Community Outreach Services/837 Modifications
Checklist
837 Process Flow*
* Process Flow diagram from LA IBHIS document “LACDMH 837 5010 Companion Guide v1 7.pdf”
LA 837 Setup
The LA 837 Setup form is introduced through the LA Provider integration Module to allow additional information to be set up for the LA 837 Professional and 837 Institutional, including the Community Outreach Services.
The Community Outreach Service Client ID is used in the LA Community Outreach Service Entry form. All services entered in that form will be saved against the COS Client ID stored in this form.
Each facility reporting the Community Outreach Service must have the client admitted into myAvatar with the following demographic information according to the LACDMH 837 5010 Companion Guide v1.7.
The Community Outreach Service Codes allow your site to restrict the services that you can select for the LA Community Outreach Service Entry form.
When the Enable Product Over-Ride For 837P Payer Identification Number (2330B-NM1-09) field is set to Yes, the 'Payer Identification Number' field (2330B-NM1-09) in the 837 5010 Professional file produced via the Electronic Billing form will be over-ridden as follows if defined:
- In PM systems only, Payer Identification Number(837P) field from the Guarantors/Payors form.
- The Payer Identification # (2010BB/2330B-NM1-09) field in the Guarantor/Program Billing Defaults form (837 Professional section).
SQL Tables:
SQL Table Name= LAPROV.la_837_setup
SQL Table Name= LAPROV.la_837_setup
LA Community Outreach Service Entry
This form allows Community Outreach Services to be entered against the Community Outreach Service client created in the LA 837 Setup form.
This form will file a service, plus file additional Community Outreach Service information that is required to report on the 837 Professional according to the “LACDMH 837 5010 Companion Guide v1.7.”
SQL Table:
SQL Table Name= LAPROV.la_cos_tx_history
LA Authorizations
The LA Authorizations form captures the authorization information (also known as P-Auth) to be included on the 837 Professional and 837 Institutional, according to the "LACDMH 837 5010 Companion Guide v1.7."
SQL Table:
SQL Table Name= LAPROV.la_authorizations
LA Guarantor/Program Billing Overrides
This form allows the site to capture Guarantor/Program Billing overrides to the "Guarantor/Program Billing Defaults" table for the 837 Professional and 837 Institutional so information can be pulled by date range. Without this form and logic, you would have to modify the Guarantor/Program Billing Defaults form depending on what bills are being generated so information is reported correctly according to the “LACDMH 837 5010 Companion Guide v1.7.”
SQL Table:
SQL Table Name= LAPROV.la_billing_overrides
Electronic Billing
The 837 Professional version 5010 and the 837 Institutional version 5010, are modified to provide support for “LACDMH 837 5010 Companion Guide v1.7.”