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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 | 837 Validations.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 | 837 Validations.xlsx | Fri Jun 15 14:56:15 2018 UTC |
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1 | SHEET: 837 I-Institut ional | |
2 | ||
3 | 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, | |
4 | Billing Pr ovider Tax Identific ation Numb er,Billing Provider Tax ID,If REF01 = "E I" then RE F02 Not NU LL,Missing Billing P rovider Ta x ID,Set a ll invoice lines to non-confor ming,2010A A,REF,REF* EI,REF02, | |
5 | Subscriber Primary I dentifier, Veteran IC N,Not NULL ,Missing V eteran ICN ,Set all i nvoice lin es to non- conforming ,2010BA,NM 1,NM1*IL,N M109, | |
6 | 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, | |
7 | 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, | |
8 | Subscriber Gender,Ve teran Gend er,Not NUL L,Missing Veteran Ge nder,Set a ll invoice lines to non-confor ming,2010B A,DMG,DMG* D8,DMG03, | |
9 | 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, | |
10 | Facility T ype Code,F acility Ty pe,Not NUL L,Missing Facility T ype,Set al l invoice lines to n on-conform ing,2300,C LM,CLM05-1 , | |
11 | Claim Freq uency Code ,Claim Fre quency,Not NULL,Miss ing Claim Frequency, Set all in voice line s to non-c onforming, 2300,CLM,C LM05-3, | |
12 | Statement From and T o Date,Sta tement Fro m and To D ate,Not NU LL,Missing Statement From and To Date,Se t all invo ice lines to non-con forming,23 00,DTP,DTP *434,DTP03 , | |
13 | Admission Type Code, Admission Type,If CL M05-1 is i n (11, 18, 21, 28, 4 1, 65, 66, 86), vali date CL101 is not NU LL; | |
14 | else if CL M05-1 is n ot in thes e values, do not eva luate this field,Mis sing Admis sion Type, Set all in voice line s to non-c onforming, 2300,CL1,C L101, | |
15 | Patient St atus,Disch arge Statu s,If CLM05 -1 is in ( 11, 18, 21 , 28, 41, 65, 66, 86 ), validat e CL103 is not NULL; | |
16 | else if CL M05-1 is n ot in thes e values, do not eva luate this field,Mis sing Disch arge Statu s,Set all invoice li nes to non -conformin g,2300,CL1 ,CL103, | |
17 | Referral N umber,VA R eferral ID ,Not NULL ,Missing V A Referral ID,Set al l invoice lines to n on-conform ing,2300,R EF,REF*9F, REF02, | |
18 | Authorizat ion Number ,VA Autho rization I D,Not NULL ,Missing V A Authoriz ation Numb er,Set all invoice l ines to no n-conformi ng,2300,RE F,REF*G1,R EF02, | |
19 | Claim Numb er,Claim I D,Not NULL ,Missing Claim ID,S et all inv oice lines to non-co nforming,2 300,REF,RE F*D9,REF02 , | |
20 | Principal Diagnosis Code,Princ ipal Diagn osis Code, Not NULL,M issing Pri ncipal Dia gnosis,Set all invoi ce lines t o non-conf orming,230 0,HI,HI*AB K,HI01-2, | |
21 | Admitting Diagnosis Code,Admit ting Diagn osis Code, If CLM05-1 is in (11 , 18, 21, 28, 41, 65 , 66, 86), validate HI01-2 is not NULL; | |
22 | else if CL M05-1 is n ot in thes e values, do not eva luate this field,Mis sing Admit ting Diagn osis,Set a ll invoice lines to non-confor ming,2300, HI,HI*ABJ, HI01-2, | |
23 | Patient Re ason for V isit,Patie nt Reason for Visit, If CLM05-1 is in (NU LL, 11, 18 , 21, 28, 41, 65, 66 , 86), do not evalua te this fi eld; | |
24 | else if CL M05-1 is n ot in thes e values, validate H I01-2 is n ot NULL,Mi ssing Pati ent Reason for Visit ,Set all i nvoice lin es to non- conforming ,2300,HI,H I*APR,HI01 -2, | |
25 | Diagnosis Related Gr oup,Diagno sis Relate d Group,If CLM05-1 i s in (11, 18, 21, 28 , 41, 65, 66, 86), v alidate HI 01-1 is no t NULL; | |
26 | else if CL M05-1 is n ot in thes e values, do not eva luate this field,Mis sing Diagn osis Relat ed Group,S et all inv oice lines to non-co nforming,2 300,HI,HI* DR,HI01-1, | |
27 | 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 0E,NM1,NM1 *77,NM109, | |
28 | 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 310E,N4,N4 03, | |
29 | Service Li ne Revenue Code,Reve nue Code,N ot NULL,Mi ssing Clai m Line Rev enue Code, Set single line to n on-conform ing,2400,S V2,SV201, | |
30 | Procedure/ Service Co de,Service Code,If C LM05-1 is in (NULL, 11, 18, 21 , 28, 41, 65, 66, 86 ), do not evaluate t his field; | |
31 | else if CL M05-1 is n ot in thes e values, validate S V202-2 is not NULL,M issing Cla im Line Se rvice Code ,Set singl e line to non-confor ming,2400, SV2,SV202- 2, | |
32 | Line Item Charge Amo unt,Line B illed Amou nt,If CLM0 5-1 is in (NULL, 11, 18, 21, 2 8, 41, 65, 66, 86), do not eva luate this field; | |
33 | else if CL M05-1 not in these v alues, val idate SV20 3 is not N ULL,Missin g Claim Li ne Billed Amount,Set single li ne to non- conforming ,2400,SV2, SV203, | |
34 | Unit or Ba sis for Me asurement Code,Servi ce Unit Id entifier,I f CLM05-1 is in (NUL L, 11, 18, 21, 28, 4 1, 65, 66, 86), do n ot evaluat e this fie ld; | |
35 | else if CL M05-1 is n ot in thes e values, validate S V204 is no t NULL,Mis sing Claim Line Serv ice Unit I dentifier, Set single line to n on-conform ing,2400,S V2,SV204, | |
36 | Service Un it Count,S ervice Uni t Count,If CLM05-1 i s in (NULL , 11, 18, 21, 28, 41 , 65, 66, 86), do no t evaluate this fiel d; | |
37 | else if CL M05-1 is n ot in thes e values, validate SV205 is n ot NULL,Mi ssing Clai m Line Ser vice Unit Count,Set single lin e to non-c onforming, 2400,SV2,S V205, | |
38 | Service Da te,Service Date,If C LM05-1 is in (NULL, 11, 18, 21 , 28, 41, 65, 66, 86 ), do not evaluate t his field; | |
39 | else if CL M05-1 is n ot in thes e values, validate D TP03 is no t NULL,Mis sing Claim Line Serv ice Date,S et single line to no n-conformi ng,2400,DT P,DTP*472, DTP03, | |
40 | ||
41 | ||
42 | SHEET: 837 P-Professi onal | |
43 | ||
44 | 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, | |
45 | 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, | |
46 | 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, | |
47 | 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, | |
48 | 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, | |
49 | 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, | |
50 | 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, | |
51 | 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, | |
52 | 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, | |
53 | 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, | |
54 | 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, | |
55 | 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, | |
56 | 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, | |
57 | 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, | |
58 | 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, | |
59 | 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, | |
60 | 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, | |
61 | 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, | |
62 | 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, | |
63 | 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, | |
64 | 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, | |
65 | 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, | |
66 | ||
67 | ||
68 | ||
69 | ||
70 | SHEET: 837 D-Dental | |
71 | ||
72 | 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, | |
73 | 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, | |
74 | 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, | |
75 | 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, | |
76 | 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, | |
77 | 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, | |
78 | 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, | |
79 | Service Da te,Date of Service,N ot NULL,Mi ssing Serv ice Date,S et all inv oice lines to non-co nforming,2 300,DTP,DT P*472,DTP0 3, | |
80 | Referral N umber,VA R eferral ID ,Not NULL ,Missing V A Referral ID,Set al l invoice lines to n on-conform ing,2300,R EF,REF*9F, REF02, | |
81 | Authorizat ion Number ,VA Autho rization I D,Not NULL ,Missing V A Authoriz ation ID,S et all inv oice lines to non-co nforming,2 300,REF,RE F*G1,REF02 , | |
82 | 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, | |
83 | 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, | |
84 | 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, | |
85 | 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, | |
86 | 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, | |
87 | 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, | |
88 | Procedure Code,Proce dure Code, Not NULL,M issing Cla im Line Pr ocedure Co de,Set sin gle line t o non-conf orming,240 0,SV3,SV30 1-2, | |
89 | 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,SV3,SV 302, | |
90 | 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,SV3,SV3 03, | |
91 | Procedure Count,Proc edure Coun t,Not NULL ,Missing C laim Line Procedure Count,Set single lin e to non-c onforming, 2400,SV3,S V306, | |
92 | ||
93 | ||
94 | ||
95 | SHEET: She et1 |
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