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837 Section - PM

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Enter information to populate values in an 837 electronic bill.

  • The 837s v5010 are modified to allow the ability to identify Payer Primary Identifier Qualifier (2010BB-NM1-08), Payer Primary Identifier (2010BB-NM1-09), and Payer Secondary Identification (2010BB/2330B-REF) at the Guarantor/Payors level rather than the Guarantor/Program Billing Defaults level.

  1. In the Submitter Payer Identification Code (1000A-N1-04) field, enter the guarantor code for the 835 file. The system will match this value to the same field in the 835 file to determine the guarantor. Once the matching occurs, the system will use the fields on the 835 section to load, compile or post the individual 835 file. If any errors occur, the file will not be compiled and the case will be reported in the error log.
    Note: If the 835 file has multiple Transaction Set Header (ST) segments, only the first one will be used to determine the guarantor.
  2. In the Submitter Primary Identification Number (1000A-NM1-09) field, enter the value that will populate the associated 837 loop.
  3. In the Receiver Primary Identification Number (1000B-NM1-09) field, enter the guarantor information that will populate the associated the associated 837 loop.
  4. In the Insurance Type Code - Other Insurance Info (2320-SBR-05) field, select the value that will populate the associated 837 loop.
  5. In the Claim Filing Indicator Code (2000B/2320-SBR-09) field, select the value that will populate the associated 837 loop.
  6. In the Explanation of Benefits (EOB) Indicator (2300-CLM-18) field, select Yes to include the explanation of benefits indicator (2300-CLM-18 segment) in the 837 file.
  7. In the 'Payer Identification' fields, enter the appropriate primary and secondary numbers and code qualifiers.
  8. In the Override Claim Filing Indicator Code (2000B-SBR-09) with value from guarantor that liability is distributed to? field, select whether or not the Claim Filing Indicator value used in the 2000B-SBR segment will come from the guarantor that the service is distributed to rather than the report-only guarantor. This field is only available for report-only guarantors.
  9. In the Insurance Type Code (2000B-SBR-05) field, select the value that will populate the associated 837 loop.
  10. In the Value to Include in 837I (2010BA-DMG-05) field, check off the Client Race value if the client's race needs to be reported in subscriber demographic segment (2010BA-DMG-05).
  11. In the If The ISA Segment Information field:
    • Select Yes to create a single ISA segment for a guarantor. This segment will not be recreated for each bill submission, to reduce bill processing time.
    • Select No to recreate the ISA Segment for each bill submission.
  12. In the Bill As Primary Guarantor (837) field, select Yes to bill this guarantor as the primary guarantor in the 837 electronic bill. This will force the guarantor to always bill as primary regardless of the guarantor order in a client's Financial Eligibility. Unless needed for a specific billing requirement, this is typically set to No.
  13. In the Other Subscriber Information To Include (837/HCFA-1500) field, select the other subscriber information to include. Select None if no other subscriber information will be included.
  14. In the Ignore the Following Financial Class(es) For Other Subscriber Information (837/HCFA-1500) field, select the financial classes to bypass in the 837 or UB-92 file.
  15. In the Include No-Pay Guarantors in Other Subscriber Information (837I/HCFA-1500) field, select whether or not to include no-pay guarantors.
    • This field is only enabled when Other Subscriber Information To Include (837/HCFA-1500) is set to Other Guarantor(s) With Liability Distributed On Claim.
  16. In the Bill Only When Denial Received From Prior No-Pay Guarantor(s) field, select Yes to prevent billing unless a denial has been received from a no-pay guarantor. This field is only enabled when:
    • Other Subscriber Information To Include (837/HCFA-1500) is set to Other Guarantor(s) With Liability Distributed On Claim and the Include No-Pay Guarantors in Other Subscriber Information (837I/HCFA-1500) field is set to Yes.
      OR
    • Other Subscriber Information To Include (837/HCFA-1500) is set to Other Guarantor(s) Assigned To Client or Other Guarantor(s) Assigned To Client (Excluding Those Not Active For The Claim Period).
  17. In the Bill Only When Payment is Received From Prior Guarantor(s) field, select Yes to prevent billing until liability has been posted for a client's prior guarantor.
  18. In the Ignore the Following Financial Classes field, select the financial classes to be ignored.
  19. In the Sort 837I CLM and UB92/UB04 Claims By field, select how claims will be sorted.
  20. In the Practitioner Categories for Coverage Needing Enrollment with Guarantor, select the categories for rendering practitioners that are required to be enrolled with the guarantor. Practitioners in unselected categories (non-required) may be suppressed from 837 files by using the Suppress Rendering Provider Name if Practitioner is Not Required to be Enrolled With Guarantor fields on the 837P and sections of the Guarantor/Program Billing Defaults form.
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