff1115001d614ccd45b469ad60a9bdb27b\docs\ETL_Mapping | 837P_Professional.xlsx | Fri Jun 15 15:00:38 2018 UTC |
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1 | SHEET: Ver sionContro l | |
2 | ||
3 | Version Nu mber,Updat e By,Date Updated,Up date Descr iption, | |
4 | V 0.1,CCRS Dev Team, 8/10/17,In itial Draf t., | |
5 | V 0.2,CCRS Dev Team, 10/10/17,U pdated to include pr ocedure co des for fl u shots, | |
6 | V 0.3,CCRS Dev Team, 10/16/17,A dded Claim ID and Cl aim Line I D Validati ons, | |
7 | V 0.4,CCRS Dev Team, 10/17/17,O rdered Fil e Validati on by Loop and Segme nt; Added Template C hecklist, | |
8 | V 0.5,CCRS Dev Team, 11/17/17,T abs/Tables that were added or modified: | |
9 | - File Val idation | |
10 | - DECISION | |
11 | - VALIDATI ON_FAILURE | |
12 | - DIM_VA_C LAIM | |
13 | - DIM_PROF ESSIONAL_C LAIM | |
14 | - F_PROFES SIONAL_MED ICAL_CLAIM _DETAILS | |
15 | ||
16 | Update Leg end | |
17 | - Drop col umn and re move ETL m apping for entries h ighlighted in yellow | |
18 | - Add colu mn and ETL mapping f or entries highlight ed in gree n | |
19 | - Rename c olumn and/ or update ETL mappin g for entr ies highli ghted in o range, | |
20 | V 0.6,CCRS Dev Team, 11/29/17,T abs/Tables that were added or modified: | |
21 | CLAIM_DIAG NOSIS | |
22 | CLAIM_LINE _DIAGNOSIS | |
23 | CLAIM_LINE _MODIFIER | |
24 | CLAIM_COND ITION_CODE | |
25 | DIM_PATIEN T | |
26 | DIM_PROVID ER | |
27 | PROVIDER_L OCATION | |
28 | ||
29 | Update Leg end | |
30 | - Drop col umn and re move ETL m apping for entries h ighlighted in yellow | |
31 | - Add colu mn and ETL mapping f or entries highlight ed in gree n | |
32 | - Rename c olumn and/ or update ETL mappin g for entr ies highli ghted in o range, | |
33 | V 0.7,CCRS Dev Team, 12/12/17,T abs/Tables that were added or modified: | |
34 | DIM_VA_CLA IM | |
35 | DIM_PROFES SIONAL_CLA IM | |
36 | F_PROFESSI ONAL_MEDIC AL_CLAIM_D ETAILS | |
37 | CLAIM_AMBU LANCE | |
38 | CLAIM_CHIR OPRACTIC | |
39 | ||
40 | Update Leg end | |
41 | - Drop col umn and re move ETL m apping for entries h ighlighted in yellow | |
42 | - Add colu mn and ETL mapping f or entries highlight ed in gree n | |
43 | - Rename c olumn and/ or update ETL mappin g for entr ies highli ghted in o range, | |
44 | V 0.8,CCRS Dev Team, 12/27/17,B aselined d ocument by cleaning up highlig hted entri es, | |
45 | V 1.0,CCRS Dev Team, 1/16/17,Up dated for Build 2 - Sprint 1 | |
46 | Tabs/Table s that wer e added or modified are highli ghted in y ellow: | |
47 | F_PROFESSI ONAL_MEDIC AL CLAIM_D ETAILS | |
48 | CLAIM_AMBU LANCE | |
49 | CLAIM_LINE _ATTACHMEN T | |
50 | CLAIM_LINE _DME | |
51 | CLAIM_LINE _DRUG | |
52 | CLAIM_LINE _SUPP_DOC | |
53 | CLAIM_LINE _MEDICAL_T EST | |
54 | ||
55 | Update Leg end | |
56 | - Drop col umn and re move ETL m apping for entries h ighlighted in yellow | |
57 | - Add colu mn and ETL mapping f or entries highlight ed in gree n | |
58 | - Rename c olumn and/ or update ETL mappin g for entr ies highli ghted in o range, | |
59 | V.B2.S4,CC RS Dev Tea m,3/16/18, Updated fo r Build 2 - Sprint 4 | |
60 | Tabs/Table s that wer e modified are highl ighted in orange | |
61 | - DIM_VA_C LAIM | |
62 | ||
63 | Tabs/Table s that wer e added ar e highligh ted in gre en | |
64 | - CLAIM_AD JUDICATION | |
65 | - CLAIM_AD JUSTMENT | |
66 | - CLAIM_CO B | |
67 | ||
68 | Tabs/Table s that wer e dropped are highli ghted in y ellow | |
69 | - DIM_PAYE R | |
70 | - CLAIM_PA YER | |
71 | - CLAIM_IN SURANCE | |
72 | ||
73 | Update Leg end | |
74 | - Add colu mn and ETL mapping f or entries highlight ed in gree n | |
75 | - Rename c olumn and/ or update ETL mappin g for entr ies highli ghted in o range, | |
76 | ||
77 | ||
78 | SHEET: Ove rview | |
79 | Worksheet Informatio n, | |
80 | Source Sys tem,X12, | |
81 | File Purpo se,Obtain feedback f rom source on antici pated sour ce to targ et mapping s, | |
82 | File Sourc e,837P, | |
83 | Approach,( 1) Source to target mappings a re based o n the data available at the ti me of this writing; data eleme nts that a re under c onstructio n or not f ully imple mented for the 2012 implementa tions are not repres ented here . (2) Wo rksheets f low from g eneral inf ormation ( claim leve l) through more deta iled infor mation (cl aim line l evel) and reference or lookup tables req uired to s upport the source to target ma ppings, | |
84 | Specific R equests, | |
85 | ||
86 | ||
87 | SHEET: 837 P Template | |
88 | ISA*00* *00 * *ZZ*13305 2274 *ZZ*121150 001 * 111129*173 9*$*00501* 000000001* 0*T*:~, | |
89 | GS*HC*1330 52274*1211 50001*2011 1129*17393 7*30*X*005 010X222A1~ , | |
90 | ST*837*000 000001*005 010X222A1~ , | |
91 | BHT*0019*0 0*00000000 2*20111123 *173937*CH ~, | |
92 | NM1*41*2*G ENERIC CLE ARINGHOUSE *****46*JK 3456789PER *IC*SUBMIT TER NAME O FTEN EMDEO N*TE*80066 67777~, | |
93 | NM1*40*2*R ECEIVER NA ME OFTEN V ETERAN'S A DMINISTRAT ION*****46 *JK3456789 ~, | |
94 | HL*1**20*1 ~, | |
95 | NM1*85*2*T PA1*****XX *100210020 2~, | |
96 | N3*111 TES TING STREE T~, | |
97 | N4*HERNDON *VA*201714 444~, | |
98 | -----2010A A|REF|REF* EI|REF02 - BILLING P ROVIDER TA X ID, | |
99 | REF*EI*010 222444~, | |
100 | HL*2*1*22* 0~, | |
101 | SBR*P*5555 -AB******* VA~, | |
102 | -----2010B A|NM1|NM1* IL|NM109 - VETERAN I CN, | |
103 | NM1*IL*1*S UBLASTNAME *SUBFIRSTN AME****MI* ABC0101~, | |
104 | N3*23 Jord an Street~ , | |
105 | -----2010B A|N4|N403 - VETERAN ZIP CODE, | |
106 | N4*PATIENT TOWN*VA*99 944~, | |
107 | -----2010B A|DMG|DMG* D8|DMG02 ( VETERAN DA TE OF BIRT H), DMG03 (VETERAN G ENDER), | |
108 | DMG*D8*195 20328*M~, | |
109 | REF*SY*060 708091~, | |
110 | NM1*PR*2*P AYER NAME OFTEN VETE RAN'S ADMI NISTRATION *****PI*12 555~, | |
111 | REF*FY*NOC D~, | |
112 | -----2300| CLM|CLM01 (PATIENT C ONTROL NUM BER), | |
113 | CLM*A01IR5 78*94***22 :B:1*Y*A*Y *Y~, | |
114 | -----2300| REF|REF*D9 |REF02 - V A REFERRAL ID , | |
115 | REF*9F*VAR EF0001~, | |
116 | -----2300| REF|REF*G1 |REF02 - V A AUTH ID , | |
117 | REF*G1*VAA UTH0001~, | |
118 | -----2300| REF|REF*D9 |REF02 - C LAIM NUMBE R, | |
119 | REF*D9*CLA IM0001~, | |
120 | -----2300| HI|HI*ABK| HI01-2 - C LAIM DIAGN OSIS CODE, | |
121 | HI*ABK:E89 38~, | |
122 | NM1*DN*1*R EFPROVIDER LASTNAME*F IRSTNAME** **XX*99955 53330~, | |
123 | -----2310B |NM1|NM1*8 2|NM109 - RENDERING PROVIDER N PI, | |
124 | NM1*82*1*R ENDLASTNAM E*RENDFIRS TNAME*A*** XX*9995553 336~, | |
125 | -----2310B |PRV|PRV*P E|PRV03 - RENDERING PROVIDER T AXONOMY, | |
126 | PRV*PE*PXC *208L52002 X~, | |
127 | -----2310C |NM1|NM1*7 7|NM109 - SERVICE FA CILITY NPI , | |
128 | NM1*77*2*S ERVICE FAC ILITY LOCA TION*****X X*16894321 23~, | |
129 | N3*123 SER VICEFAC ST REET~, | |
130 | -----2310C |N4|N403 - SERVICE F ACILITY ZI P CODE, | |
131 | N4*SERVICE FACTOWN*VA *042409994 ~, | |
132 | --2400 SER VICE LINE- -, | |
133 | LX*1~, | |
134 | SV1*HC:K00 01:RR:KH:B R*75*UN*1* **1:2~, | |
135 | PWK*CT*AD~ , | |
136 | CR3*I*MO*9 9~, | |
137 | DTP*472*RD 8*20050321 -20050321~ , | |
138 | DTP*463*D8 *20040321~ , | |
139 | DTP*461*D8 *20050321~ , | |
140 | MEA*TR*HT* 70~, | |
141 | -----2400| REF|REF*6R |REF02 - C LAIM LINE ID, | |
142 | REF*6R*LX0 001-1~, | |
143 | --2420E OR DERING PRO VIDER--, | |
144 | NM1*DK*1*W ILSON*RAND ALL****XX* 1111155555 ~, | |
145 | N3*1226 WE ST RAILROA D STREET~, | |
146 | N4*LAFAYET TE*IN*4790 5~, | |
147 | REF*1G*M12 345~, | |
148 | PER*IC*LEE *TE*765925 9999~, | |
149 | ||
150 | --2440 FOR M IDENTIFI CATION COD E--, | |
151 | LQ*UT*02.0 3B~, | |
152 | FRM*1*Y~, | |
153 | FRM*2*N~, | |
154 | FRM*3*N~, | |
155 | FRM*4*N~, | |
156 | FRM*5**8~, | |
157 | FRM*8*N~, | |
158 | FRM*9*Y~, | |
159 | SE*01*0000 00001~, | |
160 | GE*01*01~, | |
161 | IEA*01*000 000001~, | |
162 | ||
163 | ||
164 | SHEET: Fil e Validati on | |
165 | ||
166 | EDI Attrib ute Name,A ttribute D escription ,Validatio n,Validati on Error M essage,Act ion on Fai l,Loop,Seg ment,Segme nt*Code,Re ference De signator, | |
167 | Billing Pr ovider Tax Identific ation #,Bi lling Prov ider Tax I D,Qualifie r = EI (RE F01) and I dentifier is Not NUL L (REF02), Missing Bi lling Prov ider Tax I D,Set all invoice li nes to non -conformin g,2010AA,R EF,REF*EI, REF02, | |
168 | Subscriber Primary I dentifier, Veteran IC N,Qualifie r = MI (NM 108) and I dentifier is Not NUL L (NM109), Missing Ve teran ICN, Set all in voice line s to non-c onforming, 2010BA,NM1 ,NM1*IL,NM 109, | |
169 | Subscriber Postal Zo ne/Zip Cod e,Veteran Zip Code,N ot NULL,Mi ssing Vete ran Zip Co de,Set all invoice l ines to no n-conformi ng,2010BA, N4,N403, | |
170 | Subscriber Birth Dat e,Veteran Date of Bi rth,Not NU LL,Missing Veteran D ate of Bir th,Set all invoice l ines to no n-conformi ng,2010BA, DMG,DMG*D8 ,DMG02, | |
171 | Subscriber Gender Co de,Veteran Gender,No t NULL,Mis sing Veter an Gender, Set all in voice line s to non-c onforming, 2010BA,DMG ,DMG*D8,DM G03, | |
172 | Patient Co ntrol/Acco unt Number ,Patient C ontrol/Acc ount Numbe r,Not NULL ,Missing P atient Con trol Numbe r,Set all invoice li nes to non -conformin g,2300,CLM ,CLM01, | |
173 | Referral N umber,VA R eferral ID ,Not NULL, except wh en Procedu re Code (2 400/SV1/SV 101-2) in ('G0008', '90658', ' 90656', '9 0662'),Mis sing VA Re ferral ID, Set all in voice line s to non-c onforming, 2300,REF,R EF*9F,REF0 2, | |
174 | Authorizat ion Number ,VA Autho rization I D,Not NULL , except w hen Proced ure Code ( 2400/SV1/S V101-2) in ('G0008', '90658', '90656', ' 90662'),Mi ssing VA A uthorizati on ID,Set all invoic e lines to non-confo rming,2300 ,REF,REF*G 1,REF02, | |
175 | Claim Numb er,Claim I D,Not NULL ,Missing C laim ID,Se t all invo ice lines to non-con forming,23 00,REF,REF *D9,REF02, | |
176 | Claim Diag nosis Code ,Claim Dia gnosis Cod e,Not NULL ,Missing C laim Diagn osis Code, Set all in voice line s to non-c onforming, 2300,HI,HI *ABK,HI01- 2, | |
177 | Rendering Provider I dentifier, Rendering Provider N PI,Not NUL L,Missing Rendering Provider N PI,Set all invoice l ines to no n-conformi ng,2310B,N M1,NM1*82, NM109, | |
178 | Rendering Provider T axonomy,Re ndering Pr ovider Tax onomy,Not NULL,Missi ng Renderi ng Provide r Taxonomy ,Set all i nvoice lin es to non- conforming ,2310B,PRV ,PRV*PE,PR V03, | |
179 | Facility P rimary Ide ntifier,Se rvice Faci lity NPI,N ot NULL,Mi ssing Serv ice Facili ty NPI,Set all invoi ce lines t o non-conf orming,231 0C,NM1,NM1 *77,NM109, | |
180 | Facility P ostal Zone /Zip Code, Service Fa cility Zip Code,Not NULL,Missi ng Service Facility Zip Code,S et all inv oice lines to non-co nforming,2 310C,N4,N4 03, | |
181 | Procedure Code,CPT/H CPCS Code, Not NULL,M issing Cla im Line Pr ocedure Co de,Set sin gle line t o non-conf orming,240 0,SV1,SV10 1-2, | |
182 | Line Item Charge Amo unt,Line B illed Amou nt,Not NUL L,Missing Claim Line Billed Am ount,Set s ingle line to non-co nforming,2 400,SV1,SV 102, | |
183 | Unit/Basis for Measu rement Cod e,Service Unit Ident ifier,Not NULL,Missi ng Claim L ine Unit I dentifier, Set single line to n on-conform ing,2400,S V1,SV103, | |
184 | Service Un it Count,S ervice Uni t,Not NULL ,Missing C laim Line Service Un it Count,S et single line to no n-conformi ng,2400,SV 1,SV104, | |
185 | Place of S ervice Cod e,Place of Service C ode,Not NU LL,Missing Claim Lin e Place of Service C ode,Set si ngle line to non-con forming,24 00,SV1,SV1 05, | |
186 | Diagnosis Code Point er,Diagnos is Pointer ,Not NULL, Missing Cl aim Line D iagnosis,S et single line to no n-conformi ng,2400,SV 1,SV107-1, | |
187 | Service Da te,Date of Service,N ot NULL,Mi ssing Clai m Line Ser vice Date, Set single line to n on-conform ing,2400,D TP,DTP*472 ,DTP03, | |
188 | ||
189 | ||
190 | ||
191 | ||
192 | SHEET: DEC ISION | |
193 | ||
194 | DECISION, | |
195 | ||
196 | Loop,Segme nt,Segment *Code,Refe rence Desi gnator,
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|
197 |
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|
198 | Initialize to 'REJEC TED',DECIS ION, | |
199 | Auto-gener ated by CC RS ETL. ,C LAIM_KEY, | |
200 | Auto-gener ated by CC RS ETL. ,C LAIM_DETAI L_KEY, | |
201 | Value copi ed from BA TCH_LOG ta ble for th e given so urce (EDI) .,ETL_BATC H_ID, | |
202 | Initialize to ETL ge nerated pr ocess date ,LAST_UPDA TED_DATE_T IME, | |
203 | Initialize to ETL us er id,LAST _UPDATED_U SER, | |
204 | ||
205 | ||
206 | ||
207 | ||
208 | ||
209 | ||
210 | ||
211 | ||
212 | ||
213 | ||
214 | ||
215 | SHEET: VAL IDATION_FA ILURE | |
216 | ||
217 | VALIDATION _FAILURE, | |
218 | ||
219 | Loop,Segme nt,Segment *Code,Refe rence Desi gnator,Com ments,KeyO rder,Targe t Element, | |
220 | Auto-gener ated by CC RS ETL. ,P K,VALIDATI ON_KEY, | |
221 | Copied fro m DECISION record,DE CISION_KEY , | |
222 | Initialize to '837P Data Valid ation',RUL E_NAME, | |
223 | Initialize to 'INVAL ID_837P_DA TA',VALIDA TION_NAME, | |
224 | Initialize to File V alidation Error Mess age,MESSAG E, | |
225 | Initialize to NULL,R EASON_CODE , | |
226 | Initialize to 0,IS_P ASSED, | |
227 | Initialize to ETL ge nerated pr ocess date ,LAST_UPDA TED_DATE_T IME, | |
228 | Initialize to ETL us er id,LAST _UPDATED_U SER, | |
229 | ||
230 | ||
231 | ||
232 | ||
233 | ||
234 | ||
235 | ||
236 | ||
237 | ||
238 | ||
239 | SHEET: F_P ROF_MEDICA L_CLAIM_DE TAILS | |
240 | ||
241 | F_PROFESSI ONAL_MEDIC AL_CLAIM_D ETAILS, | |
242 | ||
243 | Loop,Segme nt,Segment *Code,Refe rence | |
244 | Designator ,Comments, Key | |
245 | Order,Targ et Element , | |
246 | Auto-gener ated by CC RS-ETL,PK, CLAIM DETA IL KEY, | |
247 | Copied fro m DIM_VA_C LAIM recor d.,FK,CLAI M KEY, | |
248 | 2400,SV1,S V101-2,Par se source value and obtain PRO CEDURE_KEY by joinin g source v alue to DI M_PROCEDUR E.PROCEDUR E_CODE. | |
249 | If source value not present in DIM_PROCE DURE, inse rt new rec ord on DIM _PROCEDURE . | |
250 | If source is NULL, s et target to -1.,FK, PROCEDURE KEY, | |
251 | 2400,SV1,S V105,Obtai n POS_KEY by joining source va lue to DIM _PLACE_OF_ SERVICE.PO S_CODE. | |
252 | If source value not present in DIM_PLACE _OF_SERVIC E, insert new record on DIM_PL ACE_OF_SER VICE. | |
253 | If source is NULL, s et target to -1.,FK, POS KEY, | |
254 | 2400,SV1,S V104,No Cl eansing or Transform ation rule s apply, c opy source value to target val ue,SERVICE _UNITS, | |
255 | 2400,SV1,S V103,Valid ate for nu meric valu es.,UNIT L ABEL, | |
256 | 2420A,NM1, NM1*82,NM1 09,If Loop 2420A NM1 *82.NM109 (NPI) valu e exists i n claim, o btain REND ERING_PROV IDER_KEY b y joining source val ue to DIM_ PROVIDER.N PI. If mat ch not fou nd, insert new provi der record . | |
257 | ||
258 | If source is NULL, s et target to -1.,FK, RENDERING PROVIDER K EY, | |
259 | Initialize to 'Y'.,I S CURRENT, | |
260 | Initialize to ETL ge nerated pr ocess date .,START DA TE, | |
261 | Initialize to NULL,E ND DATE, | |
262 | Initialize to 'EDI', SOURCE SYS TEM, | |
263 | 2300,REF,R EF*F5,If s egment/cod e exists i n claim, i nitialize target to '837PX'. I f segment/ code does not exist, initializ e target t o '837P'. ,SOURCE EN TITY, | |
264 | 2400,DTP,D TP*472,DTP 03,Parse s ource valu e string b efore '-' and map to target. I f '-' does not exist , populate source to target. , SERVICE DA TE FROM, | |
265 | 2400,SV1,S V102,Valid ate for nu meric valu es.,CHARGE AMOUNT, | |
266 | Value copi ed from BA TCH_LOG ta ble for th e given so urce (EDI) .,FK,ETL_B ATCH_ID, | |
267 | 2400,REF,R EF*6R,REF0 2,No Clean sing or Tr ansformati on rules a pply, copy source va lue to tar get value. If source value doe s not exis t, increme nt value f or each cl aim line s tarting fr om 1.,LINE _ITEM_CONT ROL_NUMBER , | |
268 | 2400,DTP,D TP*472,DTP 03,Parse s ource valu e string a fter '-' and map to target. I f '-' does not exist , populate source to target. , SERVICE DA TE TO, | |
269 | 2400,QTY,Q TY01,No Cl eansing or Transform ation rule s apply, c opy source value to target val ue,AMB_PAT IENT_LABEL , | |
270 | 2400,QTY,Q TY02,No Cl eansing or Transform ation rule s apply, c opy source value to target val ue,AMB_PAT IENT_COUNT , | |
271 | Initialize to system datetime. ,LAST UPDA TED DATE, | |
272 | Initialize to databa se User ID .,LAST UPD ATED USER, | |
273 | 2400,LX,LX 01,Insert a details/ line recor d for each LX segmen t in a cla im record and map so urce refer ence desig nator valu e to targe t.,SERVICE _LINE_NUMB ER, | |
274 | 2400,NTE,N TE02,No Cl eansing or Transform ation rule s apply, c opy source value to target val ue,LINE_NO TE, | |
275 | 2420E,NM1, NM1*DK,NM1 09,If Loop 2420E NM1 *DK.NM109 (NPI) valu e exists i n claim, o btain ORDE RING_PROVI DER_KEY by joining s ource valu e to DIM_P ROVIDER.NP I. If matc h not foun d, insert new provid er record. | |
276 | ||
277 | If source is NULL, s et target to -1.,FK, ORDERING_P ROVIDER_KE Y,ADD, | |
278 | ||
279 | ||
280 | SHEET: CLA IM_AMBULAN CE | |
281 | ||
282 | CLAIM_AMBU LANCE, | |
283 | ||
284 | Loop,Segme nt,Segment *Code,Refe rence Desi gnator,Com ments,KeyO rder,Targe t Element, | |
285 | 2300,CR1,I nsert a ne w record o n CLAIM_AM BULANCE fo r each CR1 segment i n loop 230 0. CLAIM_A MBULANCE_K EY is auto -generated by CCRS E TL,PK,CLAI M_AMBULANC E_KEY, | |
286 | Copied fro m DIM_VA_C LAIM recor d.,FK,CLAI M KEY, | |
287 | Initialize to system datetime. ,LAST UPDA TED DATE, | |
288 | Initialize to databa se User ID .,LAST UPD ATED USER, | |
289 | 2300,CR1 , CR101,Clea nsing and transforma tion rules do not ap ply, copy source val ue to targ et value., WEIGHT_LAB EL, | |
290 | 2300,CR1 , CR102,Clea nsing and transforma tion rules do not ap ply, copy source val ue to targ et value., PATIENT_WE IGHT, | |
291 | 2300,CR1 , CR104,Clea nsing and transforma tion rules do not ap ply, copy source val ue to targ et value., TRANSPORT_ REASON_COD E, | |
292 | 2300,CR1 , CR105,Clea nsing and transforma tion rules do not ap ply, copy source val ue to targ et value., DISTANCE_L ABEL, | |
293 | 2300,CR1 , CR106,Clea nsing and transforma tion rules do not ap ply, copy source val ue to targ et value., TRANSPORT_ DISTANCE, | |
294 | 2300,CR1 , CR109,Clea nsing and transforma tion rules do not ap ply, copy source val ue to targ et value., TRIP_PURPO SE, | |
295 | 2300,CR1 , CR110,Clea nsing and transforma tion rules do not ap ply, copy source val ue to targ et value., STRETCHER_ PURPOSE, | |
296 | 2300,CRC,C RC02,Clean sing and t ransformat ion rules do not app ly, copy s ource valu e to targe t value.,A MB_IS_CERT IFIED, | |
297 | 2300,CRC,C RC03,Clean sing and t ransformat ion rules do not app ly, copy s ource valu e to targe t value.,A MB_PAT_CON DITION_COD E_1,RENAME , | |
298 | 2300,CRC,C RC04,Clean sing and t ransformat ion rules do not app ly, copy s ource valu e to targe t value.,A MB_PAT_CON DITION_COD E_2,ADD, | |
299 | 2300,CRC,C RC05,Clean sing and t ransformat ion rules do not app ly, copy s ource valu e to targe t value.,A MB_PAT_CON DITION_COD E_3,ADD, | |
300 | 2300,CRC,C RC06,Clean sing and t ransformat ion rules do not app ly, copy s ource valu e to targe t value.,A MB_PAT_CON DITION_COD E_4,ADD, | |
301 | 2300,CRC,C RC07,Clean sing and t ransformat ion rules do not app ly, copy s ource valu e to targe t value.,A MB_PAT_CON DITION_COD E_5,ADD, | |
302 | 2310E | |
303 | 2310E | |
304 | 2310E,NM1 | |
305 | N3 | |
306 | N4,NM1*PW | |
307 | ||
308 | ,N301,Clea nsing and transforma tion rules do not ap ply, copy source val ue to targ et value., PICKUP_ADD RESS1 ,REN AME, | |
309 | 2310E | |
310 | 2310E | |
311 | 2310E,NM1 | |
312 | N3 | |
313 | N4,NM1*PW | |
314 | ||
315 | ,N302,Clea nsing and transforma tion rules do not ap ply, copy source val ue to targ et value., PICKUP_ADD RESS2,ADD, | |
316 | 2310E | |
317 | 2310E | |
318 | 2310E,N4,N M1*PW | |
319 | ||
320 | ,N401,Clea nsing and transforma tion rules do not ap ply, copy source val ue to targ et value., PICKUP_CIT Y,ADD, | |
321 | 2310E | |
322 | 2310E | |
323 | 2310E,N4,N M1*PW | |
324 | ||
325 | ,N402,Clea nsing and transforma tion rules do not ap ply, copy source val ue to targ et value., PICKUP_STA TE_SHORT_N AME,ADD, | |
326 | 2310E | |
327 | 2310E | |
328 | 2310E,N4,N M1*45 | |
329 | ||
330 | ,N403,Clea nsing and transforma tion rules do not ap ply, copy source val ue to targ et value., PICKUP_POS TAL_CODE,A DD, | |
331 | 2310F | |
332 | 2310F | |
333 | 2310F,NM1 | |
334 | N3 | |
335 | N4,NM1*45 | |
336 | ||
337 | ,N301,Clea nsing and transforma tion rules do not ap ply, copy source val ue to targ et value., DROPOFF_AD DRESS1 ,RE NAME, | |
338 | 2310F | |
339 | 2310F | |
340 | 2310F,NM1 | |
341 | N3 | |
342 | N4,NM1*45 | |
343 | ||
344 | ,N302,Clea nsing and transforma tion rules do not ap ply, copy source val ue to targ et value., DROPOFF_AD DRESS2,ADD , | |
345 | 2310F | |
346 | 2310F | |
347 | 2310F,N4,N 401,Cleans ing and tr ansformati on rules d o not appl y, copy so urce value to target value.,DR OPOFF_CITY ,ADD, | |
348 | 2310F | |
349 | 2310F | |
350 | 2310F,N4,N 402,Cleans ing and tr ansformati on rules d o not appl y, copy so urce value to target value.,DR OPOFF_STAT E_SHORT_NA ME,ADD, | |
351 | 2310F | |
352 | 2310F | |
353 | 2310F,N4,N 403,Cleans ing and tr ansformati on rules d o not appl y, copy so urce value to target value.,DR OPOFF_POST AL_CODE,AD D, | |
354 | ||
355 | ||
356 | SHEET: CLA IM_LINE_SU PP_DOC | |
357 | ||
358 | CLAIM_LINE _SUPP_DOC, | |
359 | ||
360 | Loop,Segme nt,Segment *Code,Refe rence Desi gnator,Com ments,KeyO rder,Targe t Element, | |
361 | 2440,LQ,LQ *UT,LQ02,I nsert a ne w record o n CLAIM_LI NE_SUPP_DO C for each populated reference designato r. CLAIM_L INE_SUPP_D OC_KEY aut o-generate d by CCRS ETL,PK,cla im_line_su pp_doc_key ,ADD, | |
362 | For each i nserted re cord, copy CLAIM_DET AIL_KEY fr om F_PROFE SSIONAL_ME DICAL_CLAI M_DETAILS record. ,F K,claim_de tail_key_p r,ADD, | |
363 | 2440,LQ,LQ *UT,LQ02,C leansing a nd transfo rmation ru les do not apply, co py source value to t arget valu e.,form_id ,ADD, | |
364 | 2440,FRM,F RM01,Clean sing and t ransformat ion rules do not app ly, copy s ource valu e to targe t value.,q uestion_nu mber,ADD, | |
365 | 2440,FRM,F RM02 or FR M03 or FRM 04 or FRM0 5,Evaluate the eleme nts after FRM01, the first ele ment that is not nul l set it t o target v alue. ,qu estion_res ponse,ADD, | |
366 | Initialize to 'Y'.,i s_current, ADD, | |
367 | Initialize to ETL ge nerated pr ocess date .,start_da te,ADD, | |
368 | Initialize to NULL., end_date,A DD, | |
369 | Initialize to 'EDI'. ,source_sy stem,ADD, | |
370 | 2300,REF,R EF*F5,If s egment/cod e exists i n claim, i nitialize target to '837PX'. I f segment/ code does not exist, initializ e target t o '837P'. ,source_en tity,ADD, | |
371 | Auto-popul ated by CC RS ETL,las t_updated_ date,ADD, | |
372 | Auto-popul ated by CC RS ETL,las t_updated_ user,ADD, | |
373 | ||
374 | ||
375 | SHEET: CLA IM_LINE_AT TACHMENT | |
376 | ||
377 | CLAIM_LINE _ATTACHMEN T, | |
378 | ||
379 | Loop,Segme nt,Segment *Code,Refe rence Desi gnator,Com ments,KeyO rder,Targe t Element, | |
380 | 2400,PWK,P WK01,Inser t a new re cord on CL AIM_LINE_A TTACHMENT for each p opulated r eference d esignator. CLAIM_LIN E_ATTACHME NT_KEY aut o-generate d by CCRS ETL,PK,cla im_line_at tachment_k ey,ADD, | |
381 | For each i nserted re cord, copy CLAIM_DET AIL_KEY fr om F_PROFE SSIONAL_ME DICAL_CLAI M_DETAILS record. ,F K,claim_de tail_key_p r,ADD, | |
382 | Initialize to NULL., claim_deta il_key_in, ADD, | |
383 | 2400,PWK,P WK01,Clean sing and t ransformat ion rules do not app ly, copy s ource valu e to targe t value.,a ttachment_ type_code, ADD, | |
384 | 2400,PWK,P WK02,Clean sing and t ransformat ion rules do not app ly, copy s ource valu e to targe t value.,a ttachment_ transmissi on_code,AD D, | |
385 | 2400,PWK,P WK06,Clean sing and t ransformat ion rules do not app ly, copy s ource valu e to targe t value.,c ontrol_num ber,ADD, | |
386 | Initialize to 'Y'.,i s_current, ADD, | |
387 | Initialize to ETL ge nerated pr ocess date .,start_da te,ADD, | |
388 | Initialize to NULL., end_date,A DD, | |
389 | Initialize to 'EDI'. ,source_sy stem,ADD, | |
390 | 2300,REF,R EF*F5,If s egment/cod e exists i n claim, i nitialize target to '837PX'. I f segment/ code does not exist, initializ e target t o '837P'. ,source_en tity,ADD, | |
391 | Auto-popul ated by CC RS ETL,las t_updated_ date,ADD, | |
392 | Auto-popul ated by CC RS ETL,las t_updated_ user,ADD, | |
393 | ||
394 | ||
395 | ||
396 | ||
397 | SHEET: CLA IM_LINE_DM E | |
398 | ||
399 | CLAIM_LINE _DME, | |
400 | ||
401 | Loop,Segme nt,Segment *Code,Refe rence Desi gnator,Com ments,KeyO rder,Targe t Element, | |
402 | 2400,CR3,C R301,Inser t a new re cord on CL AIM_LINE_D ME for eac h populate d referenc e designat or. CLAIM_ LINE_DME_K EY auto-ge nerated by CCRS ETL, PK,claim_l ine_dme_ke y,ADD, | |
403 | For each i nserted re cord, copy CLAIM_DET AIL_KEY fr om F_PROFE SSIONAL_ME DICAL_CLAI M_DETAILS record. ,F K,claim_de tail_key,A DD, | |
404 | 2400,CR3,C R301,Clean sing and t ransformat ion rules do not app ly, copy s ource valu e to targe t value.,d me_certifi cation_typ e,ADD, | |
405 | 2400,CR3,C R302,Clean sing and t ransformat ion rules do not app ly, copy s ource valu e to targe t value.,u nit_label, ADD, | |
406 | CR303,Clea nsing and transforma tion rules do not ap ply, copy source val ue to targ et value., dme_durati on,ADD, | |
407 | 2400,DTP,D TP*607,DTP 03,Cleansi ng and tra nsformatio n rules do not apply , copy sou rce value to target value.,rec ertificati on_date,AD D, | |
408 | 2400,DTP,D TP*463,DTP 03,Cleansi ng and tra nsformatio n rules do not apply , copy sou rce value to target value.,beg in_therapy _date,ADD, | |
409 | 2400,DTP,D TP*461,DTP 03,Cleansi ng and tra nsformatio n rules do not apply , copy sou rce value to target value.,las t_certific ation_date ,ADD, | |
410 | 2400,CRC,C RC*09,CRC0 2,Cleansin g and tran sformation rules do not apply, copy sour ce value t o target v alue.,dme_ is_certifi ed,ADD, | |
411 | 2400,CRC,C RC*09,CRC0 3,Cleansin g and tran sformation rules do not apply, copy sour ce value t o target v alue.,dme_ condition_ code_1,ADD , | |
412 | 2400,CRC,C RC*09,CRC0 4,Cleansin g and tran sformation rules do not apply, copy sour ce value t o target v alue.,dme_ condition_ code_2,ADD , | |
413 | Initialize to 'Y'.,i s_current, ADD, | |
414 | Initialize to ETL ge nerated pr ocess date .,start_da te,ADD, | |
415 | Initialize to NULL., end_date,A DD, | |
416 | Initialize to 'EDI'. ,source_sy stem,ADD, | |
417 | 2300,REF,R EF*F5,If s egment/cod e exists i n claim, i nitialize target to '837PX'. I f segment/ code does not exist, initializ e target t o '837P'. ,source_en tity,ADD, | |
418 | Auto-popul ated by CC RS ETL,las t_updated_ date,ADD, | |
419 | Auto-popul ated by CC RS ETL,las t_updated_ user,ADD, | |
420 | ||
421 | ||
422 | SHEET: CLA IM_LINE_ME DICAL_TEST | |
423 | ||
424 | CLAIM_LINE _MEDICAL_T EST, | |
425 | ||
426 | Loop,Segme nt,Segment *Code,Refe rence Desi gnator,Com ments,KeyO rder,Targe t Element, | |
427 | 2400,MEA,M EA01,Inser t a new re cord on CL AIM_LINE_M EDICAL_TES T for each populated reference designato r. CLAIM_L INE_MEDICA L_TEST_KEY auto-gene rated by C CRS ETL,PK ,claim_lin e_medical_ test_key,A DD, | |
428 | For each i nserted re cord, copy CLAIM_DET AIL_KEY fr om F_PROFE SSIONAL_ME DICAL_CLAI M_DETAILS record. ,F K,claim_de tail_key,A DD, | |
429 | 2400,MEA,M EA01,Clean sing and t ransformat ion rules do not app ly, copy s ource valu e to targe t value.,m easurement _code,ADD, | |
430 | 2400,MEA,M EA02,Clean sing and t ransformat ion rules do not app ly, copy s ource valu e to targe t value.,m easurement _type,ADD, | |
431 | 2400,MEA,M EA03,Clean sing and t ransformat ion rules do not app ly, copy s ource valu e to targe t value.,m edical_tes t_result,A DD, | |
432 | Initialize to 'Y'.,i s_current, ADD, | |
433 | Initialize to ETL ge nerated pr ocess date .,start_da te,ADD, | |
434 | Initialize to NULL., end_date,A DD, | |
435 | Initialize to 'EDI'. ,source_sy stem,ADD, | |
436 | 2300,REF,R EF*F5,If s egment/cod e exists i n claim, i nitialize target to '837PX'. I f segment/ code does not exist, initializ e target t o '837P'. ,source_en tity,ADD, | |
437 | Auto-popul ated by CC RS ETL,las t_updated_ date,ADD, | |
438 | Auto-popul ated by CC RS ETL,las t_updated_ user,ADD, | |
439 | ||
440 | ||
441 | SHEET: CLA IM_LINE_DR UG | |
442 | ||
443 | CLAIM_LINE _DRUG, | |
444 | ||
445 | Loop,Segme nt,Segment *Code,Refe rence Desi gnator,Com ments,KeyO rder,Targe t Element, | |
446 | 2410,LIN,L IN02,Inser t a new re cord on CL AIM_LINE_D RUG for ea ch populat ed referen ce designa tor. CLAIM _LINE_DRUG _KEY auto- generated by CCRS ET L,PK,claim _line_drug _key,ADD, | |
447 | For each i nserted re cord, copy CLAIM_DET AIL_KEY fr om F_PROFE SSIONAL_ME DICAL_CLAI M_DETAILS record. ,F K,claim_de tail_key_p r,ADD, | |
448 | Initialize to NULL., claim_deta il_key_in, ADD, | |
449 | 2410,LIN,L IN03,For e ach popula ted LIN re ference de signator, obtain key value fro m DIM_NDC table by m atching to the produ ct_NDC. I f not foun d, set val ue to -1. | |
450 | ,FK,NDC_ke y,ADD, | |
451 | 2410,CTP,C TP04,Clean sing and t ransformat ion rules do not app ly, copy s ource valu e to targe t value.,d rug_quanti ty,ADD, | |
452 | 2410,CTP,C TP05,Clean sing and t ransformat ion rules do not app ly, copy s ource valu e to targe t value.,d rug_unit_l abel,ADD, | |
453 | 2410,REF,R EF*XZ,REF0 1,Cleansin g and tran sformation rules do not apply, copy sour ce value t o target v alue.,drug _reference _identifie r,ADD, | |
454 | 2410,REF,R EF*XZ,REF0 2,Cleansin g and tran sformation rules do not apply, copy sour ce value t o target v alue.,drug _prescript ion_number ,ADD, | |
455 | Initialize to 'Y'.,i s_current, ADD, | |
456 | Initialize to ETL ge nerated pr ocess date .,start_da te,ADD, | |
457 | Initialize to NULL., end_date,A DD, | |
458 | Initialize to 'EDI'. ,source_sy stem,ADD, | |
459 | 2300,REF,R EF*F5,If s egment/cod e exists i n claim, i nitialize target to '837PX'. I f segment/ code does not exist, initializ e target t o '837P'. ,source_en tity,ADD, | |
460 | Auto-popul ated by CC RS ETL,las t_updated_ date,ADD, | |
461 | Auto-popul ated by CC RS ETL,las t_updated_ user,ADD, | |
462 | ||
463 | ||
464 | SHEET: CLA IM_CHIROPR ACTIC | |
465 | ||
466 | CLAIM_CHIR OPRACTIC, | |
467 | ||
468 | Loop,Segme nt,Segment *Code,Refe rence Desi gnator,Com ments,KeyO rder,Targe t Element, | |
469 | 2300,CR2,I nsert a ne w record o n CLAIM_CH IROPRACTIC for each CR1 segmen t in loop 2300. CLAI M_CHIRO_KE Y is auto- generated by CCRS ET L,PK,CLAIM _CHIRO_KEY , | |
470 | Copied fro m DIM_VA_C LAIM recor d.,FK,CLAI M KEY, | |
471 | 2300,DTP,D TP*454,Cle ansing and transform ation rule s do not a pply, copy source va lue to tar get value. ,INIT_TREA TMENT_DATE , | |
472 | 2300,DTP,D TP*453,Cle ansing and transform ation rule s do not a pply, copy source va lue to tar get value. ,ACUTE_MAN IFEST_DATE , | |
473 | 2300,DTP,D TP*455,Cle ansing and transform ation rule s do not a pply, copy source va lue to tar get value. ,LAST_XRAY _DATE, | |
474 | 2300,CR2,C R208,Clean sing and t ransformat ion rules do not app ly, copy s ource valu e to targe t value.,P ATIENT_CON DITION_COD E, | |
475 | 2300,CR2,C R210,Clean sing and t ransformat ion rules do not app ly, copy s ource valu e to targe t value.,P ATIENT_CON DITION_DES C, | |
476 | Initialize to 'Y'.,I S CURRENT, | |
477 | Initialize to ETL ge nerated pr ocess date .,START DA TE, | |
478 | Initialize to NULL., END DATE, | |
479 | Initialize to 'EDI', SOURCE SYS TEM, | |
480 | 2300,REF,R EF*F5,If s egment/cod e exists i n claim, i nitialize target to '837PX'. I f segment/ code does not exist, initializ e target t o '837P'. ,SOURCE EN TITY, | |
481 | Initialize to system datetime. ,LAST UPDA TED DATE, | |
482 | Initialize to databa se User ID .,LAST UPD ATED USER, | |
483 | ||
484 | ||
485 | SHEET: CLA IM_DIAGNOS IS | |
486 | ||
487 | CLAIM_DIAG NOSIS, | |
488 | ||
489 | Loop,Segme nt,Segment *Code,Refe rence Desi gnator,Com ments,KeyO rder,Targe t Element, | |
490 | 2300,HI,HI *ABK,HI01- 2, HI02-2… HI0X-2 (wh ere X = # of Diag),F or segment starting with HI*AB K, create a row for each diagn osis code present (u p to 12). For examp le, HI*ABK :8901*ABF: 87200*ABF: 5559~ woul d result i n 3 record s on claim _diagnosis . | |
491 | Within eac h referenc e designat or, parse source val ue after ' :' and joi n source v alues to D IM_DIAGNOS IS_CODE.DI AGNOSIS_CO DE to retr ieve DIM_D IAGNOSIS_C ODE.DIAGNO SIS_KEY. Filter the join by a dding VERS ION = ICD1 0 to the s election c riteria.,F K,DIAGNOSI S KEY, | |
492 | Initialize to NULL., QUALIFIER, | |
493 | Initialize to 'Y'.,I S CURRENT, | |
494 | Initialize to ETL ge nerated pr ocess date .,START DA TE, | |
495 | Initialize to NULL., END DATE, | |
496 | Initialize to 'EDI'. ,SOURCE SY STEM, | |
497 | 2300,REF,R EF*F5,If s egment/cod e exists i n claim, i nitialize target to '837PX'. I f segment/ code does not exist, initializ e target t o '837P'. ,SOURCE EN TITY, | |
498 | 2300 | |
499 | 2300,HI | |
500 | HI,HI01-2, HI02-2…HI 0X-2 (wher e X = # of Diag),Ins ert a new record on CLAIM_DIAG NOSIS for each HI*AB K referenc e designat or. . CLAI M_DIAGNOSI S_KEY auto -generated by CCRS E TL,PK,CLAI M DIAGNOSI S KEY, | |
501 | Initialize to NULL., DIAGNOSIS POA, | |
502 | For each i nserted re cord, copy CLAIM_KEY from DIM_ VA_CLAIM r ecord. ,FK ,CLAIM_KEY , | |
503 | ||
504 | ||
505 | ||
506 | ||
507 | ||
508 | SHEET: CLA IM_LINE_DI AGNOSIS | |
509 | ||
510 | CLAIM_LINE _DIAGNOSIS , | |
511 | ||
512 | Loop,Segme nt,Segment *Code,Refe rence Desi gnator,Com ments,KeyO rder,Targe t Element, | |
513 | 2400,SV1,S V107-1, SV 107-2, | |
514 | SV107-3, S V107-4,Ins ert a new record on CLAIM_LINE _DIAGNOSIS for each populated reference designator . CLAIM_LI NE_DIAGNOS IS_KEY aut o-generate d by CCRS ETL,PK,CLA IM LINE DI AGNOSIS KE Y, | |
515 | 2400 | |
516 | ||
517 | ||
518 | ||
519 | 2300,SV1 | |
520 | ||
521 | ||
522 | ||
523 | HI,HI*ABK, SV107-1, S V107-2, | |
524 | SV107-3, S V107-4 | |
525 | ||
526 | ||
527 | HI01-2, HI 02-2…HI0X- 2 (where X = # of Di ag),For ea ch populat ed SV107 r eference d esignator, obtain so urce point er value ( i.e., 1, 2 , 3 or 4) and match to corresp onding HI0 X-2 source diagnosis value. | |
528 | ||
529 | Within eac h referenc e designat or, parse source val ue after ' :', place decimal af ter first three char acters, an d join val ue to DIM_ DIAGNOSIS_ CODE.DIAGN OSIS_CODE to retriev e DIM_DIAG NOSIS_CODE .DIAGNOSIS _KEY. Fil ter the jo in by addi ng VERSION = ICD10 t o the sele ction crit eria.,FK,D IAGNOSIS K EY, | |
530 | For each i nserted re cord, copy CLAIM_DET AIL_KEY fr om F_PROFE SSIONAL_ME DICAL_CLAI M_DETAILS record. ,F K,CLAIM DE TAIL KEY, | |
531 | 2400,SV1,S V107-1, SV 107-2, | |
532 | SV107-3, S V107-4,For each inse rted recor d, parse r eference d esignator source val ue between each ':' and map to target. , POINTER OR DER, | |
533 | Initialize to 'Y'.,I S CURRENT, | |
534 | Initialize to ETL ge nerated pr ocess date .,START DA TE, | |
535 | Initialize to NULL., END DATE, | |
536 | Initialize to 'EDI'. ,SOURCE SY STEM, | |
537 | 2300,REF,R EF*F5,If s egment/cod e exists i n claim, i nitialize target to '837PX'. I f segment/ code does not exist, initializ e target t o '837P'. ,SOURCE EN TITY, | |
538 | Auto-popul ated by CC RS ETL,LAS T UPDATED DATE, | |
539 | Auto-popul ated by CC RS ETL,LAS T UPDATED USER, | |
540 | Initialize to NULL., CLAIM DETA IL KEY DT, | |
541 | ||
542 | ||
543 | ||
544 | ||
545 | SHEET: CLA IM_LINE_MO DIFIER | |
546 | ||
547 | CLAIM_LINE _MODIFIER, | |
548 | ||
549 | Loop,Segme nt,Segment *Code,Refe rence Desi gnator,Com ments,KeyO rder,Targe t Element, | |
550 | 2400,SV1,S V101-3, SV 101-4, | |
551 | SV101-5, S V101-6,Wit hin each r eference d esignator, parse sou rce value after ':' and map va lue to tar get.,MODIF IER CODE, | |
552 | Initialize to 'Y'.,I S CURRENT, | |
553 | Initialize to ETL ge nerated pr ocess date .,START DA TE, | |
554 | Initialize to NULL., END DATE, | |
555 | Initialize to 'EDI'. ,SOURCE SY STEM, | |
556 | 2300,REF,R EF*F5,If s egment/cod e exists i n claim, i nitialize target to '837PX'. I f segment/ code does not exist, initializ e target t o '837P'. ,SOURCE EN TITY, | |
557 | 2400,SV1,S V101-3, SV 101-4, | |
558 | SV101-5, S V101-6,Ins ert a new CLAIM_LINE _MODIFIER record for each popu lated refe rence desi gnator. CL AIM_LINE_M ODIFIER_KE Y auto-gen erated by PIT.,PK,CL AIM LINE M ODIFIER KE Y, | |
559 | Initialize to NULL., FK,CLAIM D ETAIL KEY IN, | |
560 | Copied fro m F_PROF_D ETAILS rec ord.,FK,CL AIM DETAIL KEY PR, | |
561 | Initialize to NULL., FK,CLAIM D ETAIL KEY DT, | |
562 | ||
563 | ||
564 | ||
565 | ||
566 | ||
567 | ||
568 | SHEET: DIM _PROVIDER | |
569 | ||
570 | DIM_PROVID ER, | |
571 | ||
572 | Loop,Segme nt,Segment *Code,Refe rence Desi gnator,Com ments,Key
|
|
573 | 2010AA,REF ,REF*EI,RE F02,Cleans ing and tr ansformati on rules d o not appl y, copy so urce value to target value.,2, TAX ID, | |
574 | 2010AA | |
575 | 2420A | |
576 | 2310B | |
577 | 2310A | |
578 | 2310C,NM1 | |
579 | NM1 | |
580 | NM1 | |
581 | NM1 | |
582 | NM1,NM1*85 | |
583 | NM1*82 | |
584 | NM1*82 | |
585 | NM1*DN | |
586 | NM1*77,NM1 09 | |
587 | NM109 | |
588 | NM109 | |
589 | NM109 | |
590 | NM109,For each sourc e segment* code value for which there is no match i n the targ et table/a ttribute, insert a n ew DIM_PRO VIDER reco rd. If a s ource segm ent*code v alue is fo und in the target ta ble/attrib ute, no ac tion.,3,NP I, | |
591 | Initialize to NULL., 7,SMALL BU SINESS, | |
592 | Initialize to 'Y'.,1 4,IS CURRE NT, | |
593 | Initalize to ETL gen erated pro cess date. ,15,START DATE, | |
594 | Initialize to NULL., 16,END DAT E, | |
595 | Initialize to 'EDI'. ,17,SOURCE SYSTEM, | |
596 | 2300,REF,R EF*F5,If s egment/cod e exists i n claim, i nitialize target to '837PX'. I f segment/ code does not exist, initializ e target t o '837P'. ,18,SOURCE ENTITY, | |
597 | 2010AA | |
598 | 2420A | |
599 | 2310B | |
600 | 2310A | |
601 | 2310C,NM1 | |
602 | NM1 | |
603 | NM1 | |
604 | NM1 | |
605 | NM1,NM1*85 | |
606 | NM1*82 | |
607 | NM1*82 | |
608 | NM1*DN | |
609 | NM1*77,NM1 03, NM104, NM105 | |
610 | NM103, NM1 04, NM105 | |
611 | NM103, NM1 04, NM105 | |
612 | NM103, NM1 04, NM105 | |
613 | NM103,For each inser ted provid er record, separate source ref erence des ignator va lues with a ','. ,20 ,PROVIDER NAME, | |
614 | Insert a n ew DIM_PRO VIDER reco rd for eac h NM1*85, NM1*82, an d NM1*DN s egment*cod e source v alue not f ound in ta rget table . PROVIDER _KEY is au togenerate d by PIT. ,PK,21,PRO VIDER KEY, | |
615 | 2010AA | |
616 | 2420A | |
617 | 2310B | |
618 | 2310A,NM1 | |
619 | NM1 | |
620 | NM1 | |
621 | NM1,NM1*85 | |
622 | NM1*82 | |
623 | NM1*82 | |
624 | NM1*DN,NM1 04 | |
625 | NM104 | |
626 | NM104 | |
627 | NM104,For each inser ted provid er record, map sourc e to targe t. ,25,PR OVIDER FIR ST NAME, | |
628 | 2010AA | |
629 | 2420A | |
630 | 2310B | |
631 | 2310A,NM1 | |
632 | NM1 | |
633 | NM1 | |
634 | NM1,NM1*85 | |
635 | NM1*82 | |
636 | NM1*82 | |
637 | NM1*DN,NM1 03 | |
638 | NM103 | |
639 | NM103 | |
640 | NM103,For each inser ted provid er record, map sourc e to targe t. ,26,PR OVIDER LAS T NAME, | |
641 | 2010AA | |
642 | 2420A | |
643 | 2310B | |
644 | 2310A,NM1 | |
645 | NM1 | |
646 | NM1 | |
647 | NM1,NM1*85 | |
648 | NM1*82 | |
649 | NM1*82 | |
650 | NM1*DN,NM1 05 | |
651 | NM105 | |
652 | NM105 | |
653 | NM105,For each inser ted provid er record, map sourc e to targe t. ,27,PR OVIDER MID DLE NAME, | |
654 | Value copi ed from BA TCH_LOG ta ble for th e given so urce (EDI) .,FK,28,ET L BATCH ID , | |
655 | ||
656 | ||
657 | ||
658 | ||
659 | ||
660 | ||
661 | ||
662 | ||
663 | ||
664 | ||
665 | ||
666 | ||
667 | ||
668 | ||
669 | ||
670 | ||
671 | ||
672 | ||
673 | ||
674 | ||
675 | ||
676 | ||
677 | ||
678 | ||
679 | ||
680 | ||
681 | ||
682 | ||
683 | ||
684 | ||
685 | ||
686 | ||
687 | ||
688 | ||
689 | ||
690 | ||
691 | ||
692 | ||
693 | ||
694 | ||
695 | ||
696 | ||
697 | ||
698 | ||
699 | ||
700 | ||
701 | ||
702 | ||
703 | ||
704 | ||
705 | ||
706 | ||
707 | ||
708 | ||
709 | ||
710 | ||
711 | ||
712 | ||
713 | ||
714 | ||
715 | ||
716 | ||
717 | ||
718 | ||
719 | ||
720 | ||
721 | ||
722 | ||
723 | ||
724 | SHEET: PRO VIDER_LOCA TION | |
725 | ||
726 | PROVIDER_L OCATION, | |
727 | ||
728 | Loop,Segme nt,Segment *Code,Refe rence Desi gnator,Com ments,KeyO rder,Origi nal Column Order,Tar get Elemen t, | |
729 | Populate e ach record 's PROVIDE R_KEY with value fro m respecti ve DIM_PRO VIDER reco rd.,FK,1,P ROVIDER KE Y, | |
730 | 2010AA | |
731 | 2310C,N3 | |
732 | N3,N301 | |
733 | N301,Clean sing and t ransformat ion rules do not app ly, copy s ource valu e to targe t value.,2 ,ADDRESS1, | |
734 | 2010AA | |
735 | 2310C,N3 | |
736 | N3,N302 | |
737 | N302,Clean sing and t ransformat ion rules do not app ly, copy s ource valu e to targe t value.,3 ,ADDRESS2, | |
738 | 2010AA | |
739 | 2310C,N4 | |
740 | N4,N401 | |
741 | N401,Clean sing and t ransformat ion rules do not app ly, copy s ource valu e to targe t value.,4 ,CITY, | |
742 | 2010AA | |
743 | 2310C,N4 | |
744 | N4,N402 | |
745 | N402,Clean sing and t ransformat ion rules do not app ly, copy s ource valu e to targe t value.,5 ,STATE SHO RT NAME, | |
746 | Initialize to NULL., 6,STATE LO NG NAME, | |
747 | 2010AA | |
748 | 2310C,N4 | |
749 | N4,N403 | |
750 | N403,Clean sing and t ransformat ion rules do not app ly, copy s ource valu e to targe t value.,7 ,POSTAL CO DE, | |
751 | 2010AA | |
752 | 2310C,N4 | |
753 | N4,N404 | |
754 | N404,Clean sing and t ransformat ion rules do not app ly, copy s ource valu e to targe t value.,8 ,COUNTRY C ODE, | |
755 | Initialize to NULL., 9,COUNTRY , | |
756 | Initialize to NULL., 10,LATITUD E, | |
757 | Initialize to NULL., 11,LONGITU DE, | |
758 | Initialize to 'Y'.,1 2,IS CURRE NT, | |
759 | Initialize to ETL ge nerated pr ocess date .,13,START DATE, | |
760 | Initialize to NULL., 14,END DAT E, | |
761 | Initialize to 'EDI'. ,15,SOURCE SYSTEM, | |
762 | If segment /code exis ts in clai m, initial ize target to '837PX '. If segm ent/code d oes not ex ist, initi alize targ et to '837 P'. ,16,SO URCE ENTIT Y, | |
763 | For each p rovider in serted on DIM_PROVID ER, insert a corresp onding new record on this tabl e. | |
764 | Target val ue auto-ge nerated by PIT.,18,P ROVIDER LO CATION KEY , | |
765 | 2010AA,PER ,PER*IC,PE R04, PER06 , PER08,If PER03, PE R05, or PE R07 source value = T E, map pro ceeding re ference de signator s ource valu e to targe t.,19,PROV IDER PHONE , | |
766 | 2010AA,PER ,PER*IC,PE R04, PER06 , PER08,If PER03, PE R05, or PE R07 source value = F X, map pro ceeding re ference de signator s ource valu e to targe t.,20,PROV IDER FAX, | |
767 | Initialize to NULL., 21,LAST UP DATED DATE , | |
768 | Initialize to NULL., 22,LAST UP DATED USER , | |
769 | ||
770 | ||
771 | ||
772 | ||
773 | ||
774 | ||
775 | SHEET: DIM _PATIENT | |
776 | ||
777 | DIM_PATIEN T, | |
778 | ||
779 | Loop,Segme nt,Segment *Code,Refe rence Desi gnator,Bus iness Name ,Comments, KeyOrder,T arget Elem ent, | |
780 | 2010BA,NM1 ,NM1*IL,NM 109,Cleans ing and tr ansformati on rules d o not appl y, copy so urce value to target value.,IN SURED ID, | |
781 | 2010BA,REF ,REF*SY,RE F02,Social Security Number,Cle ansing and transform ation rule s do not a pply, copy source va lue to tar get value. ,SSN, | |
782 | 2010BA,NM1 ,NM1*IL,NM 109,Member Identific ation Numb er,If NM1* IL.NM109 s ource valu e is not f ound in ta rget table /attribute , insert a new patie nt record using NM1* IL source value to t arget. If source val ue is foun d in targe t, perform address c hange vali dation.,ME MBER ID, | |
783 | 2010BA,NM1 ,NM1*IL,NM 103,Cleans ing and tr ansformati on rules d o not appl y, copy so urce value to target value.,LA ST NAME, | |
784 | 2010BA,NM1 ,NM1*IL,NM 104,Cleans ing and tr ansformati on rules d o not appl y, copy so urce value to target value.,FI RST NAME, | |
785 | 2010BA,NM1 ,NM1*IL,NM 105,Cleans ing and tr ansformati on rules d o not appl y, copy so urce value to target value.,MI DDLE INITI AL, | |
786 | 2010BA,DMG ,DMG*D8,DM G02,Cleans ing and tr ansformati on rules d o not appl y, copy so urce value to target value.,DA TE OF BIRT H, | |
787 | 2010BA,DMG ,DMG*D8,DM G03,Cleans ing and tr ansformati on rules d o not appl y, copy so urce value to target value.,SE X, | |
788 | 2010BA,DMG ,DMG*D8,DM G04,Cleans ing and tr ansformati on rules d o not appl y, copy so urce value to target value.,MA RITAL STAT US, | |
789 | 2010BA,N3, N301,On re cord inser t: | |
790 | Map loop 2 010BA sour ce values to target. | |
791 | ||
792 | Address ch ange valid ation when Member ID exists: | |
793 | If any loo p 2010BA s ource addr ess value does not m atch respe ctive targ et element value, en d-date the existing patient re cord and i nsert new patient re cord using loop 2010 BA source values. If all loop 2010BA sou rce addres s values m atch respe ctive targ et element values, n o action. ,ADDRESS1, | |
794 | 2010BA,N3, N302,ADDRE SS2, | |
795 | 2010BA,N4, N401,CITY, | |
796 | 2010BA,N4, N402,STATE CODE, | |
797 | 2010BA,N4, N403,POSTA L CODE, | |
798 | 2010BA,N4, N404,Clean sing and t ransformat ion rules do not app ly, copy s ource valu e to targe t value.,C OUNTRY COD E, | |
799 | Initialize to NULL., STATE , | |
800 | Initialize to NULL., COUNTRY, | |
801 | On record insert: | |
802 | Initialize to 'Y'. | |
803 | ||
804 | On update: | |
805 | Update exi sting reco rd value t o 'N' and initialize inserted record val ue to 'Y'. ,IS CURREN T, | |
806 | Initalize to ETL gen erated pro cess date. ,START DAT E, | |
807 | On record insert: | |
808 | Initialize to NULL. | |
809 | ||
810 | On update: | |
811 | Update exi sting reco rd value t o ETL proc ess date a nd initial ize insert ed record value to N ULL.,END D ATE, | |
812 | Initialize to 'EDI'. ,SOURCE SY STEM, | |
813 | 2300,REF,R EF*F5,If s egment/cod e exists i n claim, i nitialize target to '837PX'. I f segment/ code does not exist, initializ e target t o '837P'. ,SOURCE EN TITY, | |
814 | Value copi ed from BA TCH_LOG ta ble for th e given so urce (EDI) .,FK,ETL_B ATCH_ID, | |
815 | Auto-gener ated by PI T. ,PK,PAT IENT KEY, | |
816 | ||
817 | ||
818 | ||
819 | ||
820 | ||
821 | SHEET: DIM _VA_CLAIM | |
822 | ||
823 | DIM_VA_CLA IM, | |
824 | ||
825 | Loop,Segme nt,Segment *Code,Refe rence Desi gnator,Com ments,KeyO rder,Targe t Element, | |
826 | 2000B,SBR, SBR03,ccn_ region,ADD , | |
827 | 2300,REF,R EF*D9,REF0 2,Cleansin g and tran sformation rules do not apply, copy sour ce value t o target v alue.,clea ringhouse_ claim_id,R EMAP, | |
828 | 2010BB,NM1 ,NM1*PR,pa yer_key,DR OP, | |
829 | 2300,REF,R EF*D9,REF0 2,Cleansin g and tran sformation rules do not apply, copy sour ce value t o target v alue.,clai m_id, | |
830 | ST,ST*837, ST03,When first 10 c haracters of source value are 005010X222 , populate FORM_TYPE _KEY based on lookup to DIM_CL AIM_FORM_T YPE using FORM_CODE = 837P. | |
831 | If source value not present on DIM_CLAIM _FORM_TYPE , insert n ew record on DIM_CLA IM_FORM_TY PE. | |
832 | If source is NULL, s et target to -1.,FK, form_type_ key, | |
833 | 2010AA | |
834 | 2010AA,NM1 | |
835 | REF,NM1*85 | |
836 | REF*EI,NM1 09 | |
837 | REF02,If N M1*85.NM10 9 (NPI) va lue exists in claim, obtain BI LLING_PROV IDER_KEY b y joining source val ue to DIM_ PROVIDER.N PI. | |
838 | If match n ot found, obtain BIL LING_PROVI DER_KEY by joining R EF*EI.REF0 2 (Tax ID) source va lue to DIM _PROVIDER. TAX_ID. | |
839 | If match n ot found a nd one of source val ues is pro vided in c laim, inse rt new rec ord on DIM _PROVIDER. | |
840 | If source is NULL, s et target to -1.,FK, billing_pr ovider_key , | |
841 | 2310A,NM1, NM1*DN,NM1 09,If NM1* DN.NM109 ( NPI) value exists in claim, ob tain REFER RING_PROVI DER_KEY by joining s ource valu e to DIM_P ROVIDER.NP I. | |
842 | ||
843 | If source is NULL, s et target to -1.,FK, referring_ provider_k ey, | |
844 | Initialize to -1.,FK ,station_k ey , | |
845 | 2010BA,NM1 ,NM1*IL,NM 109,Obtain PATIENT_K EY by join ing source value to DIM_PATIEN T.MEMBER_I D. | |
846 | If value d oes not ex ist, inser t new pati ent record .,FK,patie nt_key , | |
847 | 2300,CLM,C LM05-3,Cle ansing and transform ation rule s do not a pply, copy source va lue to tar get value. ,claim_fre q_code, | |
848 | 2300,CLM,C LM01,Clean sing and t ransformat ion rules do not app ly, copy s ource valu e to targe t value.,p atient_acc ount_numbe r, | |
849 | Initialize to 'Y'. , is_current , | |
850 | Initialize to ETL ge nerated pr ocess date .,start_da te , | |
851 | Initialize to NULL. ,end_date , | |
852 | Initialize to 'EDI', source_sys tem , | |
853 | 2300,REF,R EF*F5,If s egment/cod e exists i n claim, i nitialize target to '837PX'. I f segment/ code does not exist, initializ e target t o '837P'. ,source_en tity , | |
854 | Initialize to NULL., obligation _number, | |
855 | Auto-gener ated by CC RS ETL,PK, claim_key, | |
856 | Initialize to -1.,FK ,status_re ason_key , | |
857 | Value copi ed from CL AIM_BATCH_ LOG table for the gi ven source (EDI).,FK ,etl_batch _id, | |
858 | 2300,REF,R EF*G1,REF0 2,No clean sing or tr ansformati on rules a pply. Cop y source v alue to ta rget value .,preauth number, | |
859 | ||
860 | 2330B,NM1, NM1*PR,If segment*co de exists in claim, initialize to 'Y'. E lse, initi alize to ' N'.,other_ insurance , | |
861 | BHT,BHT*00 19,BHT04,D ate source system co nsumed the claim.,cl aim_create d_date, | |
862 | 2310C,NM1, NM1*77,NM1 09,If NM1* 77.NM109 ( NPI) value exists in claim, ob tain SERVI CE_FACILIT Y_KEY by j oining sou rce value to DIM_PRO VIDER.NPI. | |
863 | If match n ot found a nd source value is p rovided in claim, in sert new r ecord on D IM_PROVIDE R. | |
864 | If source is NULL, s et target to -1.,ser vice_facil ity_key, | |
865 | 2300,REF,R EF*9F,REF0 2,Cleansin g and tran sformation rules do not apply, copy sour ce value t o target v alue.,refe rral_numbe r, | |
866 | 2310B,NM1, NM1*82,NM1 09,If Loop 2310B NM1 *82.NM109 (NPI) valu e exists i n claim, o btain REND ERING_PROV IDER_KEY b y joining source val ue to DIM_ PROVIDER.N PI. If mat ch not fou nd, insert new provi der record . | |
867 | If source is NULL, s et target to -1.,ren dering_pro vider_key, | |
868 | 2300,CLM,C LM02,Ensur e data is numeric an d conforme d to curre ncy format on load,c harge_amou nt, | |
869 | 2300,NTE,N TE02,Clean sing and t ransformat ion rules do not app ly, copy s ource valu e to targe t value.,c laim_note, | |
870 | ||
871 | ||
872 | SHEET: CLA IM_ADJUDIC ATION | |
873 | ||
874 | CLAIM_ADJU DICATION, | |
875 | ||
876 | Loop,Segme nt,Segment *Code,Refe rence | |
877 | Designator ,Comments, Key | |
878 | Order,Targ et Element , | |
879 | Auto-gener ated by CC RS-ETL,PK, claim_adju dication_k ey, | |
880 | Copy from DIM_VA_CLA IM record, FK,claim_k ey, | |
881 | 2330B,NM1, NM1*PR,NM1 03,Cleansi ng and tra nsformatio n rules do not apply , copy sou rce value to target value.,FK, payer_id, | |
882 | 2320,AMT,A MT*D,AMT02 ,Cleansing and trans formation rules do n ot apply, copy sourc e value to target va lue.,payer _paid_amou nt, | |
883 | 2320,AMT,A MT*A8,AMT0 2,Cleansin g and tran sformation rules do not apply, copy sour ce value t o target v alue.,non_ covered_am ount, | |
884 | 2320,AMT,A MT*EAF,AMT 02,Cleansi ng and tra nsformatio n rules do not apply , copy sou rce value to target value.,rem aining_pat ient_liabi lity_amoun t, | |
885 | 2330B,DTP, DTP*573,DP T03,Cleans ing and tr ansformati on rules d o not appl y, copy so urce value to target value.,pa id_date, | |
886 | Initialize to 'Y'.,i s current, | |
887 | Initialize to ETL ge nerated pr ocess date .,start da te, | |
888 | Initialize to NULL,e nd date, | |
889 | Initialize to 'EDI', source sys tem, | |
890 | Initialize to '837P' ,source en tity, | |
891 | Auto-popul ated by CC RS ETL,las t updated date, | |
892 | Auto-popul ated by CC RS ETL,las t updated user, | |
893 | ||
894 | ||
895 | SHEET: CLA IM_ADJUSTM ENT | |
896 | ||
897 | CLAIM_ADJU STMENT, | |
898 | ||
899 | Loop,Segme nt,Segment *Code,Refe rence Desi gnator,Com ments,KeyO rder,Targe t Element, | |
900 | Insert a n ew CLAIM_A DJUSTMENT record for each CAS segment in loop 2320 (can be u p to 5 per claim). Claim_adju stment_key is auto-g enerated b y CCRS-ETL .,PK,claim _adjustmen t_key, | |
901 | Copy from DIM_VA_CLA IM record, FK,claim_k ey, | |
902 | Cleansing and transf ormation r ules do no t apply, c opy source value to target val ue.,payer_ id, | |
903 | 2320,CAS,C AS01,Clean sing and t ransformat ion rules do not app ly, copy s ource valu e to targe t value.,a djustment_ type, | |
904 | 2320,CAS,C AS02,Find carc_key i n DIM_CARC _CODE by m atching co de and set value,FK, carc_key_1 , | |
905 | 2320,CAS,C AS03,Clean sing and t ransformat ion rules do not app ly, copy s ource valu e to targe t value.,a djustment_ amount_1, | |
906 | 2320,CAS,C AS04,Clean sing and t ransformat ion rules do not app ly, copy s ource valu e to targe t value.,a djustment_ quantity_1 , | |
907 | 2320,CAS,C AS05,Find carc_key i n DIM_CARC _CODE by m atching co de and set value,FK, carc_key_2 , | |
908 | 2320,CAS,C AS06,Clean sing and t ransformat ion rules do not app ly, copy s ource valu e to targe t value.,a djustment_ amount_2, | |
909 | 2320,CAS,C AS07,Clean sing and t ransformat ion rules do not app ly, copy s ource valu e to targe t value.,a djustment_ quantity_2 , | |
910 | 2320,CAS,C AS08,Find carc_key i n DIM_CARC _CODE by m atching co de and set value,FK, carc_key_3 , | |
911 | 2320,CAS,C AS09,Clean sing and t ransformat ion rules do not app ly, copy s ource valu e to targe t value.,a djustment_ amount_3, | |
912 | 2320,CAS,C AS10,Clean sing and t ransformat ion rules do not app ly, copy s ource valu e to targe t value.,a djustment_ quantity_3 , | |
913 | 2320,CAS,C AS11,Find carc_key i n DIM_CARC _CODE by m atching co de and set value,FK, carc_key_4 , | |
914 | 2320,CAS,C AS12,Clean sing and t ransformat ion rules do not app ly, copy s ource valu e to targe t value.,a djustment_ amount_4, | |
915 | 2320,CAS,C AS13,Clean sing and t ransformat ion rules do not app ly, copy s ource valu e to targe t value.,a djustment_ quantity_4 , | |
916 | 2320,CAS,C AS14,Find carc_key i n DIM_CARC _CODE by m atching co de and set value,FK, carc_key_5 , | |
917 | 2320,CAS,C AS15,Clean sing and t ransformat ion rules do not app ly, copy s ource valu e to targe t value.,a djustment_ amount_5, | |
918 | 2320,CAS,C AS16,Clean sing and t ransformat ion rules do not app ly, copy s ource valu e to targe t value.,a djustment_ quantity_5 , | |
919 | 2320,CAS,C AS17,Find carc_key i n DIM_CARC _CODE by m atching co de and set value,FK, carc_key_6 , | |
920 | 2320,CAS,C AS18,Clean sing and t ransformat ion rules do not app ly, copy s ource valu e to targe t value.,a djustment_ amount_6, | |
921 | 2320,CAS,C AS19,Clean sing and t ransformat ion rules do not app ly, copy s ource valu e to targe t value.,a djustment_ quantity_6 , | |
922 | Initialize to 'Y'.,i s current, | |
923 | Initialize to ETL ge nerated pr ocess date .,start da te, | |
924 | Initialize to NULL., end date, | |
925 | Initialize to 'EDI'. ,source sy stem, | |
926 | Initialize to '837P' .,source e ntity, | |
927 | Auto-popul ated by CC RS ETL,las t updated date, | |
928 | Auto-popul ated by CC RS ETL,las t updated user, | |
929 | ||
930 | ||
931 | SHEET: CLA IM_COB | |
932 | ||
933 | CLAIM_ADJU DICATION, | |
934 | ||
935 | Loop,Segme nt,Segment *Code,Refe rence | |
936 | Designator ,Comments, Key | |
937 | Order,Targ et Element , | |
938 | Auto-gener ated by CC RS-ETL,PK, claim_cob_ key, | |
939 | Copy from DIM_VA_CLA IM record, FK,claim_k ey, | |
940 | 2330B,NM1, NM1*PR,NM1 09,Cleansi ng and tra nsformatio n rules do not apply , copy sou rce value to target value.,FK, payer_id, | |
941 | 2330B,NM1, NM1*PR,NM1 03,Cleansi ng and tra nsformatio n rules do not apply , copy sou rce value to target value.,pay er_name, | |
942 | 2330B,N3,N 301,Cleans ing and tr ansformati on rules d o not appl y, copy so urce value to target value.,pa yer_addres s1, | |
943 | 2330B,N3,N 302,Cleans ing and tr ansformati on rules d o not appl y, copy so urce value to target value.,pa yer_addres s2, | |
944 | 2330B,N4,N 401,Cleans ing and tr ansformati on rules d o not appl y, copy so urce value to target value.,pa yer_city, | |
945 | 2330B,N4,N 402,Cleans ing and tr ansformati on rules d o not appl y, copy so urce value to target value.,pa yer_state_ code, | |
946 | 2330B,N4,N 403,Cleans ing and tr ansformati on rules d o not appl y, copy so urce value to target value.,pa yer_postal _code, | |
947 | 2330A,NM1, NM1*IL,NM1 09,Cleansi ng and tra nsformatio n rules do not apply , copy sou rce value to target value.,ins ured_id, | |
948 | 2330A,NM1, NM1*IL,NM1 04,Cleansi ng and tra nsformatio n rules do not apply , copy sou rce value to target value.,ins ured_first _name, | |
949 | 2330A,NM1, NM1*IL,NM1 03,Cleansi ng and tra nsformatio n rules do not apply , copy sou rce value to target value.,ins ured_last_ name, | |
950 | 2330A,NM1, NM1*IL,NM1 05,Cleansi ng and tra nsformatio n rules do not apply , copy sou rce value to target value.,ins ured_middl e_initial, | |
951 | 2330A,N3,N 301,Cleans ing and tr ansformati on rules d o not appl y, copy so urce value to target value.,in sured_addr ess1, | |
952 | 2330A,N3,N 302,Cleans ing and tr ansformati on rules d o not appl y, copy so urce value to target value.,in sured_addr ess2, | |
953 | 2330A,N4,N 401,Cleans ing and tr ansformati on rules d o not appl y, copy so urce value to target value.,in sured_city , | |
954 | 2330A,N4,N 402,Cleans ing and tr ansformati on rules d o not appl y, copy so urce value to target value.,in sured_stat e_code, | |
955 | 2330A,N4,N 403,Cleans ing and tr ansformati on rules d o not appl y, copy so urce value to target value.,in sured_post al_code, | |
956 | Initialize to 'Y'.,i s_current, | |
957 | Initialize to ETL ge nerated pr ocess date .,start_da te, | |
958 | Initialize to NULL,e nd_date, | |
959 | Initialize to 'EDI', source_sys tem, | |
960 | Initialize to '837P' ,source_en tity, | |
961 | Auto-popul ated by CC RS ETL,las t_updated_ date, | |
962 | Auto-popul ated by CC RS ETL,las t_updated_ user, | |
963 | ||
964 | ||
965 | SHEET: DIM _PAYER (dr op) | |
966 | ||
967 | DIM_PAYER, | |
968 | ||
969 | Loop,Segme nt,Segment *Code,Refe rence Desi gnator,Com ments,KeyO rder,Targe t Element, | |
970 | 2010BB | |
971 | 2330B,NM1 | |
972 | NM1,NM1*PR | |
973 | NM1*PR,NM1 09 | |
974 | NM109,Inse rt a new D IM_PAYER r ecord for each NM1*P R segment* code sourc e value no t found in target ta ble. Paye r_key is a utogenerat ed by CCRS ETL.,PK,p ayer_key, | |
975 | 2010BB | |
976 | 2330B,NM1 | |
977 | NM1,NM1*PR | |
978 | NM1*PR,NM1 09 | |
979 | NM109,For each inser ted record , map sour ce to targ et,payer_i d, | |
980 | 2010BB | |
981 | 2330B,NM1 | |
982 | NM1,NM1*PR | |
983 | NM1*PR,NM1 03 | |
984 | NM103,For each inser ted record , map sour ce to targ et,payer_n ame, | |
985 | Initialize to 'Y'.,i s current, | |
986 | Initialize to ETL ge nerated pr ocess date .,start da te, | |
987 | Initialize to NULL., end date, | |
988 | Initialize to 'EDI'. ,source sy stem, | |
989 | Initialize to '837P' .,source e ntity, | |
990 | Auto-popul ated by CC RS ETL,las t updated date, | |
991 | Auto-popul ated by CC RS ETL,las t updated user, | |
992 | ||
993 | ||
994 | SHEET: CLA IM_PAYER ( drop) | |
995 | ||
996 | CLAIM_PAYE R, | |
997 | ||
998 | Loop,Segme nt,Segment *Code,Refe rence Desi gnator,Com ments,KeyO rder,Targe t Element, | |
999 | Copied fro m DIM_VA_C LAIM recor d.,FK,clai m key, | |
1000 | PK,claim p ayer key, | |
1001 | 2010BB | |
1002 | 2330B,NM1 | |
1003 | NM1,NM1*PR | |
1004 | NM1*PR,NM1 03 | |
1005 | NM103,For each inser ted record , map sour ce to targ et.,payer name,DROP, | |
1006 | 2010BB | |
1007 | 2330B,NM1 | |
1008 | NM1,NM1*PR | |
1009 | NM1*PR,NM1 09 | |
1010 | NM109,For each inser ted record , map sour ce to targ et.,plan i d,DROP, | |
1011 | 2320,OI,OI 06,Cleansi ng and tra nsformatio n rules do not apply , copy sou rce value to target value.,rel ease of in fo, | |
1012 | 2320,OI,OI 03,Cleansi ng and tra nsformatio n rules do not apply , copy sou rce value to target value.,ass ignment of benefits, | |
1013 | 2320,AMT,A MT*D,AMT02 ,Cleansing and trans formation rules do n ot apply, copy sourc e value to target va lue.,payer _paid_amou nt,rename from prior _payment, | |
1014 | 2320,AMT,A MT*EAF,AMT 02,Cleansi ng and tra nsformatio n rules do not apply , copy sou rce value to target value.,pat ient_respo nsibility_ amount,ren ame from e stimated_a mount_due, | |
1015 | Initialize to 'Y'.,i s current, | |
1016 | Initialize to ETL ge nerated pr ocess date .,start da te, | |
1017 | Initialize to NULL., end date, | |
1018 | Initialize to 'EDI'. ,source sy stem, | |
1019 | 2300,REF,R EF*F5,If s egment/cod e exists i n claim, i nitialize target to '837PX'. I f segment/ code does not exist, initializ e target t o '837P'. ,source en tity, | |
1020 | ST,ST*837, ST02,Clean sing and t ransformat ion rules do not app ly, copy s ource valu e to targe t value.,r ow id, | |
1021 | Auto-popul ated by PI T.,last up dated date , | |
1022 | Auto-popul ated by PI T.,last up dated user , | |
1023 | ||
1024 | ||
1025 | ||
1026 | Repeat as necessary up to a ma ximum of t en times. Any one cl aim can ca rry up to a, | |
1027 | total of 1 1 payers ( ten carrie d in Loop ID-2320, a nd one car ried in Lo op ID-2010 BB)., | |
1028 | Once all t he claim l evel payer s have bee n identifi ed, use th e 2400 loo p once for each, | |
1029 | original b illed serv ice line. Use 2430 l oops to sh ow line le vel adjust ment by ea ch payer, | |
1030 | ||
1031 | ||
1032 | ||
1033 | ||
1034 | SHEET: CLA IM_INSURAN CE (drop) | |
1035 | ||
1036 | CLAIM_INSU RANCE, | |
1037 | ||
1038 | Loop,Segme nt,Segment *Code,Refe rence Desi gnator,Com ments,KeyO rder,Targe t Element, | |
1039 | ||
1040 | 2330B,NM1, NM1*PR,Ins ert a new record on CLAIM_INSU RANCE for each NM1*P R segment in loop 23 30B. INSUR ANCE_KEY i s auto-gen erated by PIT. ,PK,I NSURANCE K EY, | |
1041 | Copied fro m DIM_VA_C LAIM recor d.,FK,CLAI M KEY, | |
1042 | 2010BA,NM1 ,NM1*IL,NM 109,For ea ch inserte d record, map source to target .,INSURED ID, | |
1043 | 2010BA,NM1 ,NM1*IL,NM 103, NM104 , NM105,Fo r each ins erted reco rd, separa te referen ce designa tor source values wi th ',' and map to ta rget.,INSU RED NAME, | |
1044 | 2320,SBR,S BR02,For e ach insert ed record, map sourc e to targe t.,RELATIO N TO THE I NSURED, | |
1045 | 2320,SBR,S BR04,For e ach insert ed record, map sourc e to targe t.,OTHER I NSURED NAM E, | |
1046 | 2320, | |
1047 | SBR, | |
1048 | SBR04,For each inser ted record , map sour ce to targ et.,INSURA NCE POLICY GROUP, | |
1049 | 2320,SBR,S BR03,For e ach insert ed record, map sourc e to targe t.,INSURAN CE POLICY NUMBER, | |
1050 | 2010BA,DMG ,DMG*D8,DM G02,For ea ch inserte d record, map source to target .,POLICY H OLDER BIRT H DATE, | |
1051 | 2010BA,DMG ,DMG*D8,DM G03,For ea ch inserte d record, map source to target .,POLICY H OLDER GEND ER, | |
1052 | Initialize to NULL., INSURANCE BEGIN DATE , | |
1053 | Initialize to NULL., INSURANCE END DATE, | |
1054 | 2320,SBR,S BR05,For e ach insert ed record, map sourc e to targe t.,INSURAN CE TYPE, | |
1055 | Initialize to 'Y'.,I S CURRENT, | |
1056 | Initialize to ETL ge nerated pr ocess date .,START DA TE, | |
1057 | Initialize to NULL., END DATE, | |
1058 | Initialize to 'EDI'. ,SOURCE SY STEM, | |
1059 | 2300,REF,R EF*F5,If s egment/cod e exists i n claim, i nitialize target to '837PX'. I f segment/ code does not exist, initializ e target t o '837P'. ,SOURCE EN TITY, | |
1060 | ST,ST*837, ST02,Clean sing and t ransformat ion rules do not app ly, copy s ource valu e to targe t value.,R OW ID, | |
1061 | 2320,AMT,A MT*D,AMT02 ,For each inserted r ecord, map source to target.,P AID AMOUNT , | |
1062 | 2320,AMT,A MT*EAF,AMT 02,For eac h inserted record, m ap source to target. ,PATIENT R EPONSIBILI TY, | |
1063 | ||
1064 | ||
1065 | ||
1066 | ||
1067 |
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