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Blue Shield of California HIPAA Transaction Standard Companion Guide Section 1 Refers to the Implementation Guides Based on X12 version 005010 Companion Guide Version Number: 1.0 June 6,2011, OCTOBER
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How to fill out 837 companion guide
How to Fill Out 837 Companion Guide:
01
Understand the Purpose: The 837 companion guide is used to provide detailed instructions for completing the 837 electronic data interchange (EDI) transaction. It serves as a reference for healthcare providers, insurance companies, and other entities involved in the electronic submission of healthcare claims.
02
Gather Necessary Information: Before filling out the 837 companion guide, gather all the necessary information related to the healthcare claim you are submitting. This includes patient information, provider details, diagnosis codes, procedure codes, and any supporting documentation required.
03
Review and Understand the Companion Guide Structure: Familiarize yourself with the structure and layout of the 837 companion guide. It typically includes segments, loops, and data elements with specific instructions on how to populate each field correctly.
04
Follow Data Mapping Guidelines: Use the data mapping guidelines provided in the companion guide to accurately transfer the required data from your internal systems to the appropriate fields in the 837 transaction. This ensures that the information is properly formatted and compatible with the recipient's system.
05
Validate the Information: Perform data validation to ensure that all the entered information is accurate, complete, and meets the required standards. This step helps to avoid processing errors or rejections during the submission process.
06
Test and Troubleshoot: Prior to the official submission, it is advisable to test the 837 transaction file using the guidelines outlined in the companion guide. This testing phase helps to identify any issues or discrepancies that may occur and allows for necessary troubleshooting.
Who Needs an 837 Companion Guide:
01
Healthcare Providers: Healthcare providers, such as hospitals, clinics, and physician practices, need the 837 companion guide to accurately submit electronic claims to insurance companies for reimbursement. It helps them navigate the complex technical requirements and ensures compliance with EDI standards.
02
Insurance Companies: Insurance companies utilize the 837 companion guide to process and adjudicate healthcare claims received from healthcare providers. It provides instructions on how to interpret the submitted data and helps in streamlining the claims processing workflow.
03
Clearinghouses and Billing Agencies: Clearinghouses and billing agencies act as intermediaries between healthcare providers and insurance companies. They rely on the 837 companion guide to facilitate the exchange of electronic claims data, ensuring that the right information is transmitted in the correct format.
04
Software Vendors: Software vendors who develop healthcare claims management systems or electronic health record (EHR) software reference the 837 companion guide to ensure their solutions can generate and interpret the required claim data accurately.
05
Compliance Experts and Consultants: Professionals specializing in healthcare compliance and EDI standards consulting use the 837 companion guide as a resource to advise healthcare organizations on accurately completing and submitting electronic claims, adhering to industry regulations.
In conclusion, understanding how to fill out the 837 companion guide is crucial for healthcare providers, insurance companies, and other entities involved in the electronic submission of healthcare claims. It enables accurate and efficient processing of claims while ensuring compliance with industry standards and guidelines.
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