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HIPAA Claim Payment Master Documentation

1. 153 153 USING PGP DES qroro ees 157 Us re GIMP C eet 158 160 Accessing Inbox Manadgel za inii resi UE 160 Checking EDI File e 161 Downloading EDI Files From 2 8 rhe renean o aS edu e Gora u xa nua cu Cr paa 163 PFOCESSING EDI FOS e 165 ACCESSING EDI 166 Accessing Send L0G 169 EiSting SER FIOS cue 171 Creating 835 EDI Files 172 Seting UP COMPANY 172 Creating Company Setup Table i cciceissacicscceccctatecssincccenetweteieriiicinceeeaseeneintcceeweusibietasiecenseneds 176 Creating 834 EDI Files from the Attached Database
2. lt 112 SA rires t 114 Configuring EDI Exchange Optional Settings 21 1 222 120 Selmo Up Hirai eric RR 120 Setting up Incoming and Outgoing Files Options 126 Running the Application Via Scheduler 5 ioco creer antes in tacit cra rer nene raa odia ico ccs c er 128 Using the Command Line Arguments Ee VC ck avus ca E 130 Working With Trading Partners oe eorr eror eru reri nore s opea Mr na P 130 Setting p Trading 22 130 Using Built in FTP Cle Fil 144 Creating Trading Partner Automatically 149 Certificate based 5 150 ret 153
3. The Test Configuration button 5 You should receive a message like this Click OK 2012 The HIPAAsuite Claim Payment Master The success message 6 Only after the configuration checks out are you allowed to save it Click the Save Field Configuration button to be exported ent Claim Lines E gt fie Level Data Ez 10 Key of Payment table TradingPartneriO E 7 Statistics T53 7 EDIFieName Provider D FieDate Facility Type E E FinancialData BPR Segment isca Perio TransactionHandlingCode 7 DebtCredt Ez Payment Method 7 SendingBankNo Sender ccountNo PayeriD Claim Status Ee PayerDivision Er ClaimAmount Recerving Bank No 7 Claim Ped 7 Elective Date Insurance Check Number or EFT Number PayersClaimlD ProductionDate Facility TypeCode Er E Payer infomation PlanID or ID EZ GreuporPelicyNum Haar Key of Payment Table u ris PayerCity PayerState PayerZip PayeriDNumber 7 SubmitterID HIN MAIC v ClaimID Key of Claim Table ey d Line Table PayerContact AdjustmentGroup Pa Fi mighty ie er Pulls Test Configuration z C Save F o The Save Field Configuration button Troubleshooting Data Fields Once you have made your selection or selected all you have to test your set
4. eese eere eene 83 Processing with the EDI Exchange Module 84 Working with the Database cca cascades peck nice Sox eu ea cta uto Y onse a ced en ecu EN n PRESE 86 Changing the RU E 87 Running the Application via Scheduler 88 EDI Exchange 91 Getting Starte ee wer 91 About EDI Exch ane C M H 91 Requesting EDI Exchange License cccssssssseeseeeeeeeeeeeeeeneeeeeneeseaseeeeeeeeeeseaenooeonaeaseaseeeeeeeseaeaaonananaasanseeeeeeseaeaoans 94 Registering EDI Exchange 96 Configuring EDI Exchange Obligatory Settings 21 1 1222 98 1 Setting up Database COmme CuO i ioci cay spaces cosa te Cet cda eren 98 2 Creating a tenet acetic 98 2 lt 999 104 3 Defining Auto Processing ODUOTIS 222 20 rn neto 110 4 Defining Communications
5. The Save Connection Information button To verify if the entered parameters are correct click on the Test Connection button 2012 2012 The Test Connection button If the test has passed successfully you will see the following notification The success message 2 The HIPAAsuite Claim Payment Master Once the test has passed successfully the Connection not checked message changes to Connection checked The Connection not checked checkbox Once you have the database connection defined and tested you can enter the table names See Selecting Fields to Export 771 If you need to create the tables first then see Creating Tablesl 21 5 3 Creating Tables Before data 53 you need to create the tables through SQL table statements You can do this using the built in function of the HIPAA Claim Payment Master Creating these tables is a quite intimidating task Once you have your connection defined 55 and tested follow the instructions below 1 Select the Data Export 835 Table Creation in the main menu HIPAA Claim Payment Master b4bit File View Data Export code Sets Image Setup EDI Exchange 835 Connection and Data Fields T 635 Payments and Paid Claims Create 835 EDI Files The 835 Table Creation menu 2 The following window will be displayed 2012 Microsoft SOL Sever
6. 178 Bug Reporting and Program Update 180 The HIPAAsuite Claim Payment Master 1 LeeuneEnirt iqe c G 180 2 Updating the PFOGFGITI sd ie M REM EE 183 Index 0 2012 Introduction 1 Introduction 1 1 About HIPAA Claim Payment Master Electronic Data Interchange EDI plays an ever increasing role in the exchange of information between healthcare providers and healthcare payers and or clearing houses Most people dont know EDI when asked about it but have an intuitive understanding when told that EDI makes ATM transactions possible When you swipe your bank card at any ATM in the world an EDI transaction is created in the ATM machine and sent through a network to your bank Your bank in turn takes the ATM transaction and sends back a response EDI transaction releasing the funds to you The banking system in the world has been working on EDI for a much longer time then the healthcare industry but we will see in our lifetime that healthcare transactions will be similarly smooth fast and reliable HIPAAsuite has software applications for all 12 HIPAA mandated transactions The HIPAA Claim Payment Master is designed to display print and save the data of EDI X12 files that are likely to come from a payer back to the provider such as the 835 Electronic Remittance re
7. Leave file for other program Sav Auto process if other program is available The EDI Exchange Setup window 3 Specify the following outgoing files options Outgoing Files e Validate outgoing files Select this checkbox to validate if the outgoing files are HIPAA compliant e Halt records if EDI compliance warnings are found Select this checkbox to suppress the sending of files with warnings or errors EDI Exchange Directory Setup Root Directory Path D EDI SMTP Server Sender s email address Send email notice of newly arrived Files smtp gmail com gmail com Add User Name Password SMTP serverrequiresLogon user example email com Connectto the SMTP server via the SSL protocol Use Port Outgoing File Other options Validate outgoing files Reject Incoming Files with more errors than set Count below Halt records if EDI compliance warnings are found EDI Files with Other Type in Inbox Q EDI Exchange is NOT yet initialized Exchange EET Nt I ERA Save Auto process if other program is available Validating outgoing files 4 Specify the following incoming files options Other Options 2012 18 The HIPAAsuite Claim Payment Master e Reject incoming files with more errors than set count below If checked the incoming files with more errors than defined will not be placed into the Inbox 7 3 3 folder EDI Exchange Set
8. Image Index Table Name The Save Database Connection button To create the image index table click on the You can create the Image Index Table through a separate screen See Creating the Image Index Tablel 49 Fields to be included in Image Index File You can select the fields that get imported into the image index by selecting the check boxes in front of the field names M Fields to be included in Image Index File Header Test Field Configuration 88 Save Field Configuration The fields to be included in Image Index File Tip As with the other field selectors you can change the field names by clicking on them This is 2012 The HIPAAsuite Claim Payment Master helpful if you have an existing database that you want to access d Taree Ep Hie rcreF ust Subscrber ast F7 Changing the field names For Database export you can test the fields configuration by clicking on the Test Field Configuration button M Fields to be included in Image Index File Header EDFilename a 4 imager ilename TradingPartner 7 Pay Date PayoriD 4 PayeeLast SubscriberLast SubscriberFirst 7 Subscriber 7 PatientLast PatientFirst Patient AmountCharged Ee AmountPaid Test Field Configuration Save Field Config
9. utput Mode Pinter C Screen The Output Mode options Note If you select the Image File format for the first time you need to define the image options See Doing Image Setup 40 2 Go to File Open Directory in the main menu HIPAA Claim Payment Ma File View Data Export Open Sample File Open Select Prinber Exit The Open Directory menu 3 Browse for the folder containing EDI files Click on that folder and then click OK Note Only claim files in ANSI 835 format can be opened via the Claim Payment Master The program will display an error message if you select a file in a different format Reference ANSI 835 is the American National Standards Institutes Health Care Claims Payment and Remittances Advice Format 2012 Getting Started 11 Browse For Folder 1 Configuration HIPAA Claim Payment Master Configuration Scripts 1 HIPAA Claim Status Responder t k HIPAA Eligibility Responder The Browse for Folder popup 4 Click on the Run button to send all files from the folder to the destination Note The pre defined settings will be applied To print the files to image configure the settings See also Configuring Program Options 18 Doing Image Setupl 40 HIPAA Claim Payment Master 64bit The Run buttons 5 The displayed Processing Results popup will report about operation results
10. AdiustmentFieason Cy Payet PreDeteminstionsivn Adiustmentidentifier Line Table ledi_paidclaimlines PayerState RepricedClaimNum Payerzip AuthorizationN um Claim Adjustments edi_claimleveladjustments PayerlD Number Select Al SelectNone Select Select None ER 1 SubrtteiD Line Adjustments edi paidclaimlinead Claim Level Adjustments Line Level Adjustments Provider Level Adj ClamiD of Claim T able Rey of Claim Line Table AduetmentGroup AdjustmentGreup talh AdustmentReason AdustnentRieason AdiustmentAmeount Adiustment mount Save Connection Information DI AdiustmentQty Test li I TECHN Select Select None Select Al Select None Select All Select Mone Save Field Configuration Test Configuration Cancel The Data and Field Setup window Connection Properties Tip If you use ODBC for the connection you will need to set up the ODBC connection first in the 2012 Using the Database 57 Windows k Control Panel Administrative Tools Data Sources ODBC setup screen Setting up the ODBC connection varies from database to database UserDSN System DSN TET TT Connection Pooling About Remove System Data Sources Microsoft Access Direer ClaimPriritetMySQL MySQL ODBC 3 51 Drmver
11. 20 NULL Ext varchar 10 NULL Fax varchar 20 NULL Email varchar 80 NULL Ack NULL char 1 NULL PayorlD varchar 30 NULL Plani varchar 30 NULL Help Save Execute Script Create Table window C3 u5 Co wj LU POR PLE 6 cL A cR LL ILL l4 1 k 3 This window allows you to edit save the table scripts 4 Define the following options e Database e Microsoft SQL Server e MySQL Genetic Company Setup Table Script SQL statements to create the Company table in your database Tip You can modify the scripts so that they run on your specific database 5 Once you have you modified the script click Save The Save button 6 Click Execute Script to create the table in the database 178 8 3 The HIPAAsuite Claim Payment Master The Execute Script button 7 Once the table has been created successfully you will see the following notification The success message Warning Executing the script will wipe out any previous table you have created Remove the script files once you are satisfied so nobody can occasionally destroy the database table Make sure there are no any error messages for successful table creation Creating 834 EDI Files from the Attached Database The HIPAA Claim Payment Master has the capability to create 835 EDI files from the re
12. INTR Chklss EFTDate 03 23 2006 Total Amt 1 845 91 Payer ID CheckW EFT No 70090169 A t Chk Iss EFT Date Payer ID Claim 2 Patient Name BETH MERRITT Member ID Number 800482461 Claim 1 Insure d Name KEVIN P MERRITT Member ID Number 800482461 Patient LEORA NEMECEK Member ID Number 800516666 Provider NEBRASKA METHODIST HOSPITAL Federal ID 99 9999999 Insure d Name LEORA G NEMECEK Member ID Number 800516666 Claim Identifier 402721323 Status Processed as Primary DRG Code Total Charge Amt 4 903 45 Facility Control Payment Amt 1 765 24 Fri n DRG Weight Patient Resp Amt 441 31 Discharge Fraction 2006032310100978 Provider Name NEBRASKA METHODIST HOSPITAL Federal ID 99 9999999 Claim Identifier 402596838 Status Processed as Secondary DRG Code Total Charge Amt 443 34 Facility Control Payment Amt 26 36 Frequency DRG Weight Patient Resp Amt 0 00 Filling Point of Service Discharge Fraction equency Filling Point of Service 2006032310100978 Adjustment Reason ations 45 Charges exceed your contracted legislated fee arrangement 89 27 Claim Line Adjudication 2 Coinsurance amount 1 Proc HC Misc Charge 443 34 Paid 26 36 Paid Units B13 Previously paid Payment for this claim service may have 2 16 2006 been provided in a previous payment i 8 31 2005
13. ASCH text Tie that can be created together with clam mages wil contain tab delimited fields and have one ine per clam Browse Output Directory for Image Index Save The ASCII Text File option Then click Save e Database Export Select this option to save the image index through ODBC into any database independent of the database used for file downloads The database setup is similar to the database setup for the export of claim payment data Specify the following database connection parameters e Database Type e Database Server Name or DSN e Database e Username e Password e Image Index Table Name 2012 4 The HIPAAsuite Claim Payment Master Image Index Configuration The Database Export option Once all database connection parameters have been specified click Test Connection to verify the connection Image Index Configuration FR re 134 Test Connection button The configuration is correct if you receive a message like this Click The success message Then click Save Database Connection 2012 Creating Image Files and PDES 47 HE Image Index Configuration Create Image Index Database Connection Parameters Database Usemame ODBC Connection x Source Name Password
14. Alter Table statement successfully executed Once you have created the tables you can start setting up the other application options See the next step Defining Auto Processing Options 110 2b Creating 999 File Tables Once you have configured the database connection Setting up Database Connectionl follow the instructions below 1 Select EDI Exchange Create 999 Files Tables in the main menu 2012 EDI Exchange 105 EDI Exchange Check EDI File Trading Partners Inbox Manager FTP Client SEF Files EDI Exchange Setup Encryption Setup Create EDI Exchange Tables Create 999 Files Tables d Autoprocess Setup Automatic Scheduler EDI Recerve Log EDI Send Log Request EDI Exchange License EDI Exchange License Information Li X gor ES The menu item to create the necessary table x E 2 The Create Tables for 999 Files screen will appear Table creation and or modification for your database is handled here 2012 106 The HIPAAsuite Claim Payment Master TENEO NU me Database amp Microsoft SQL Sever Oracle MySQL Generic CREATE TABLE ImplementationAck ID int IDENTITY NOT NULL FileName varchar 100 NULL ISenderlD varchar 15 NULL SendTime datetime NULL GroupControlNo 9 NULL TransactionControlNo varchar 9 NULL FuncitionallD char 2 NULL
15. Tip Every database system has their own little syntax idiosyncrasies and the scripts might require tweaking You can edit the table scripts in this screen and save your modified scripts One example are date and time or money data types that do not exist in SQL Server 2005 You can just rename those types to datetime and save you script and it will run fine Create Tables for EDI Exchange S Microsoft SQL Server O MySQL Generic TRANS LOG TRANS LOG ERRORS SEND LOG COMPANY SETUP TransLog Table script 1 CREATE TABLE dbo TRANS LOG ID varchar 200 NOT NULL PayloadID varchar 200 NULL TRADING PARTNER varchar 15 NULL TRANSACTION TYPE char 3 NULL ORIG TRANSACTION TYPE char 3 NULL IPROCESS DATE date NULL IPROCESS TIME time 0 NULL OPERATOR varchar 20 NULL RECORD_IDS NULL bi CHECK MESSAGES Ibigint NULL IResponseFile varchar 300 NULL AcknowledgementFile varchar 300 NULL ExitCode smallint NULL CONSTRAINT TRANS LOG PRIMARY KEY CLUSTERED ID ASC 22 ON PRIMARY 5 The Save button 6 For each script on every tab click Execute Script to create the corresponding table in the database 2012 102 The HIPAAsuite Claim Payment Master town i LL Database Microsoft SQL Server MySQL Generic 1 CREATE TABLE dbo TradingPartner
16. TradingPartnerlD varchar 15 NOT NULL TradingPartnerlD QUAL char 2 NULL ETINNo varchar 15 NULL varchar 40 NULL Contact varchar 100 NULL Phone varchar 15 NULL Extension varchar 10 NULL Email varchar 75 NULL Fax varchar 15 NULL LocalFtpUser varchar 20 NULL LocalFtpPassword varchar 20 NULL Address 1 varchar 100 NULL Address 2 varchar 100 NULL City varchar 30 NULL State char 2 NULL Zip varchar 10 NULL IFtpAddress varchar 50 NULL PutDirectory varchar 50 NULL GetDirectory varchar 50 NULL FtpArchive varchar 20 NULL FtpUserName varchar 40 NULL FtpPassword varchar 40 NULL IFTPPort varchar 12 NULL Outbox varcharl 50 NULL Execute Scrip The Execute Script button Notice Creating tables means clicking the Execute Script button in all five tabs of the Create Tables for EDI Exchange window Then close this window 7 Once the table has been created successfully you will see the following notification Table TradingPartner successfully created The Create Table script success message Warning Double execution of a script wipes out the previous table you have created prompt will warn you before deleting an existing table To Add Remove fields use the Compare Script button Remove the script files once you have created the tables so nobody can destroy the tables
17. 2012 12 The HIPAAsuite Claim Payment Master 2 4 Explaining HIPAA Claims The HIPAA Claim Payment Master enables you to understand electronic remittance advices by translating HIPAA code sets into meaningful words The HIPAA Claim Payment Master translates the code sets and orders the information so that you can see exactly what payments were made and which deductions taken The top part of the form contains e The sender and receiver of the transaction that is the payer who paid the claim Explanation of Payment ere Great Benefit Plan idis DR MARCUS J WELBY 100 MAIN STREET 55 HIGH STREET The receiver of KANSAS CITY 64108 The sender of the SEATTLE WA 98123 the transaction Pay Method Check transaction Bank ID Account Account Chk IssJEFT Date 05 18 2002 Total Amt 175 00 Weaver ID CheckEFT Ma 16588 The sender and receiver information of the 835 transaction located at the top Further you can find the following data e Patient information e Provider information e The claim level information e The claim line adjudication e Service line information Summary information is displayed upfront and each claim listed with the adjudication information and service line information structured with all the details found in the EDI file 2012 Getting Started 13 Patient information Patient Mame JOHN P DOE Member ID Number 11122333301
18. Image Index File Options C Sereen Creabe Image Index Table The Image Setup menu The following window will appear m Image Setup Image File Location Output Directory For Image Files DAED Output E Individual Image Filename Image Format Pn TIFF Format C PDFFormat Lamm Iaenmurnerr err Ug L C Patrent Last Mane Glar IL Color n Images 2 2 21 C Bill Provider 10 Claim ID 6 Red Black Image folder options Indradual Image Filename settings Cim acte only if Display option is None SUI cL LAE LY Sub Folders for Year Month and Day Options Otherwise program creates p d one Image file for all Claims Sub Folders for Year and Week C Sub Folders for Year and Day Save e Cancel The Image Setup window You can set the options described below Once the options have been set click Save e Image File Location Determine the destination folder where the images will be stored e Individual Image Filename These settings are active only if display option is set to One Claim per Page see Configuring Program Options 18 Otherwise the program creates one image file for all claims You have three choices for the generation of image file names Claim Identifier CLP 01 The result file name will be comprised of the Claim Identifier in the format like t
19. e Processed Files Root This field has a pre generated path You can change this path by changing the EDI Root Directory e Trading Partner s Repository Mandatory setting Click on the three dots button to access the Select Folder window There you choose an existing folder or create a new one Once you have specified the directory settings click on the Create Folders Using Trading Partner ID EDI Identifiers Options RemoteFTP Contact Encrypion Folders CORE Local Directory Settings Outgoing Files Root Trading Partner s Outbox D EDI Outbox TXEBS Processed Files Root Trading Partner s Repository D EDI ProcessedFiles TXEBS Naming Convention CMS Create Folders Using Trading Partner ID button e File Naming Convention Health Insurance Exchanges HIX demand that a carrier adheres to more or less complex File naming conventions Since these conventions are often really complicated we decided to hard code several schemes California 2012 EDI Exchange ws Maryland DC and the CMS scheme are currently configured and we will add other schemes if needed CORE Tab This tab stores settings for the use of CORE Compliant SOAP and MIME enveloped transactions When using a Requester or similar application these settings apply to the information source When using a Responder or similar application these settings apply to the information requester rece
20. 2012 EDI Exchange 103 by accident Caution The double execution warning message Make sure there are no error messages and the table creation has been completed successfully Compare Script with existing Table HIPAAsuite products go through continual development and improvements Often these changes lead to new fields in the database While it is easy to drop a table and regenerate it with the new fields you will loose all the data in the table To avoid this trouble there is the button Compare Script with existing Table you click this the table structure in your database will be compared with the script There are two possible outcomes Your table is up to date You have all the fields your table There is nothing to do Table is up to date or if your table is missing recently added fields you will see a window pop up that shows an Alter Table script with which you can add those fields to the table without interfering with existing data 2012 104 The HIPAAsuite Claim Payment Master 7 2 3 Alter Table TradingPartner 2 Add SourceEntitylD char 2 NULL ISourcelDGQualifier char 2 NULL SourceMame varchar b0 NULL ISourcelD varchar 50 NULL The Alter Table script that shows as a result of missing fields You can now click the Execute Script button and the field will be added and a message will confirm your changes Table successfully altered
21. Settings s Configuration The Edit button This configuration file has a lot more than what you need and in most cases all you have to do is remove the at the beginning of a line in order to put that line into effect At first time only patient and subscriber information is de identified and provider information is left intact That is easily changed by removing the at the beginning of some of the lines 2012 The HIPAAsuite Claim Payment Master xizdeid cfg Notepad File Ect Format View Help Sample configuration file for x12deid version 1 3 4 1 03 KZ contains B37P I D B35 270 271 276 277 278 834 820 The lines have two parts separated by one or more spaces or tabs The first part is the tag for the segment to replace or de identify The second part is the replacement data In the replacement data any empty data element will indicate that the data 1s not to be replaced and the original data must remain intact otherwise if there 15 replacement data in that element the replacement data will be used instead of the original and if the replacement data is a single tilde then the element will be blanked out Blanking out with tildes should rarely be used as it distorts the original data If the original did not have data 1 an element the output will not have data in that element even if the replacement data exists If the replacement data starts with then
22. 2012 2012 HIPAA Claim Payment Master amp 4bit DataExport CodeSets Image Setup n ass Output Mode 0 7 About Printer i Check For Updates Screen 1 Praject History C mege Fie i Report an Issue Chil Data Import Features and Licenses The De identify Utility menu item 2 Look through the information on the Introduction screen Optionally check the Do not show this message again option Click OK De Identify utility This free software removes protected health information PHI from X12 HIPAA transactions This facilitates the testing of the transactions without n opa indmiduals privacy This application is courtesy of w The introductory window 3 Familiarize yourself with the information Click OK X12 De Identification Utility Claredi is making available a program to tranzachons This should facilitate the testing of the HIPAA transachions without compromising individuals pracy The software be free for all E ELMO eae Ue a o VOLI Please feel free to use this program with your HIPAA transactions all we are suggestions f configuration files we wanl to know about these too conto rini fio we are using comes mostly irom the HIPAA Implementation It is your responsibilty to make sure Ihe configuration meets you requiremen
23. HIPAA Claim Payment Master Manual Copyright Martin Scholl Consulting Inc The HIPAAsuite Claim Payment Master Table of Contents Part 1 Part Il oa fF N Part 111 Oo OF FP DO Part IV Part VI Foreword 0 Introduction 1 About HIPAA Claim Payment Master 4 2 1 Getting Started 4 sir igitiir 4 Processing a Payment AdVICe C DUE e Neve DE 5 Opening Folder Containing EDI 1 222 9 Explaining 8 2 2 12 15 Configuring the Application 18 Configuring Program aa 18 SCIECUNG a 21 LOOS aee MI 25 Using tlie EDI EGIIOF ARE GE 27 Using Command Line Arguments CLI 30 Running the Applicati
24. HIPAAsuite HIPAA Claim Payment 1 1 _ xe auto To setup autoprocess options go to EDI Exchange gt Autoprocess Setup 2012 Autoprocessing Check EDI File Trading Partners Inbox Manager FTP Client SEF Files EDI Exchange Setup Encryption Setup Create EDI Exchange Tables Create 999 Files Tables utoprocess Setup Automatic Scheduler EDI Receive Log EDI Send Log Request EDI Exchange License EDI Exchange License Information Autoprocess Setup option in EDI Exchange menu Any options selected for autoprocessing will carry over to the command line Get Ales from Trading Partners Check servers for new files and place them into Inbox Default Automatic Processing Options Export in Database Create Autoresponse Print Save to Image Excel 1 ASCII EDI Exchange Automatic Processing options 2012 The HIPAAsuite Claim Payment Master 6 3 Working with the Database To generate an 834 file using the Database the following command line arguments are needed in order 1 EDI To flag the command for EDI file creation 2 Indicates the EDI file is to be built form a query 3 Resulting filename A filename for the resulting file A fully qualified path may be used A relative address ex 834forTradingPartner 834 edi will result in the file being written to the
25. Options in the main menu HIPAA Claim P unl Mi aster Babit File View Data Export Code Sets Image Help ia EXE Duty yut lode E dc t uU Options menu Alternatively you can click on the Setup button located on the main toolbar 2012 186 The HIPAAsuite Claim Payment Master HIPAA Claim Payment Master 6 amp 4bit File View DataExport CodeSets Image Setup EDI Exchange Help The Setup button The following screen will appear Check the Never check for update option and click Save Log all File Processing Log all Processing except Viewing 2 Never check for update L Record errors only ta lag Pop ups Display Option Document Color On Screen One Page per Claim Red One Claim after another Black Processed Files Leave in Place Move C Delete Moved File Directory Directory Path Save Help Cancel The Options window To update the application manually go to Help Check for Update in the main menu HIPAA Claim Fayment Master 64bit File view DataExport CodeSets Image Setup EDIExchange Help 2 3 57 La TEDI lt 2 Help Documentation utput Mode Screen Project History C image File Report an Issue De Identify Utility Data Import Features
26. 123456789 The Try button 3 Configuring the Application 3 1 Configuring Program Options To configure the program options select Setup Options in the main menu 2012 Configuring the Application o HIPAA Claim Payment Master b4bit Fie View DataExport Code Sets Image Setup EDI Exchange Company Setup Create Company Setup Table a ATH Output Mode The Options menu Alternatively you can click on the Setup button located on the main toolbar HIPAA Claim Payment Master 6 amp 4bit View DataExport X Code Sets Image Setup EDI Exchange BO The Setup button The following screen will appear Update Log all File Processing Log all Processing except Viewing Never check for update Record errors only log Pop ups ES Option Document Color On Screen On Paper One Page per Claim di ad One Claim after another Black Black Processed Files Leave in Place C Move C Delete Moved File Directory Directory Path Cancel The Options window You can configure the options described below Once you have finished editing the options click Save Update The following option is available e Never Check for Update Select this option in order not to automatically 2012
27. 3 and Initializing EDI Exchangel n4 EDI Compliance Check EDI standards are strict and precise adherence to the standards is very important so that any organization can work with them regardless of their backend system software EDI Exchange has a built in compliance engine that checks incoming files for compliance The engine also generates a report listing each problem with the exact location Outgoing EDI files can also be checked and you have an option to withhold individual records that violate the rules Read more in Checking EDI Files EDI Control for Transactions The EDI protocols have a few supporting transaction sets that are useful to the smooth functioning of EDI exchanges They provide the sender with an instant feedback on receipt The following transaction sets are available 1 Acknowledgment e 997 999 Functional Acknowledgment e 277U 277CA Unsolicited Claim Status Response in case of Claims Logging EDI Exchange has several logs that are instrumental to keep processing in order and allows to forensically investigate mishaps There are three logs in EDI Exchange Incoming file log See Accessing EDI Receive Log el 2012 94 The HIPAAsuite Claim Payment Master Outgoing file log See Accessing EDI Send Logl sl e Daily transaction log Requesting EDI Exchange License If your trial has expired you can request an extension to the trial If you purchased the product a
28. Generate a public private key pair Load an existing private key file Parameters Type of key to generate 7 SSH 1 RSA SSH 2 RSA 55 2 DSA Number of bits in a generated key 2048 Creating a public private key pair with puttygen You can save the public and private keys separately as ppk files but that is not what we need But puttygen has also tool to convert the keys to pem files The top menu has a Pam ereen 777 777 Conversions Import key Help Export OpenSSH key E Export ssh com key u37Tul RR 1 DrTr2Tvg3uSAC TnJ8DLpaDcricAkdlUJx4VUtp tab Conversions Hm iles ZrK RC Ene P Ti WRRHT a 25 ir Converting the SSH key into a pem certificate When we click on Export OptnSSH key we can then save the key with an pem ending and that is it 2012 EDI Exchange 153 7 5 Using Encryption 7 5 1 About Encrytion EDI Exchange supports the Private Key Infrastructure PKI encryption method This type of encryption is the most generally accepted method of protecting EDI Files from being pried upon by unauthorized persons Without going further into the details of PKI Public key encryption is a cryptographic technique which enables users to securely communicate on an insecure public network and reliably verify the identity of a user via digital signatures Read more in Private Key Infrastructure A public key infrastructure PKI is a
29. I in Line 24 gt NM1 QC 1 DEMO JOHN MI 123456789 at Position 8 DESCRIPTION Value 123456789 not found Date armunn n 1 ina DA gt 1 7 NAA ITYLINI TTAATIT 17224565790 st Pncitinn 2 IIM GOCDIDTIOION AM3swimiinm lannth nf 4 4 alamant ic od 4 nm 1 Files processed EDI compliance check results after further processing was aborted Files without a valid trading partner will be placed into the suspended files directory The final action taken after the analysis is recorded at the end of the results Waming In Linie 107 gt LIN N4 050244 LzZDUU S FOSMION 1 VCOLHIF IUN LAR Clement GESIgnaled NOL cornrain dat Warning in Line 167 gt LIN N4 63629126003 at Position 2 DESCRIPTION No data in mandatory data element 235 in Data Warning in Line 168 gt SE 166 031111112 at Position 2 DESCHRIPTION Transaction set Message header control number 0001 d Warning in Line 169 gt GE 1 1 at Position 2 DESCRIPTION Functional group header control number 00001 does not match traile The file has 1 Interchanges 1 Functional Groups and 1 Transaction Sets The file contains 4 Claims The file was moved to H H IPAAsuite HIPAAsurteCommDinSuspense 3 Akeyhealth 83 7 on 10 17 2012 at 9 50 AM ossis This file s processing was aborted The file was moved to the suspended files folder Certificate based authentication in SFTP SFTP or FTP over secure sh
30. Includes PGP Shredder which can completely destroy unwanted disk based files and folders Drive Encryption be centrally deployed and managed by Symantec Encryption Management Server 158 The HIPAAsuite Claim Payment Master 7 5 4 PGP Desktop key benefits 1 Secures email without burdening users to improve compliance with policies and regulations without hindering productivity 2 Allows users to easily and transparently share encrypted files and folders improving data security without impacting user productivity 3 Management by Encryption Management Server centralizes creation deployment and management of data security policies and reporting PGP Desktop bundles the following products 1 Drive Encryption See System Requirements 2 Desktop Email Encryption See System Requirements 3 Encryption Management Server See System Requirements Using GnuPG GnuPG is an Open Source project for the implementation of the OpenPGP Pretty Good Privacy protocols of encryption GnuPG allows to encrypt and sign your data and communication features a versatile key management system as well as access modules for all kinds of public key directories GnuPG also known as GPG is a command line tool with features for easy integration with other applications Front end applications and libraries are also available Version 2 of GnuPG also provides support for S MIME GnuPG is a free software so it can be freely us
31. My Network Places The Windows Task Scheduler 2 Click on Add Scheduled Task and the Scheduled Task Wizard will guide you through the setup process 3 In the first window read the welcome message and click Next Scheduled Task Wizard This wizard helps you schedule a task for Windows to perform You select the gl lal el alta a The Scheduled Task Wizard window 4 Browse to the HIPAAClaimPaymentMaster exe executable file 2012 The HIPAAsuite Claim Payment Master Scheduled Task Wizard Click the program you want Windows to run To see more programs click Browse 7 Fie Manager VJ Accessibilty Wizard j amp CDSee Pro 25 QJ Address Book Adobe Bridge 53 Adobe Device Central 53 Th Ales Tuba The Scheduled Task Wizard window By default the application is located in c program Files HIPAAsuite HIPAA Claim Payment MasterMHIPAAClaimPaymentMaster exe Select Program to Schedule Look in 23 HIPAA Claim Payment Master ass t 9 PdfSharp dii My E PrajectHisbory txt Documents 8 QlmLicenseLib dll Thumbs db Deskbop S Interop AcroPDFLib dll My Computer My Network Places Selecting a program to schedule Click Next 5 Type a name for this task Choose a time interval e Daily 2012 Configuring the Application 35 e We
32. OnginalGroupControlNo varchar 8 NULL Version varchar 12 NULL AckCode char 1 NULL IncludedT S int NULL ReceivedTS int NULL AcceptedTS int NULL ErrorCode1 char 3 NULL ErrorCode2 char 3 NULL ErrorCode3 char 3 NULL ErrorCode4 char 3 NULL ErrorCode5 char 3 NULL PRIMARY KEY ID Compare Script with existing Table The Bo create 3 Select the database type you use for your host HIPAA application e Database e Microsoft SQL Server SQL Server 2008 and above e Oracle e MySQL Note In case your database is not listed modify the scripts or ask your database administrator to make the necessary modifications 1 The following tables are part of EDI Exchange e ImplementationAck SQL statements to create the ImplementationAck table in your database This table contains information about Acknowledements e TransactionResponse SQL statements to create the TransactionResponse table in your database This table contains individual transactions contained in 999 files 2012 EDI Exchange e SegmentErrors SQL statements to create the SegmentErrors table in your database This table contains individual segments in error contained in 999 transactions e ElementNotes SQL statements to create the ElementNotes table in your database The table contains the elements in error in a specific segment 5 You can modify the scripts so that they run on your specifi
33. ibility 2 Coinsurance amount 2 16 2006 Service End Claim 2 Patient Name BETH MERRITT Member ID Number 800482461 Insure d Name KEVIN P MERRITT Member ID Number 800482461 Provider Name NEBRASKA METHODIST HOSPITAL Federal ID 99 9999999 The One Page per Claim mode Claim Identifier 402721323 Total Charge Amt 4 903 45 Payment Amt 1 765 24 Patient Resp Amt 441 31 Claim Line Adjudication Status Processed as Primary Facility Frequency Filling Point of Service DRG Code Control DRG Weight Discharge Fraction 2006032310100978 1 Proc HC MISC Charge 162 30 Paid 58 42 Paid Units 1 ndl Adjustment Reason Group Adjustm ent Reason Amount Qt Contractual Obligations 45 Charges exceed your contracted legislated fee arrangement 89 27 Patient Responsibility 2 Coinsu rance amount 14 61 2 16 2006 Service End 2 16 2006 The One Claim after Another mode 2012 Configuring the Application 21 Document Color You have the choice to render the form in red or in black The following options may be defined Note The data is always black e On Screen Choose a color for the form when displaying claims on screen e On Paper Choose a color for the form when printing claims e On Images Choose a color for the form when s
34. 1 Using the Print option as a Command Line Argument Again be sure that you have tested the Image printing before trying the command line mode Using Several Arguments You can have a combination of the above arguments For example C o Program Files HIPAAsuite HIPAA Claim Payment Master HIPAACLaimPaymentMaster e 83511 41 will both export the 820 1 edi file to the Database and print the file Command line arguments 511 edi Y Processing of D VEDNG35I1 ed started at 11 10 2015 11 35 14 File 3511 ed processing started at 11 10 2015 11 35 14 Payments will be printed Payment Records will be exported 1 Payments with 1 claims have been printed 1 Payments with 1 claims have been exported Processing of the file 83511 edi ended at 11 10 2015 11 35 27 The Trading Partner with the ID 123458787 is not set up It took 0 minutes 12 335 seconds to process this file The average time was 12 336 seconds per record Processing ended at 11 10 2015 11 35 27 Excerpt from HIPAA Claim Payment Master log after command line processing 6 2 Processing with the EDI Exchange Module Processing EDI Files with the EDI Exchange Module Enabled The only argument you need in this case is Auto The directory to look for new files and the processing options are defined in the setup screens for EDI Exchange No further arguments are needed Files
35. 11 24 PM Processing of the file c121 20803 k 3835 began at 5 11 24 PM 2 Payments with 13 claims have been exported Processing of the file c12120803 k 835 ended at 5 11 34 PM Log Opened at 5 13 40 PM Processing of the file c12120803 k 835 began at 5 13 40 2 Payments with 13 claims been exported Processing of the file c12120809 k 635 ended at 5 14 01 PM The transaction log for a specific day 3 4 Using the EDI Editor EDI files are often hard to read especially if they have no carriage returns and line feeds to put each segment on a line of its own The EDI Editor available in the HIPAA Claim Payment Master replaces all Element separators with a star all sub element separators with a colon and all segment separators with a tilde even if the original file uses different delimiters To Open EDI Editor To access the EDI Editor select the EDI Editor option under View menu item 2012 The HIPAAsuite Claim Payment Master By HIPAA Claim Payment Master The EDI Editor menu Alternatively you can click on the EDI icon on the toolbar to invoke the EDI Editor This option is only enabled when you have opened an EDI 5 m HIPAA Claim Payment Master 32bit The EDI Editor button The following screen will appear E File 83512 edi 1 ISA Q0 pi rr 12456759 20 610442 020518 1601 U 00401 2298800002 0 T 2 GS HP 9998387766 937654 20021026 1135 229
36. C only 4010 C only 5010 Contact Person 0000 EDI Files will be Telephone DO Production E Mail OT Acknowledgement req cen The Company Setup window 3 You can configure the following options e Company Information e EDI Version e Contact Information e SA 14 and 15 Read the detailed descriptions further 4 Once you have finished editing the options click Save 2012 174 The HIPAAsuite Claim Payment Master Company Information e Name Company name Obligatory option Address 1 Address 2 e City Obligatory option e State e ZIP Obligatory option e ISA Segment Sender Identification Important option It identifies your organization for all EDI transactions Most commonly the Qualifier is ZZ and a free form up to 15 character Obligatory option e Qualifier Unique key to the trading partner database file The qualifier has to be 2 bytes Obligatory option Approved qualifiers are e 01 Duns Dun amp Bradstreet e 14 Duns Plus Suffix 20 Health Industry Number HIN e 27 Carrier Identification Number as assigned by HCFA e 28 Fiscal Intermediary Identification Number as assigned by HCFA e 29 Medicare Provider and Supplier Identification Number as assigned by HCFA e 30 U S Federal Tax Identification Number e 33 National Association of Insurance Commissioners Company Code NAIC e ZZ Mutuall
37. Culins Benes Access ODBC Orve HCW Drreer do Microsoft Access HIPAAsuteDB ODBC Dirver HIFAAsuteMyS UL MySUL ODBE 3 51 Driver SUL O DBC SOL Serve Drreer do Microsoft Access ieme Sample Database 2005 Microsoft Access REI k e Sande liskshace AON Mien rres nesr the indicated data provider A a p ai E KIC on this machine including NT services ey ODBC System data source stores information about how to connect to The ODBC Administration screen in Windows Define the database connection properties e Database Type e MS SQL Server MS SQL Server Integrated Security ODBC Connection ODBC Connection for Oracle Database Server e Database e Username Password e Payment Table Claim Table e Line Table 2012 The HIPAAsuite Claim Payment Master e Claim Adjustments e Line Adjustments e Provider Level Adjustments Database and Field Setup HIPAA Provider Printer Extract Capabilities 0 The HIPAA Provider Printer nately treats a payment advice record as a single Object The Payment data from EDI file into its proprietary data object can translate and export this data into any ODBC compliant database such as Microsoft SQL Server IBM AS400 Oracle and so can be extended Customizabons are possible Ask Vendor for details mysql I Payment Table Claim Table Line Table The connection propert
38. MySOLGenenc Payment Claims Claim Level Adj Claim Lines Claim Line Adj Provider Level Adj CiProgramData HIPAASuite HIPAA Claim Payment Master ScriptsiClaimPayrents SOLServer sql 1 CREATE TABLE dba edi claimpayment ID bigint IDENTITY 1 1 NOT NULL File Level Data TradingPartnerlD char 15 NULL EDIFileName varchar 100 NULL FileDate date NOT NULL FileTime lime NULL LoadDate date NULL P ea time NULL inancialData BPR Segment TransactionHandlingCode char 1 NULL PaymentAmount varchar 12 NULL Payment char 1 NULL ntMethod arl 3 NULL PaymentFormat varchar 10 NULL 16 SendingBankNoQual char 2 NULL 17 SendingBankNo varchar 15 NULL 18 SenderAccountNa varchar 25 NULL 13 PayerlD varchar 5O NULL 20 PayerDivision varchar 25 NULL 2 ReceningBankNoQual char 2 NULL 22 RecemingBankNo varchar 15 NULL 23 IRecemerAccountNoQuall Icharl 3 NULL Save Execute Script 2 eJ m RE a mg i Cu co x L5 Las The Create Tables window 3 Define the following options Database e Microsoft SQL Server e MySQL Genetic Tabs On the following tabs there are SQL scripts used to create the appropriate tables e Payment Claims e Claim Level Adj e Claim Lines 2012 The HIPAAsuite Claim Payment Master e Claim Line Adj e
39. NOT yet initialized Initialize EDI Exchange zs B AM Leave for other program Auto process if other program is available The Save button 2012 EDI Exchange 125 Troubleshooting Email Settings If you have problems with setting up the email server please contact your administrator He She should know values to specify and how to test the settings Below is an example of what happens when the email server does not respond Failure After a time out you get a failure notice After acknowledging the failure you get a more detailed error message in the process result screen sos 0000000 Percent Done Sending email to There was a problem with the email See the log below 220 smtp gmail com ESMTP p190sm14373805ywp 56 gsmtp EHLO 25 smtp at your service 3 5 250 EMHANCEDSTATUSCODES 25U0 PIPELINIMG 250 CHUMKIMG 250 SMTPUTF amp AUTH LOGIM CRLF 530 5 7 0 Must issue a STARTTLS command first p 190s MAIL FROM lt example gmail com gt lt CRLF gt TO zexample amp email com cC 530 5 7 0 Must issue a STARTTLS command first p190sm 1458 73805ywp 56 gsmtp 530 5 7 0 Must issue a STARTTLS command first 3805 56 gsmtp RSET lt CRLF gt BUS yw sm The process result screen with a detailed error message 2012 126 The HIPAAsuite Claim Payment Master 7 3 2 Setting up Incoming and Outgoing Files Options To check if
40. The HIPAAsuite Claim Payment Master connect to HIPAAsuite com server and check for program updates Log All File Processing The HIPAA Claim Payment Master has the ability to keep a log of EDI file processing The log writing is mandatory in the program See Log 25 The following option is available Log All Processing Except Viewing Manual operations other than viewing on screen will be logged Display Option The following option is available e One Page per Claim Select this option to put the image of a single claim on one page or a single image file In the following image you can see the second claim of a payment The header information is repeated on each page If this option is selected then you can specify the rule for giving the names to your image files see Doing Image Setupl 40 Individual Image Filename options e One Claim after Another Select this option to list the claims one after the other In the following image you can see that one claim is displayed after the other Explanation of Payment Explanation of Payment From Mutual of Omaha To JENNY EDMUNDSON MEMORIAL HOSPITAL Aberdeen Health Care Service Ctr Mutual of Omaha Plaza From Mutual of Omaha To JENNY EDMUNDSON MEMORIAL HOSPITAL Omaha NE 68175 Aberdeen Health Care Service Ctr Mutual of Omaha Plaza Check 5 Omaha 68175 Account Pay Method Check Bank ID 03 23 2006 Total Amt 1 845 91 Account E Account
41. To resolve this issue do the following 1 Go to the http www edidev com ediregis htm site 2 Some systems may require Microsoft Redistributable Package to be installed first In this case download one of the following components according to your OS bit depth 2012 120 The HIPAAsuite Claim Payment Master The recommended minimum system requirement for Framework EDT 256 MB RAM 1GB available disk space Windows 2000 2003 2008 AP Vista Prer equisites Some systems may Micmeod Packages to be installed to support E d Framewedk EDNET 32 610 dewalead Viral 2005 Radistriburibile Package NET4 22 bit kines Visual C 2010 Readies Package x NET 64 bir download Niscrosof Vissal C 2005 Redisiburabie Packare x64 EDI 64 bit download Micreeal Visual C 2010 Esdaseributabie Pekare x64 3 Download one of the following components you need according to your OS bit depth e Framework EDI Enterprise evaluation 32 bit e Framework EDI Professional evaluation 64 bit 4 Install downloaded components and start again the EDI Exchange initialization procedure 7 3 Configuring EDI Exchange Optional Settings 7 3 4 Setting up Email Notifications EDI Exchange can send emails to operators and trading partners to notify them about files and processing results This functionali
42. ame RevenueCode data object It can translate and export this data FieDate O FaciltyT ype SubmittedProcedureCode ints any ODBC compliant database such as EI Financial ata Segment oO FiscalFenadD ate oO Charged amp mount Microsoft SOL Server 5400 Oracle and 0 TransactionH andlingCode ClasrnCournt The default fields that come with the product Positioning UnisPaid can extended Customizations possible i n aden TotalCharges JU nisChaged PaymentMethod Gaim Data L 5eraceD ate Connection Properties SendingBankNo Gani PrevideiCantiolto Database Type LJ ClamPozitioninFile ClamStatus AltachmentCode Clscn amp mount LocationNunihes Database Server Name CismPaid PatiersResponzibilty HealthcarePolicylD ElfectiveD ate InsursnceType Alowed mount Database CheckNumber or EFT Number PayersCleimiD zl Username ProductionD ate Facility T ypeCode Select Select None D 30 a H sad Provider Level Adjustments as swor Payer ID GiouporPolicyNum D Tabla Payment Table edi cisimpayment Paverhddresst MemberdentNum u ip snc Payerhddress2 O PriochuthNum Claim Table pai 4
43. and Remittances Advice Format 2012 Getting Started BY Choose EDI file LE I KW i HIPAA Claim Payment Master Samples Search Samples ra Yr Fevortes Mame Date modified BE Desktop B35T1 edi 2 5 2012 1 05 EDI File 48 Downloads LEE 2 5 2012 1 05 EDI File gt Recent Places Libraries Documents a Music t Pictures gt Videos Computer t Local Disk C C gt D Metwork 41 gt File 8350 24 gu files 7 7 pen Cancel E The Choose EDI File window 3 Make sure the program tool bar is displayed in the left area To display the left program bar with options select View Info Bar 4 Select one of the following modes in the Output Mode box The Output mode defines the destination where the result file will be sent to e Printer Select this option to print the opened EDI file e Screen This is a default mode select this option to display the EDI file on screen in a preview window e Image File Select this mode to create TIFF or PDF file You should have the settings configured to print the file to image Read more in Creating Image Files from 38 2012 The HIPAAsuite Claim Payment Master The Output Mode options 5 Click on the Run button IB
44. and individual transaction in violation of HIPAA rules can be held back Note You can enable automatic compliance check on outgoing and incoming EDI files See Setting up Incoming and Outgoing Files Options 128 Follow the instructions below to check EDI files for compliance 1 Select Check EDI File under the EDI Exchange menu item EDI Exchange Check EDI File Trading Partners Inbox Manager FTP Client SEF Files EDI Exchange Setup Encryption Setup Create EDI Exchange Tables Create 999 Files Tables Autoprocess Setup Automatic Scheduler EDI Receive Log EDI Send Log Request EDI Exchange License EDI Exchange License Information The Check EDI File menu item Alternatively you can click on the Select and Check EDI File button in the Inbox Manager window Read more in Accessing Inbox Managerl l 2012 EDI Exchange 163 Loading EDI Files into Inbox Processing Inbox ail Activity Log and Warnings Filename 140123142208h x12 SEF file HIPAAClaimMaster SEF Files 837 005010X222A1 SemRef SEF loaded for transaction set 005010 222 1 The Transaction type is 837 Version 005010X222A1 Passed No Errors No Warnings The file has 1 Interchanges 1 Functional Groups and 1 Transaction Sets The file contains 4 Claims The Select and Check EDI File button 2 In the opened file selection dialog select an EDI file and click Open 3 In the Inbox Manager you can see the
45. basic information together with the file path to the image The HIPAA Claim Payment Master can create such an index through ODBC into any database independent of the database used for file downloads Select Image Image Index File Options the main menu to access the Image Index Configuration window 2 HIPAA Claim Payment Master 64bit File View DataExport Code Sets EDI Exchange Help Image Viewer Image Setup Dutput Mode Image File Options Prine lt Sereen Create Image Index Table The Image Index File Options menu You can define which fields to include and configure your database settings Here are all options Create Image Index Check this option to create the image index Select one of the following options to specify the format 2012 Creating Image Files and PDFs 45 e ASCII Text File The image Index File is an ASCII text file that can be created together with claim images It will contain tab delimited fields and have one line per claim In the Text File with Image Files Path field specify the output directory for image index Click Browse to select the destination place Note The image index ASCII file currently works only when you save individual images for each claim Image Index Configuration D Iv Create Image Index Text File Database Export Text File with Image Files Paths Image index File is
46. because this care may be covered by 4B payer per Coordination of benedit s Contr actual Obligations 42 Charges exceed our fee schedule or maximam Sene Dae 2 Proc ADDUZ2 adus because 1 paver pir Coordination of beneits 2 Proc AD DOZ20 Ch 25 Units B Pudpustmant Reason Group Adjustment Reason Patent a Pamen adjusted because this care may be covered by another pir coordination of beets Contractual Obligations Saraca Ow saaa Y 000230 Fa On Reason Group Adjustment Reason Hespnnsibiliny 22 Payer adjusted because this care may be covered by another 15 8 eis Smere NENNEN The display of an 835 Payment Advice 2 3 Opening a Folder Containing EDI Files The Open Directory function works only when the output mode is not Screen but Data Export or Image File Follow the instructions below to open a batch of EDI files located in one folder 2012 o The HIPAAsuite Claim Payment Master 1 Make sure the Printer or Image File mode is selected in the Output Mode box The Output mode defines the destination where the result file will be sent to Note You cannot display a batch of EDI files on screen in a preview window it is possible only for one file See Processing a Payment Advice File 55 m HIPAA Claim Payment Mast File View DataExport
47. data element 66 ir Warning in Line 11 gt NM1 85 2 KEY HEALTH DEMO at Position 9 DESCRIPTION No data in mandatory data element 67 ir Warning in Line 14 gt REF 1J at Position 2 DESCRIPTION No data in mandatory data element 127 in Data Segment REF Warning in Line 14 gt REF 1J at Position 2 DESCRIPTION Conditional data element missing Element 127 Position 2 CODE Warning in Line 14 gt REF 1J at Position 3 DESCRIPTION Conditional data element missing Element 352 Position 3 CODE Warning in Line 14 gt REF 1J DESCRIPTION The REQUIRED rule syntax for data segment REF has been violated At least one of Warning in Line 14 gt REF 1J DESCRIPTION Conditional syntax check failed for segment REF Buffer REF 1J CODE 12459 Warning in Line 15 gt PER IC TE at Position 2 DESCRIPTION No data in mandatory data element in Data Segment C Warning in Line 15 gt PER IC TE at Position 4 DESCRIPTION No data in mandatory data element 364 in Data Segment 1 Warning in Line 15 gt PER IC TE at Position 4 DESCRIPTION Conditional data element missing Element 364 Position A CC Warning in Line 15 gt PER IC TE DESCRIPTION The PAIRED rule syntax for data segment PER has been violated All of the datz Warning in Line 15 gt PER IC TE DESCRIPTION Conditional syntax check failed for segment PER Buffer PER IC TE COD
48. directory find a folder for the year you are looking log for Then find a sub folder for the necessary month with files for each day Double click a file which has the name equal to the necessary date The log will look like this Transaction Log ial x 2 2312010 Y Help Log Opened at 11 13 20 Processing of the file c121 20803 k 3835 began at 11 18 20 Remittance Advices will be printed 2 Payments with 1 claims have been printed Processing of the file c121 20803 k 835 ended at 11 19 21 Log Opened at 11 23 41 Processing of the file c121 20803 k 835 began at 11 23 41 AM Remittance Advices will be printed 2 Payments with 1 claims have been printed Processing of the file c121 20803 k 835 ended at 11 23 42 Log Opened at 2 21 18 PM Processing of the file 1 21 20809 k 835 began at 2 21 19 PM 2 Payments with 13 claims have been exported Processing of the file c1 2120803 k 835 ended at 2 21 20 Log at z 28 27 PM Processing of the file c121 20803 k 38 35 began at 2 28 27 PM 2 Payments with 13 claims have been exported Processing of the file c121 20803 k 3835 ended at 2 28 35 PM Log Opened at 5 07 38 Processing of the file c12120803 k 835 began at 5 07 38 PM 2 Payments with 13 claims have been exported Processing of the file c12120803 k 835 ended at 5 07 47 PM Log Upened at 5 09 09 Processing of the file c121 20803 k 8 35 began at 5 09 09 PM Log Opened at 5
49. easiest to change directory to c Program Files HIPAAsuite HIPAA Claim Payment Master and then call the executable 2 The first command line argument is the path to a directory Alternatively you could have the path to a specific file The program will see if the argument pertains to a file Or a directory 3 The second argument is a Y indicating that the data will be exported 4 The third argument is blank It would instruct the program to create image files in accordance to the setup See Doing Image Setupl 40 5 The forth argument is a Y This instructs the program to print the images of the payments 6 The fifth argument is the name of the printer to which the output is to be directed Using Command Prompt Follow the instructions below to use the command line arguments in Windows Command Prompt 1 Start a Windows Command Prompt Go to Start Programs Accessories Command Prompt Alternatively you can go to Start Run type without quotes and press Enter 2 Type your command and click Enter 2012 32 The HIPAAsuite Claim Payment Master 3 6 CoNo C Program Files HIPAAsuiteSHIPAA Claim Payment ter exe C ED Inboxs835 7 7 Lexmark MSAA Series The Windows Command Prompt screen The command returns a system code which is not displayed to the users e 1 means error e o means everything went okay So testing
50. it after a free evaluation has expired Registration Number xm The license information screen 2012 098 HIPAAsuite Claim Payment Master 7 2 7 2 1 7 2 2 Once you click on Register you can enter the license key that you have previously received via email from us see Requesting EDI Exchange Licensel 941 Click on Register and you will see the registration message the Result area Registration Form EDI Exchange Result Thank you for evaluating EDI Exchange EDI Exchange is fully functional with certain trial limitations This evaluation version expires in 14 days Extending the trial by entering a license key Close the Registration Form and continue using the EDI Exchange Configuring EDI Exchange Obligatory Settings 1 Setting up Database Connection EDI Exchange work is based on the database connection that you define under Database Connection and Data Fields in the main menu of the HIPAA host application Make sure the connection has already been set up and tested before proceeding with EDI Exchange Then proceed to the next step Creating Database Tables 2 Creating Database Tables Once you have configured the database connection Setting up Database Connection 98 follow the instructions below 1 Select EDI Exchange gt Create EDI Exchange Tables in the main menu 2012 EDI Exchange 9 EDI Exchange Check EDI File Trading Partners Inb
51. system for the creation storage and distribution of digital certificates which are used to verify that a particular public key belongs to a certain entity The PKI creates digital certificates which map public keys to entities securely stores these certificates in a central repository and revokes them if needed A PKI consists of e A certificate authority CA that both issues and verifies the digital certificates e A registration authority which verifies the identity of users requesting information from the CA e A central directory is a secure location to store and index keys A certificate management system EDI Exchange relies on other software to establish the PKI It only uses the capabilities of these programs through their Application Programming Interface API You need to separately install either PGP Desktopl s or the open source GPG4Win programs and set them up with the public keys of your trading partners and your own private key 7 5 2 Setting up Encryption EDI Exchange allows you to set up the encryption for your EDI files Follow the steps below 1 Access the Encryption Setup window by selecting Encryption Setup under the EDI Exchange menu 2012 154 The HIPAAsuite Claim Payment Master EDI Exchange Check EDI File Trading Partners d B Inbox Manager FTP Client SEF Files EDI Exchange Setup Encryption Setup Create EDI Exchange Tables Create 999 Files Tables Autoprocess Setup Aut
52. the button Records Saved p Notification window Using PGP Desktop Pretty Good Privacy PGP is a data encryption and decryption computer program that provides cryptographic privacy and authentication for data communication PGP is often used for signing encrypting and decrypting texts e mails files directories and whole disk partitions to increase the security of e mail communications PGP and similar products follow the OpenPGP standard RFC 4880 for encrypting and decrypting data For more information see How PGP works EDI Exchange supports PGP encryption and works seamlessly with PGP Desktop and open source Gpg4Win applications PGP Desktop Symantec s encryption solutions is a comprehensive suite of encryption applications which provides flexible multi layered encryption by bundling Drive Encryption to secure the files stored on local hard drives and Desktop Email Encryption to secure confidential data in email For more information see PGP Desktop documentation PGP Desktop key features 1 Hard drive encryption software locks down the entire contents of a laptop desktop external drive or USB flash drive including boot sectors system and swap files 2 Enables encrypted email and secure AIM Instant Messages 3 Creates storage independent encrypted containers for transport and sharing of specific files using included utilities PGP Self Decrypting Archive PGP Virtual Disk and PGP Zip 4
53. the software Once you receive the response with the key for EDI Exchange you can bring the Registration Form screen up again and click on Register Enter the key to unlock EDI Exchange In the Result area you will see that EDI Exchange has been registered EDI Exchange Result Thank you for evaluating EDI Exchange EDI Exchange is fully functional with certain trial limitations This evaluation version expires in 14 days Entering the license key 2012 The HIPAAsuite Claim Payment Master 7 1 3 Registering EDI Exchange EDI Exchange is licensed separately from the host application HIPAA Claim Master for example The reason is that EDI Exchange will work on all HIPAAsuite Products that are installed on your particular computer For example if you have HIPAA Claim Master and HIPAA Enrollment Master licensed only one license of EDI Exchange is needed and the module will work across two products When you first install a HIPAAsuite product of your choice a 15 day EDI Exchange trial is included Once the trial expires EDI Exchange loses its functionality The menu items under EDI Exchange become disabled except the last ones that allow you to license and enable the product PAA Mester 3261 B A File Forms View Search Claim Entry Edit DataBase Code Sets Logs Image Setup EDI Exchange e Check EDI File Trading Partne
54. time period 4 The log will be displayed in form of a tree EDI Log Displayed log 5 You can open the folder icons and see details related to each file 2012 EDI Exchange 16 7 6 6 2012 EDI Licey Query EH 1902990005 claim missing DTPOS6 ed Trans Type 837 Trading Partner PLEASE FILL THIS RECORD Compliance Check Date 04 27 2012 Compliance Check Time 1 30 PM Result Waming in Line 16 gt DESCRIPTION Missing mandatory segment in EDI fle Segment PAT is expects Waning in Line 21 gt CLM A37YH556 3025 00 13 A 1 at Postion 6 DESCRIPTION No data in mand Waming in Line 21 gt CLM A37YH556 3025 0077713 A 1 at Position 8 DESCRIPTION No data in mand Warring in Line 21 gt CLM A37YH556 3025 00 13 A 1 at Postion 9 DESCRIPTION Ma data in mand Warming in Line 21 gt CLM A371H556 3025 007713 A 1 at Postion 18 DESCRIP TION Mo data in man Warming in Line 25 gt HBK 784027 at Position 2 st SubElement 2 DESCRIPTION No data in mand Waming in Line 28 gt NM1 71 177XX 1285740290 at Postion 3 DESCRIPTION No data in mandate Waming in Line 29 gt 1285740290 at Position 3 DESCRIPTION No data in mandate Warming in Line 29 NM1 7271 XX 1285740290 a Postion 4 DESCRIPTION No data in mandate Warming in Line 37 gt Group 98910 at Position 9 DESCRIPTION Value 98910 not f Warring in Line 37 gt SBA P Gau
55. your files are HIPAA compliant EDI Exchange can run a compliance check on outgoing EDI files For incoming files you can specify an acceptable error level These settings are especially important with new trading partner relationships or with new processes since it always takes a while until an EDI process runs without issues and problems Follow the instructions below 1 Select EDI Exchange Setup under the EDI Exchange menu item Check EDI File Trading Partners Inbox Manager FTP Client SEF Files EDI Exchange Setup Encryption Setup Create EDI Exchange Tables Create 999 Files Tables Autoprocess Setup Automatic Scheduler EDI Receive Log EDI Send Log Request EDI Exchange License EDI Exchange License Information TL i rf gt q A The EDI Exchange Setup menu item 2 The following window will appear 2012 EDI Exchange EDI Exchange Directory Setup Root Directory Path SMTP Server _ Sender s email address Send email notice of newly arrived Files rN User Name Recipients SMTP server requires Logon Connectto the SMTP server via the SSL protocol Use Port Validate outgoing files Reject Incoming Files with more errors than set Count below Halt records if EDI compliance m warnings are found EDI Files with Other Type in Inbox DI Exchange is NOT ve 8 9
56. 013 at 3 58 PM 2 Files processed Activity Log and Warnings information 7 6 5 Accessing EDI Receive Log EDI Exchange has a file log Each processed file creates an entry the Trans rog table You can access the EDI Log window to query this table and see what files came in and how they were processed You can access the EDI Receive Log once the application has been initialized Follow the instructions below 1 To open the EDI Log window select EDI Receive Log under the EDI Exchange menu item 2012 2012 The menu for the FDI Receive Log Check EDI File Trading Partners Inbox Manager FTP Client SEF Files EDI Exchange Setup Encryption Setup Create EDI Exchange Tables Create 999 Files Tables Autoprocess Setup Automatic Scheduler EDI Recerve Log EDI Send Log Request EDI Exchange License EDI Exchange License Information EDI Exchange 2 To display data specify the time period and select trading partner e Time Period Period of time when the file was processed Choose one of the available options e Receive Date e Load Date e Trading Partner Name You can select your trading partner from the list If you select all your trading partners will be included 3 Click on the Find Log Files button to see the list of log files corresponding to your query 168 The HIPAAsuite Claim Payment Master EDI Log Specifying the
57. 08 nur Payor Initiated Reductions B5 Payment adjusted because coverage program guidelines were not met or were exceeded Senice Date ULL NNNM The display of the Remittance advice for a single claim you can see that the information resembles the paper EOBs EOP s that were traditionally sent by mail The HIPAA Claim Payment Master translates the code sets and orders the information so that you can see exactly what payments were made and which deductions taken Summary information is displayed upfront and each claim listed with the adjudication information and service line information structured with all the details found in the EDI file Read more in Identifying the Informationl 12 2012 4 The HIPAAsuite Claim Payment Master 2 2 1 Getting Started Starting the Application Once the HIPAA Claim Payment Master is installed you can launch it from the Start menu Start Programs All Programs HIPAASuite HIPAA Claim Payment Master HIPAA Claim Payment Master Manual for HIPAA Claim Payment Master HIPAA Authorizer HIPAA Claim Master HIPAA Comm Center p Eligibility Responder 1 HIPAA Premium Payment Master HIPAACIimStabusResponder HIPAS Sune di Payment z The HIPAA Claim Payment Master is launched from the Start menu The following screen will appear 2012 Getting Started 5 HIPAA Claim Payment Master 64bit File Vi
58. 10 2 DEFAULT NULL ServiceDateFram date DEF SULT HULL SenaceDateTo DEFAULT MULL UNIQUE KEY ID ENMGINEzInnioDB AUTO _INCREMENT 4 DEFAULT CHARSET 1818 The Create Image Index Table window with the MySQL Generic option selected 5 Click on the Execute Script button The Execute Script button Then you will receive a notification like this Click OK The success message 6 Then click Save Example 2012 Creating Image Files and PDFs 53 You can use the following MySQL SQL script CREATE TABLE edi 835imageindex ID bigint 20 NOT NULL AUTO INCREMENT EDIFilename varchar 100 DEFAULT NULL ImageFilename varchar 100 DEFAULT NULL ClaimNo varchar 35 DEFAULT NULL TradingPartnerID char 15 DEFAULT NULL PayDate date DEFAULT NULL PayorID varchar 25 DEFAULT NULL PayorName varchar 60 DEFAULT NULL varchar 25 DEFAULT NULL PayeeLast varchar 60 DEFAULT NULL SubscriberID varchar 15 DEFAULT NULL SubscriberLast varchar 60 DEFAULT NULL SubscriberFirst varchar 35 DEFAULT NULL PatientID varchar 15 DEFAULT NULL PatientLast varchar 60 DEFAULT NULL PatientFirst varchar 35 DEFAULT NULL AmountCharged decimal 10 2 DEFAULT NULL AmountPaid decimal 10 2 DEFAULT NULL ServiceDateFrom date DEFAULT NULL ServiceDateTo date DEFAULT NULL UNIQUE KEY ID ENGINE InnoDB AUTO INCREMENT 4 DEFAULT CHARSE
59. 15 To 8 5 2015 Trading Partner Name 2012 EDI Exchange 3 To display the log data select the time period and a trading partner e Time Period Period of time when the file was processed Choose one of the available options e Receive Date e Load Date e Trading Partner Name Select a trading partner in the list If you select All all trading partners will be included 4 Click on the Find Log Files button to display the list of log files corresponding to your query 7 6 7 Listing SEF Files SEF Standards Exchange Format files are repositories of standards information that define the format of EDI documents SEF files are the basis for the compliance check engine that EDI Exchange uses These files contain all rules of the implementation guide of a transaction There is a SEF file for each transaction that EDI Exchange is licensed for For example for 837 transactions we have SEF files for institutional professional and dental claims in 4010 4010A1 and 5010A1 version and the 997 and 999 transactions 1 To access the list of available SEF Files select SEF Files under the EDI Exchange menu 2012 172 The HIPAAsuite Claim Payment Master EDI Exchange Check EDI File Trading Partners Inbox Manager FTP Client EDI Exchange Setup Encryption Setup Create EDI Exchange Tables Create 999 Files Tables Autoprocess Setup Automatic Scheduler EDI Receive Log EDI Send Log Req
60. 3157D02D23E12DB8CAD3ABCB322B338DAA Ownertrust unknown Stored on this computer Photo Actions At the moment Kleopatra does not support photos Trust Certifications made by this Certificate in certificates It has no support for adding nor for displaying them This is for the following reasons Photos give a false sense of security Photos increase the size of certificates Certificate details with Kleopatra 2012 16 The HIPAAsuite Claim Payment Master 7 6 7 6 1 Using EDI Exchange Features Accessing Inbox Manager Using the Inbox Manager you can access the most important functions of EDI Exchange Inbox Manager allows you to download EDI files into the Inbox folder and process these files This screen handles the post processing of the EDI files their compliance check and auto processing options 1 To access the Inbox Manager click the Inbox Manager under the EDI Exchange menu EDIExchange Help Check EDI File Trading Partners Inbox Manager FTP Client SEF Files EDI Exchange Setup Encryption Setup Create EDI Exchange Tables Create 999 Files Tables Autoprocess Setup Automatic Scheduler EDI Receive Log EDI Send Log Request EDI Exchange License EDI Exchange License Information The Inbox Manager menu item 2 The following screen will come up 2012 7 6 2 2012 EDI Exchange Check EDI File Loading EDI Files into Inbox Processi
61. 8 6 2013 6 12 Application 316 Js id EB psftp exe 8 6 20136 12PM_ Application 328 KB EP putty chm 8 6 2013 6 12PM Compiled HTML 438 KE wd putty cnt 8 6 2013 6 12PM CNT File 32 KB Orca putty exe 8 6 2013 6 12 Application 484 KB putty hlp 8 6 2013 6 12PM Help file 644 KB gt puly puttygen exe 8 6 2013 6 12 PM Application 180 KB 2 README bt 1 23 20071238 PM Text Document 2 KB D his a unins000 dat 12 30 2013 12 30 Media file d 4 KB Realtek d unins000 exe 12 30 2013 12 30 Application 705 KB website 11 16 2004 1114 Internet Shortcut 1 n Samsung The programs and files that come with putty One of the programs is puttygen exe This program creates the necessary keys When you start it up you can generate a key pair 152 The HIPAAsuite Claim Payment Master PuITY Key Generator File Key Conversions Help Key Public key for pasting into OpenSSH authorized keys file ssh 4sa P AAAAB3NzaC Tyc2EAAAABJGAAAGEAgl3 Ln BGIKMGJtEOFPSysh5CPhle TINENzoDH E u3 TuL5cearzV a DrIr2Tvg3ub XC InJ8DLpaDcricAkd UJx4VCtp T RXmnfa Xs WTV3BasaRgwt 5kRv OHm gqhu aGrMRVPjnzrkKbSCFp VeP2i WhRHTa256ubXmX5E HGtgb5uhi KOIklJJFHG6 Key fingerprint ssh sa 63 8e 37 48 93 90 02 33 39 2h la b 1 00 12 cd a3 Key comment rea key 20131230 Key passphrase passphrase Actions
62. 800002 X 004010X091 3 ST 835 229800002 BPR C 175 00 C CHK eeeeeneeee 0020518 5 TRN 1 16588 1521685100 6 DTM 405 20020509 7 NT PR Great Benefit Plan 8 37100 MAIN STREET 9 NA KANSAS CITY MO 64108 10 MARCUS J WELB Y FI 097654322 N3 55 HIGH STREET HA SEATTLE WA S5123 CLP 014268085256 2 115 0 85 8 13 082892421 15 NMI QC T redascted redacted MI redacted 16 NMT IL 1 redacted redacted MI redacted 7 HMT1 82 2 redacted F l redacted 18 REF 1L 0508042 104 19 SVC AD D0140 LIMITED EVALUATION 67 0 20 DTM 472 20080828 21 CAS PR 22 48 8 27 CAS CO 42 18 2 231 24 DTM 472 200808287 25 CAS PR 22 21 2 CAS CO 42 4 87 The EDI Editor window 2012 Configuring the Application To Cut Copy Paste When you right click anywhere in the text a context menu will appear with typical test edit options such as cut copy and paste File 83512 edi Help 1 En 123455 2 GS HP 9998887766 987654 20021026 1135 2293800 3 ST 835 229800002 4 BPR C 175 00 C CHK me 700205187 5 TRN 1 16588 1521685100 5 DIM 405 20020509 7 NT PR Great Benefit Plan 8 N3 100 MAIN STREET N4 KANSAS 641087 el 13 LX 1 14 CLP 01426808626 2 15 NMI QC T redacted 116 NMT IL 1 redacted 17 NMI 82 2 redacted 18 REF 1L 0508042104 19 SVC AD DOT40 LI 120 DTM 472 20080828 21 C
63. AS PR 22 48 8 Find 22 CAS CO 42 18 2 Replace Context menu JATION 67 0 To Find and Replace The Find and Replace utilities work as in a common text editor To use them right click somewhere in the document and then from the displayed context menu select the Find or Replace command Alternatively you can press Ctrl F simultaneously on your keyboard to bring the text search utility The Find pop up Pressing Ctrl H simultaneously will bring up the Replace utility 2012 The HIPAAsuite Claim Payment Master 3 9 Te ff Rehcewak 1 Match case mes The Replace popup To Save the Changes As long as you dont save there will be no changes to the file If you make changes to the file the Save button becomes enabled and you can save any changes The HIPAA Claim Master will further work with those changed files so you dont have to open the file again Notice Changing EDI files can be a tricky undertaking You should be experienced in the format of the 835 and understand that an 835 claim file could be a legal document that should not be altered without the consent of the originator HE File 63512 edi E 5 Help 1 ISA UOU gg AE 123456 893 20 610442 020518 1601 U 00401 229500002 0 B 2 GS HP 83998887766 987654 20021026 1135 223800002 X 004010091 51 835 229800002 4 BPR C 175 00 C CHK 20020518 The Save button Usin
64. Code 5503 Trading Partner Assigned ID 5 Click on Save The Save button 6 The newly added Trading Partner s name will appear in the right pane Trading Partner Options The company information of a trading partner can be specified on the top of the form 2012 HIPAAsuite Claim Payment Master Trading Partners Name and Type Required Address City State zip EDI File Exchange Method Status Email Addresses to send process results Type Top area of the Trading Partners window Name and Type e Name Trading partners company name Required field e Address Trading partners company address e City e State e Zip e Status Trading partner s status Choose one of the available options e Inactive No upload into a database system through ODBC will be done e Test Only All outgoing EDI messages will be stamped with Test ISA 15 Records will only be exported to the test environment e Approved All outgoing EDI messages will be stamped with Production ISA 15 Records will be exported to the Live system with ODBC e Type There are five types of trading partners select the necessary one e Providers Hospitals doctors or other health care providers e VANs Value Added Networks like clearing houses or EDI Networks e Service bureaus Third party entities such as repricing organizations e Sponsors Entities that sponsor the benefit
65. Contact Tab stores contact information for your selected Trading Partner 2012 wo The HIPAAsuite Claim Payment Master EDI Identifiers Options RemoteFTP Contact Encryption Folders CORE Contact Information Contact Name Communication Number Numbers 12345657 11111111 Local Access for and HIPAAsuite Web User Name Registered Users Password The Contact tab Contact Information Enter the name and the number into the corresponding fields and select the communication type from the drop down list e Contact Name e Communication Numbers Valid Communication number qualifiers are e TE Stands for Telephone e FX Stands for Fax e EX Stands for Extension e EM Stands for email Click the button and the contact will appear in the Communication Numbers table Note The information that you fill in goes also into EDI files in the PER segment Local Access for FTP and HIPAAsuite Web To register a user enter the user name and the password into the corresponding fields and click the Add button The user will appear in the Registered Users table e User Name e Password 2012 EDI Exchange Registered Users Encryption Tab EDI Exchange supports PKI encryption Encryption keys are defined by the email address of the owner Both supported products PGP and GnuGP use this logic Read more in Using E
66. EDI Root directory 4 Query The query to be used to build the EDI file 5 Trading Partner The trading partner to be used to build the ISA and GS segments If this argument is left blank the last Trading Partner used to build an EDI file in Creating 834 EDI Files from the Attached Databasel 17 will be used Example of creating an EDI file from a database query Files HIPAAsuite HIPAA Claim Payment Master gt HIPAACLaimPaymentMaster e xe EDI QE D EDI 834TEST edi SELECT FROM edi_claimpayment TESTTRADINGPARTMER EDI file creation command specifying records with a query The above example has e EDI as the first argument flagging this command as a file creation command e The second argument is meaning that an EDI file is to be created using the results from a SQL query e Argument 3 is the filename for the resulting file Since 15 fully qualified path the file is not written to the EDI Root directory and instead uses the specified path e The fourth argument is the query whose results will be used to create the file e The fifth argument is the receiving Trading Partner and will result in an EDI file named 834TEST edi in D EDI containing the results of database query SELECT FROM edi claimpayment The following is the log entry created by this command 2012 6 4 2012 Autoprocessing Command line arguments EDI QE D EDNS3ATEST edi
67. Federal ID Provider Name JOHN WELBY 987121234 Provider information Claim identifier 985019 Status Processed as Primary DRG Code Total Charge Amt 305 00 Facility Office Control 229800001 Payment Amt 175 00 Frequency ORG Weight PatientRespAmt 15 00 Filling Provider Organization Discharge Fraction The claim level information Recelved 05 04 2002 Claim Line Adjudication Pala S608 Bund 5500 The claim line adjudication Bence Date 221 Fani Bd m 5 Paid Unt AdjustmentResson Group WiusmenRemen 22 av Payor Initiated Reductions B5 Payment adjusted because coverage program guidelines were not 115 00 oova TO 835 transaction information structure Further you can see more screen shots of electronic remittance advices Claimidentfier F0801300095 Status Reversal of Previous Payment DRG Code 872 Total Charge Arnt 9 959 50 Facility Contro 20802400235502 Payment Ami 8 042 91 Frequency Void Cancel of Prior Claim DRG Weight 1 3783 Patient Resp Amt Filling Medicare Part A Discharge Fraction 851 Medical Record ID 0000802659 Receved 1 24 2008 j 1 13 2008 Statement End Coverage Amount 9 959 50 Covered Actual 3 The claim level information with 1 REF segment 3 DTP segments 1 AMT segment and 1 QTY segment Med
68. Follow the instructions below 1 Select EDI Exchange Setup under the EDI Exchange menu item 2012 EDI Exchange 115 Check EDI File Trading Partners Inbox Manager FTP Client SEF Files EDI Exchange Setup Encryption Setup Create EDI Exchange Tables Create 999 Files Tables Autoprocess Setup Automatic Scheduler EDI Receive Log EDI Send Log Request EDI Exchange License EDI Exchange License Information La E The EDI Exchange Setup menu item 2 The following window will appear EDI Exchange Directory Root Directory Path SMTP Server Senders email address C Send email notice of newly arrived Files User Name Password Recipients SMTP serverrequires Logon Connectto the SMTP server via the SSL protocol Use Port Validate outgoing files Reject Incoming Files with more errors than set Count below Halt records if EDI compliance warnings found EDI Ales with Other Type in Inbox EDI Exchange is NOT yet initialized Leave file for other program Auto process if other program is available The EDI Exchange Setup window Note The icon in the lower left corner indicating that EDI Exchange has not been initialized yet 3 After setting the root directory see the previous step Defining Communications 2012 e The HIPAAsuite Claim Payment Master Directoryl 2l you can init
69. H STREET NA SEATTLE WA 98123 x CLP 385019 1 305 00 1 7 5 00 15 00 12 273800001 11 HMI QC 1 DOE JOHN PMI 11122333301 NM1 82 7 WELBY JOHN FI 387121234 DTM 050 20020504 SVC HC 99244 75 00 60 00 DTM 472 20020501 A ye PR 00 V LL amm au mu PI mu ee L a a P P The beginning of an 835 EDI file The above is an example of an 835 file One can easily see bits of information but a lot of it is translated into codes that are not intelligible Most often EDI files have no carriage returns so that the information looks even more confusing 2012 Introduction 3 Explanation of Payment Payer Great Benefit Plan DR MARCUS J WELEHY 100 MAIN STREET 55 HiGH STREET KANSAS CITY MO 64108 SEATTLE WA 98123 Fay Method Check Bank 10 Account Account Chk IssJEFT Date 05 18 2002 Total Amt Payer ID CheckEFT 16588 Sm Claim 1 Y Patient Name JOHN P DOE Member ID Number Provider JOHN WELBY Federal ID 987121234 Claim Identifier 985019 Slatus Processed as Primary DRG Code Total Charge Amt Facil Office Control 229800001 Payment Amt Frequency DRG Weight Patient Resp Amt Filling Provider Organization Discharge Fraction Received 04 05 2002 Claim Line Adjudication ohare YB agushenResonGrp wjsmenRemwn Patent Responsibility re Senica Date Proc 81
70. HIPAA Claim Payment Mast File view DataExport Dutput Mode Printer Screen mage File Data Import The Run buttons 6 When you click on the Run button the file will be parsed and the information displayed The HIPAA Claim Payment Master recognizes the type of the EDI transaction and displays Payment Advice and Claim Status information separately The following pertains to the X12 835 Electronic Payment Advice As in our example the output mode is Screen the claim is displayed in a separate window 2012 Getting Started 9 Print Close 1 1 Hep Explanation of Payment DR J WELET 100 MAIN STREET 55 HiGH STREET KANSAS CITY MO 64108 SEATTLE WA 981273 Pay Method Check Bank ID Account Account E Chk Iss JEFT Date wasii Total Amt 175 00 Payer IL Checker T 18588 Patent Name redacted redacted Member ID Number redacted insured Name nedacted redacted Member ID Nurnber react ad ProwiderName redacted Federal redacted Claim fenier 014 Pani iii iei Stslus Processed as Secondary DRG Code Total Charge Amt 115 00 F acili Control U8231972421 Paymanit Amt 0 00 Frequency DRG Weight Patient Resp Amt 845 80 Filling Poin of Servite Discharge Frattion Claim Line Adjudication 1 Proc AD D0140 Change 67 100 Pad Units Burdi AmusineniResson Group Adjustment Reason Patient Pies porsibility 22 Payer adjusted
71. NULL Outbox varcharl bO NULL E Jc Cn 4 3 Select the database type you use for your host HIPAA application e Database e Microsoft SQL Server SQL Server 2008 and above e MySQL Note In case your database is not listed modify the scripts or ask your database administrator to make the necessary modifications 4 The following tables are part of EDI Exchange e TradingPartner SQL statements to create the TradingPartner table in your database This table contains information about trading partners e Trans Log SQL statements to create the TRANS LOG table in your database This table contains incoming file information keeps track of all EDI files that you receive and the compliance check report e Trans Log Errors SQL statements to create the TRANS LOG ERRORS table in 2012 EDI Exchange your database This table collects the results of the compliance check and keeps track of all sent files e Send Log SQL statements to create the SEND LOG table in your database The table contains information about EDI files created and sent to trading partners Company Setup SQL statements to create the COMPANY SETUP table in your database This table collects information about you the sender of EDI information 5 You can modify the scripts so that they run on your specific database Once you have you modified the script click Save
72. Name Eamus PaidAmount PlaniD E e UnitsPaid PayerAddressi FoticniResponsibiity UnitsCharged PayerAddress2 ServiceDate PayerCity a ProviderControINo PayerState acilityTypeCode AuthNo PayerZip iau AttachmentCode PayeriDNumber sisi LocationNumber SubmitterID depre ee PriorAuthNo HIN RepricedClaimNum Tax OrigRefNo PayerContact RemarkCodes x ReceivedDate The Database Schema to Electronic Remittance Advice 835 window This window shows how the tables are inter related Selecting Fields to Export Once you have created your tables and tested connection and table names you can select which fields to export Follow the instructions below 1 Select Data Export 835 Connection and Data Fields in the main menu HIPAA Claim Payment Master 64bit 635 Payments and Paid 835 Table Creation 635 Database Schema Create 835 EDI Files The 835 Connection and Data Fields menu 2 You will be confronted with the following screen where you can set up the database The HIPAAsuite Claim Payment Master connection and enter the names of the database tables HE Database and Field Setup M HIPAA Provider Printer Extract Capabilities Fields to be exported The HIPAA Provider Printer natively treats a Payment parent advice record as single Object The Fie Level Data HIPAA Provider Printer extracts the complete Tradin
73. Once connected the content of the folder on the server is displayed On the right 2012 148 The HIPAAsuite Claim Payment Master side you can browse your local PC 5 To upload a file to the server select the file on your local PC and click on the Put button FTP Client 26 Da put 834 09 test test E readme The file will appear in the remote folder You will receive the File filename successfully uploaded message on the bottom status bar of the FTP client Remote Serer Local DAEDMnbox C My Computer C3 C zc 5 BIN 6 download file from the server select file in the left side and then click on the Get button Client User Password Directo lexample gmailcom leagail ee sy FIP Secure FTP C SFTP gc SRECYCLE BIN C dvd The file will appear in the local folder You will receive the File filename successfully 2012 EDI Exchange ws 7 4 3 2012 downloaded message the bottom status bar of the FTP client SRECYCLE BIN dvd EC EDI EncryptedFiles amp Inbox C3 Outbox 1 ProcessedFiles C3 SuspendedFies Galery File test edi successfully downloaded Creating a Trading Partner Automatically When you process file with EDI Exchange the sender s ID is compared to the trading partners on
74. Provider Level Adj Tip You can modify the scripts so that they run on your specific database On each tab click Save The Save button On each tab click Execute Script to create the corresponding table in the database The Execute Script button Once the table has been created successfully you will see the following notification The success message The following screen shots displays MySQL script to create tables 2012 ClaimLevel Adj ClaimLines Claim Line Provider Level Adj CREATE TABLE edi claim k C dO DO v 12 13 14 15 16 d 9 MJ c2 tad MN payment bigint 20 NOT NULL AUTO File Level Data TradingPartnerlD varchar 15 DEFAULT NULL EDIFileName varchar 100 DEFAULT NULL FileDate date DEFAULT NULL FileTime time DEFAULT NULL LoadDate date DEFAULT NULL LaoadTime time DEFAULT NULL l FinancialData BPR Segment TransactionHandlingCode char 1 DEFAULT NULL PaymentAmount varchar 12 DEFAULT NULL DebitCredit char 1 DEFAULT NULL PaymentMethod char 3 DEFAULT NULL PaymentFormat varchar 10 DEFAULT NULL SendingBankNoQual char 2 DEFAULT NULL SendingBankNo varchar 15 DEFAULT NULL SenderAccountNo varchar 25 DEFAULT NULL PayeriD 50 DEFAULT NULL PayerDivision varchar 25 DEFAULT NULL HeceivingBankNoQual char 2 DEFAULT N
75. S SSL aware FTP clients implicit FTPS was expected to listen on the IANA Well Known Port 990 TCP for the FTPS control channel and 989 TCP for the FTPS data channel This allowed administrators to retain legacy compatible services on the original 21 TCP FTP 2012 EDI Exchange 139 control channel e SFTP also known as over SSH is deemed the most secure form of uses encryption certificates There are 3 different ways to authenticate a SFTP connection With user name and password just like a regular FTP connection User name and a certificate User name certificate and password Remote Connection and Directories You need the FTP address the user name and password to establish the connection and the directory information where files are picked up and where dropped off Fill in the following fields e FTP Address This is usually the IP address of the server e User Name Password e Put Directory This is the directory where you drop off files e Get Directory This is the directory where you download files from It is possible that a trading partner has two FTP servers one for put and another one for get If so check Different Download Server and additional fields will become visible so you can specify the those connection parameters After Download You have two choices Files on the server will be either deleted or moved to another folder of your choice Contact Tab The
76. SELECT FROM edi_claimpayment TESTTRADINGPARTNER Processing started at 11 10 2015 12 03 36 EDI creation started at 12 03 36 SQL Query SELECT FROM edi claimpayment Humber af found payments 2 Humber af found claims 2 Checking on compliance Transaction with check number 16568 Humber of payments 2 Humber of claims in payments 2 Processing ended at 12 03 37 File created DAXEDMS3ATEST edi Processing ended at 11 10 2015 12 03 37 PM Excerpt of HIPAA Claim Payment Master log Changing the Default Company The default company is the identity you assume as the sender when creating EDI files This affects the ISA GS and NM1 sender segments A single entity may have a need to act as multiple sender identities and so has a need to change the information in the EDI envelopes The default company can be changed using command line arguments affecting the 15 and GS sender ID segments Segment Sender Identifier HIPAASUITE Qualifier Z Mutually Defined Application Senders Code GS 2 HIPAASUITET Tax ID 9876543210 Sender ID segments in Company Setup To change the default company a single argument is needed Setcompany followed by the company ID of the company you wish to set setcompany lt ID gt The Companys ID in this case is not its EDI identifier but the value of the ID row in the COMPANY SETUP table It can also be found in the Company Setup window Current Company sis 11 4 1 TES
77. Schema To access the database schema select the Data Export 835 Database Schema in main menu HIPAA Claim Payment Master 64bit 835 Connection and Data Fields 835 Payments and Paid Claims 835 5 Table Creation Create 835 EDI Files 2012 9 5 2012 The 835 Database Schema menu You will see the following window 1 1 Database Schema for Electronic Remittance Advice 35 edi providerleveladjustments ID edi claimpayment Faymentip TE ee ProviderlD f in edi_claimleveladjustments TradingPartnerlD FiscalPeriodDate AdjustmentReason ID EDIFileName E Filedate Adjustmentidentifier ClaimID jus Adjustmentore TransactionHandlingCode t m t nce eae ae Adjustment amp mount edi paidclaimlinead PaymentMethod Pn Yo SendingBankNo ID 2 LineID SenderAccountNo 2 FaymentiO AdjustmentGroup 0 1 ProviderlD edi paidclaimlines AdjustmentReason PayerDivision v ID Adjustment mount ReceivingBankNo FiscalPeriodDate ClaimID AdjustmentQty ReceiverAccountMo ClaimCount ProcedureCade Effectivedate RevenueCode CheckNumber icum AdjProcedureCode Productiondate derit ChargedAmount Payer
78. T Number 7 Production Diate E FA Payer Information 2 bye Payer ID Parcs Payertddress 1 5 ProviderlD 7 PayerAddress 2 v FiscalPeriodDate PayerState Payer D Number Ez ClaimlD Key of Claim Table E AdustmentGroup Fields that caused problems are unchecked now and excluded from export Now you can test the configuration again You should get the success message The success message Only after the configuration checks out are you allowed to save it Click on the Save Field Configuration button 5 6 Browsing Exported Data The HIPAA Claim Payment Master can take the records in the database to which it exports and reassembles the information so that it can be viewed just like the images 2012 Using the Database from the EDI file Select the Data Export 835 Payments and Paid Claims in the main menu HIPAA Claim Payment Master 835 Table Creation Creabe 835 EDI Files The 835 Payments and Paid Claims menu You will see the following screen When you click on a payment on the left the claims associated with this payment get loaded on the right side smalswam 517500 175 00 175 00 vam 175 00 The 835 Payments and Paid Claims window Double clicking on a claim will load this claim in a preview window 2012 The HIPAAsuite Claim Payment Master 5 7 HIPAA Pre
79. T utf8 Tip Make sure you use a correct symbol not in the script Tip If you encounter errors running the script on MySQL or other database systems then modify it until it works or consult with your database administrator to make the modifications SQL Scripts share over all platforms a lot of syntax but still each flavor demands its own adjustments 5 Using the Database 5 1 Exporting the Data The HIPAA Claim Payment Master can export the data contained in a 835 Payment Advice to any ODBC aware database such as Microsoft SQL Server Oracle AS400 etc The structure of the 835 transaction is quite nested and in order to truly export the data in a 2012 8 The HIPAAsuite Claim Payment Master normalized manner it is necessary to create 6 different tables with the following relationships edi claimpayment TradingPartnerID EDIFileName Filedate TransactionHandlingCode PaymentAmount DebitCredit PaymentMethod SendingBankha Sender amp ccountHao PayerID PayerDivision ReceivingBankNo Receiver amp ccountHo Etfectivedate CheckNumber Productiondate PayerHame PlanID PayerAddress1 PayerAddress2 Payercity PayerState PayerZip PayerlDNumber SubmitterID HIN PayerContact edi_providerleveladjustments ID PaymentID ProviderID FiscalPeriodDate AdjustmentReason Adjustmentidentifier Adjustment amp mount edi paidelaims Vw 2 PaymentiD ProviderlD FacilityTyp
80. TRESPONDER 2 HIPAASUITE1 3 HIPAASUITE2 Add company Default company Company selection in Company Setup The HIPAAsuite Claim Payment Master 6 5 Example The command argument setcompany 3 PERS MUI TUB Files HIPAAsuite HIPAA Claim Payment Master gt HIPAACLaimPaymentMaster e xe setcompany 3 will set the default company to ID 3 which is HIPAASUITE2 in the example picture above The log entry for this command will be Set default company with ID 3 Company 3 is set as a default company Excerpt from log Default company changed Running the Application via Scheduler The HIPAA Claim Payment Master can be automated through a scheduler A scheduler is software that can be programmed to execute a certain task at a certain time repeatedly Windows has such a scheduler built in The Windows scheduler can be used to let the HIPAA Claim Payment Master execute in regular intervals without user intervention Usually one would let the HIPAA Claim Payment Master scan a directory and then print create image files or export the data and remove the files to prevent duplicate processing Note Please consult Windows help files for further information on setting up the scheduler 1 If the task scheduler is installed on your system you will find it in the Control Panel To open Scheduled Tasks click Start Control Panel Scheduled Tasks Note In different Windows versions the w
81. Telephone e Ext e Fax e E mail ISA 14 and 15 e EDI files will be ISA element 14 determines if the resultant file contains test or production data e test production e Acknowledgement TA1 req ISA element 15 indicates whether you want a TA1 acknowledgement for files that you send out 8 2 Creating Company Setup Table You can create the Company Setup Table by following the steps below in the HIPAA Claim Payment Master 1 To configure the program options select Setup Create Company Setup Table in the main menu HIPAA Claim Payment Master 64bit View Data Export Code Sets Image Setup JEDI Exchange A Company Sebup Create Company Setup Table Dutput Mode The Create Company Setup Table menu 2 The following screen will appear 2012 2012 Creating 835 EDI Files 177 Create Table Mi Database Microsoft SOL Sever MySQL Generic Company Setup Table script 1 iii TABLE 960 SETUP ID bigint IDENTITY 1 1 NOT NULL varchar 60 NULL Address va NULL 5 Address2 varchar b5 NULL 5 City varchar 30 NULL State char Z NULL Zip char 5b NULL Zip 4 char 4 NULL varchar 15 NULL SenderlDGualifier char 2 NULL EdiMo varchar 15 NULL EIN varchar 60 NULL FilelD char 3 NULL Contact varchar 80 NULL
82. These options are important for the hand over from EDI Exchange to the other HIPAAsuite program that hosts EDI Exchange Follow the instructions below to specify the Auto Process Options 1 Select EDI Exchange Autoprocess Setup in the main menu EDI Exchange Check EDI File Trading Partners B Inbox Manager FTP Client SEF Files EDI Exchange Setup Encryption Setup Create EDI Exchange Tables Create 999 Files Tables Autoprocess Setup Automatic Scheduler EDI Receive Log EDI Send Log Request EDI Exchange License EDI Exchange License Information 2012 EDI Exchange 111 The Autoprocess Setup menu item 2 The following screen will appear if the host HIPAA application is Enrollment Master Automatic Processing Options Get Alles from Trading Partners Check FTP servers for new files and place them into Inbox Default Automatic Processing Options E Export in Database Print Saveto Excel ASCII Save Defining the Auto Processing Options 3 The following options can be specified Check Path Options e Check FTP servers for new files If checked EDI Exchange automatically looks for new files for all trading partners that have FTP connection set up Then the program gets all the waiting files and puts them into the Inbox In the second step it goes through every file Default Automatic Processing Options e Export in Database If selected the module exp
83. ULL ReceivingBankNo varchar 15 DEFAULT NULL ReceiverAccauntNaQual char 3 DEFAULT NULL Save Execute The Payments tab The HIPAAsuite Claim Payment Master Create Tables C Microsoft SQL Server mysauceneric Claim LevelAdi Claim Lines Claim Line Adj Provider Level Adj CREATE TABLE edi paidclaims ID bigint 20 NOT NULL auto increment PaymentlD bigint 20 NOT NULL COMMENT Foreign Key l Statisics TS3 ProviderlD char 15 default NULL Facility Type char 3 default NULL FiscalPenodDate date default NULL ClaimCount int 6 default NULL PasitionlInSummary int 6 default NULL TotalCharges char 15 default NULL Claim Data ClaimiD varchar 20 default NULL ClaimPositionInFile int 6 default NULL ClaimStatus char 2Z default NULL ClaimAmount varchar 10 default NULL ClaimPaid varchar 10 default NULL PatientResponsibilitr char 10 default NULL InsuranceType char 2 default NULL PayersClaimlD varchar 50 default NULL FacilityTypeCode char 3 default NULL ClaimFrequency char 1 NULL DRGCode char 4 NULL DRGWeioht decimali 15 4 NULL Save Execute Script m CO CO SJ UM 4 LN 12 13 14 15 16 17 18 g 0 The Claims tab 2012 ES Create Tables f Microsoft SQL Server Mysauceneric 1 CREATE TABLE edi claimleveladj
84. a 2012 Configuring the Application 25 PaymentMethod PaymentMethod Number of records In codeset Close Help 5 Description Automated Clearing House Financial Institution Option Check Federal Reserve Funds Fayrnent Data The PaymentMethod code set configuration window 4 Click on the Save button to save the changes PaymentMethod PaymentMethod Number of records in codeset Help n Description Automated Clearing House Financial Institution Option Check Fe deral Reserve Funds Hon Payment Data The Save button 3 3 Accessing Logs The HIPAA Claim Payment Master can log its activities This is especially helpful when running the program automatically through the scheduler see Running the Application via Schedulerl 321 Notice To start logging the activity activate the Log All Processing Except Viewing option See Configuring Program Options 181 In case of any problem the first thing is checking the log where all actions and all error messages related to an EDI file are written down and saved Follow the instructions below to access the log files for your HIPAA Claim Payment Master 2012 The HIPAAsuite Claim Payment Master Click View Log in the main menu HIPAA Claim Payment Master amp 4bit ae 9 The Log menu Log files are s
85. ad from FTP Server button Inbox Manager Check EDI File Select and creck EDI Fite The Download from FTP Server button 2012 EDI Exchange 16 3 When the process has been finished the Activity Log and Warnings area displays the report Inbox Manager Check EDI File lige rere Processing inbox Select and Check EDI File Download from FTP Server Download from FTP Server Process Inbox Checking servers at 3 40 15PM 1 Trading Partners are set up for FTP transfer Checking for files at Trading Partner PARTNER T Successfully connected to PARTNER T s directory File test test edi deleted on server 1 Files moved from FTP Servers into Inbox CAProgramDats HIPAA suite HIPAA Enrollment W 1 Files moved from FIP Servers into Inbox Activity Log and Warnings information 7 6 4 Processing EDI Files EDI Exchange Inbox Manager allows you to process EDI files downloaded to the Inbox folder beforehand Note Once you have saved the auto processing options see Defining Auto Processing Options 110 the files will not only be analyzed but also processed according to the defined settings The auto processing enables you to combine and run multiple fulfillment steps together for example export saving printing 1 Once Downloading EDI Files From FTP Server is completed and no errors are displayed click on the Process Inbox button This will autop
86. and Licenses The Check for Updates menu item 2012 Back Cover
87. aving claims to image files Processed Files Since the HIPAA Claim Payment Master program can be launched by the Windows scheduler see Running the Application via Scheduler 32 it is important to either move or delete processed files so that they will not be picked up again You have the choice to either do nothing move the processed files to a specific folder or delete the files e Leave in Place Select this option to do nothing with processed files Note Not recommended e Move Select this option to move the processed files to a specified folder e Delete Select this option to delete the processed files Outbox Directory Path Specify the place where the result files images PDFs will be located 3 2 Selecting a Code Set EDI relies on transaction code sets A transaction code is a basic EDI message type The HIPAA Claim Payment Master translates HIPAA code sets into meaningful words a corresponding longer explanation or description For example facility code 25 means a Birthing Center gender code means Male At the onset of EDI one of the main design ideas was to make the EDI files as short as possible and to allow different languages to use the same descriptions by reducing long verbose explanations to 2 3 byte long codes Computer storage was incredibly expensive and making any file larger than it absolutely had to was considered wasteful The code sets are stored in the file coaesets xmi in the configura
88. ay to access the Task Scheduler can differ Consult your Windows version documentation 2012 Autoprocessing Scheduled Tasks EN 1 10 xj Je Control Panel CL My Documents My Network Places The Windows Task Scheduler 2 Click on Add Scheduled Task and the Scheduled Task Wizard will guide you through the setup process 3 In the first window read the welcome message and click Next Scheduled Task Wizard This wizard helps you schedule a task for Windows and then schedule amp for a convenient time The Scheduled Task Wizard window 4 Browse to the HIPAAClaimPaymentMaster exe executable file 2012 90 The HIPAAsuite Claim Payment Master Scheduled Task Wizard Click the program pou want Windows bo run To see more programs click Browse p Fie Manages 5 Wizard OPAC See Pro 25 W Address Book Adobe Bridge C53 LH Adobe Device Cental CS3 Adak Tall 7 The Scheduled Task Wizard window By default the application is located in c program Files HIPAAsuite HIPAA Claim Payment MasterMHIPAAClaimPaymentMaster exe Click Next 5 Type a name for this task Choose a time interval e Daily e Weekly e Monthly e One time only e When my computer starts e When log on Click Next 6 Enter the name and password of a
89. c database Once you have you modified the script click Save Tip Every database system has their own little syntax idiosyncrasies and the scripts might require tweaking You can edit the table scripts in this screen and save your modified scripts One example are date and time or money data types that do not exist in SQL Server 2005 You can just rename those types to datetime and save you script and it will run fine E marce cont hehe WEN Database Microsoft SQL Sever Oracle MySQL Generic ImplementationAck Table script CREATE TABLE ImplementationAck ID int IDENTITY NOT NULL FileName varchar 100 NULL SenderlD varchar 15 NULL SendTime AA NULL GroupControlNo varchar 8 NULL TransactionContralMo varchar 8 NULL FuncitionallD char 2 NULL OriginalGroupControlNo varchar 8 NULL Version varchar 12 NULL AckCode char 1 NULL IncludedTS int NULL ReceivedTS int NULL AcceptedT S int NULL ErrorCode1 char 3 NULL 2 char 3 NULL ErrorCode3 char 3 NULL ErrorCode4 char 3 NULL ErrorCode5 char 3 NULL PRIMARY KEY ID b d Compare Script with existing Table Save The Save button 6 For each script on every tab click Execute Script to create the corresponding table in the database 2012 The HIPAAsuite Claim Payment Master 2 Siete Database Microsoft SQL Sever Oracle MySQL Ge
90. char 00 DEFAULT MULL imager iename varchar 100 DEFAULT NULL Claimho 35 DEFAULT NULL TradingPartneriD char 15 DEFAULT NULL Pay Date date DEFAULT NULL 25 DEFAULT NULL varchar X60 DEFAULT NULL Payee 25 DEFAULT NULL lt varchar 0 DEFAULT NULL SubscriberiD varchar 15 DEFAULT NULL Subscriber ast varchar 60 DEFAULT NULL SubscriberFirst varchar 35 DEFAULT NULL PatientiD varchar 15 DEFAULT NULL PatientLast varchar 60 DEFAULT NULL PatientFirst varchar 35 DEFAULT NULL AmountCharged decimalk10 2 DEFAULT NULL A amp mountPaid decimal 30 21 DEFAULT NULL ServiceDateFrom date DEFAULT MULL ServiceDateTo date DEFAULT NULL Y The Create Image Index Table window 3 Select one of the necessary options e Microsoft SQL Server e MySQL Genetic 4 Then make sure the image index table script is correct 2012 Creating Image Files and PDFs 51 Create Image Index Table REATE TABLE dba fedi_83Simageinde f ID bigint IDENTITY 1 1 NOT NULL lenire varchar 100 DEFAULT MULL imager iename varchar ct 00 DEFAULT NULL ClaimMo varchar 35 DEFAULT NULL TradingPartneriD char 1 5 DEF AULT NULL PayDate date DEFAULT NULL ParvoriD 25 DEF AULT NULL varchar K60 DEFAULT NULL Pay
91. concerns Save as Copy to Clipboard Draw with mouse while pressing any key ELR PEPEE PANE 454 002072001 1 UN 00802 7 2212001 1 UN ee eee IL eL iis EUREN ERE NIRE NEN NIS 5 le aa uu mua a cw ucc NR D QU ee eee Gapa ee eg aaa adden 5 Then enter as much information into the Description field as possible 6 Now enter your email address so that we can get in contact with you 7 Indicate whether this is a new bug or a follow up on an existing issue 8 Then click on Send 9 Once the bug information has been submitted successfully you will receive a notification Click OK 10 Then you will get updates on the issue by email 9 2 Updating the Program By default the program checks for updates automatically When the new version is out you will see an update report on the Changes in Versions window It shows which changes have been made and displays all differences between your version and the current version To continue with update click Update 2012 184 The HIPAAsuite Claim Payment Master Changes in versions Version 2 2 4 1403 of HIPAACIaimPaymentMasterb4 is now available You are using 2 2 3 837 Do you want to download and install it Changes in versions i
92. cords stored in the attached database In general any record that has been imported by the HIPAA Claim Payment Master can be exported as EDI file Records that have been added through other processes outside of the HIPAA Claim Payment Master have to be vetted for completeness One way to do this is to create the records and let the HIPAA Claim Payment Tool generate the EDI file Now you can test the EDI file for compliance with a free tool such as Softshare s EDI Notepad or full fledged HIPAA compliance tools If you use the EDI Exchange module you can check outgoing EDI files on the fly and even withhold individual records that generate warning messages Follow the instructions below to create EDI files 1 Select Data Export Create 835 EDI Files in the main menu HIPAA Claim Payment Master 64bit File View Data Export Sets 835 Connection and Data Fields 2 Image Setup EDI Exchange 9 j i 2 The Create 835 Transaction Sets window will be displayed amp 35 Payments and Paid Claims 835 Table Creation 835 Database Schema pe Ccrestessseniries Screen The Create 835 EDI Files menu 2012 Creating 835 EDI Files 179 635 Transaction Sets eron Effective Date 4010 5010 1071 3 2013 Select Trading Partner Fields witht wall be populated by the process Exit Gol Writ
93. de GS 03 the application receiver code You can enter it into the corresponding field Most of the time it is not necessary Assigned ID Some trading partners like health insurance exchanges will give a plan an ID that is different from the ISA identifier defined in the Company Setup screen of the application Especially in the creation of filenames is this Assigned ID important Options Tab 2012 EDI Exchange EDI Identifiers Options Remote Contact Encryption Folders CORE Send EDI Acknowledgement 997 or 399 Send e mail with compliance check and process results Send e mail notification when receiving Files Send e mail notification when sending Files Reject Files with Compliance Errors EDI Exchange 1 Create a 27 CA for 837 Claims One ST SE loop per claim The Options Tab You can choose one of the following options e Send EDI Acknowledgment 997 or 999 This check box allows sending Functional Acknowledgment transactions to the Trading Partner e Send e mail with compliance check and process results This option allows sending the compliance check results back to your contact at the Trading Partner via email No PMI will be transmitted Adding an email address is important even when the Communication method is not Email e Send e mail notification when receiving files This option allows sending an acknowledgment email of EDI files This option is not necessary whe
94. dentifiers to send them EDI files or 999 acknowledgment send email notifications and compliance check results encryption keys and file transport mechanisms Once you have created the trading partner table see Creating Database Tables and initialized EDI Exchange see Initializing EDI Exchangel 4 you can set up the relationships with your trading partner Follow the instructions below 1 Select Trading Partners under the EDI Exchange menu 2012 EDI Exchange 131 Inbox Manager FTP Client SEF Files ED Exchange Setup Encryption Setup Create EDI Exchange Tables Create 999 Files Tables Autoprocess Setup Automatic Scheduler EDI Log EDI Send Log Request EDI Exchange License EDT Exchange License Information The Trading Partners menu item 2 The following screen will appear 2012 132 The HIPAAsuite Claim Payment Master Name and Type EDI Version 8 4010 5010 EDI Identifiers and Qualifier The Trading Partners window 3 Click the New button to start entering the trading partner information 4 Define the necessary options They are described further 2012 EDI Exchange 133 Name and Type Name Required Address City EDI File Exchange Method EDI Version i 4010 5010 ISA Identifier and Qualifier Record Key ETIN Number and Qualifier Application Sender Code 6502 46 Application Receiver
95. e FiscalPeriodDate ClaimCaount TotalCharges ClaimID Claimstatus Claim mount ClaimPaid PatientResponsiblity Insurancelype PayersClaimID FacilityTypeCode MIA Prior amp uthNum RepricedClaimHum MedicalRecordMHum OrigRefNo ReceivedDate The relationship of the tabes involved in the 835 transaction Y ID ClaimID AdjustmentGroup AdjustmentReason Adjustment mount AdjustmentQty edi_paidclaimlines Y ID ClaimlID ProcedureCode RevenueCode AdjProcedureCode ChargedAmount Paid amp maount UnitsPaid UnitsCharged ServiceDate ProviderControlNo AuthHa AttachmentCode LocationHumber FriorAuthHa Allowed amp Amount T x RemarkCodes edi claimleveladjustments edi paidclaimlinead V ID LinelD AdjustmentGroup AdjustmentReason Adjustment mount AdjustmentOty The data is written to the database once the Run button has been clicked and only if the Data Import checkbox is activated 2012 Using the Database 55 HIPAA Claim Payment Mast The Data Import check box The Processing Results window will display notification about data export ofthe cain 83511 edi ended at 3 13 2012 3 00 02 AM The Processing Results window The sequence of actions to setup the data export is the following e Setting up Database Connection 551 e Creating Tables 62 e Viewing the Database Schemal 7o e Selecting Fields to Exportl 71 Brows
96. e CommCode e DateQualifier e EntityCode F to P e FacilityTypes e Filing e Frequency e GenderCode e D e PaymentMethod e PlaceOfService toZ e Quantity Qualifier e RDMCode e REFCode e RemarkCodes e ServicelD e Status e lt 2012 HIPAAsuite Claim Payment Master The following screen shot illustrates how to select the PaymentMethod code set for display F HIPAA Claim Payment Master 64bit He Data Export Code Sets JImage Setup EDI Exchange Help Facility Types Qutput Mode Filing Pinter Frequency Gesner GenderCode C Image File PlaceOr Service The PaymentMethod sub menu 3 The Code Set configuration window will be displayed Double click the field to edit it and type in the new value Below you can see such window for PaymentMethod The window provides the following information e Number of records in codeset The total number of codes For example for PaymentMethod it is equal to 5 e Codes and their corresponding descriptions The codes are indicated in the source EDI files The descriptions are displayed instead of codes in the result easy to read files For example for PaymentMethod there are the following codes and corresponding descriptions e ACH Automated Clearing House e BOP Financial Institution Option e CHK Check e FWT Federal Reserve Funds e NON Non Payment Dat
97. e is an EDI file but has extra blocking characters in it You can instruct the HIPAA Claim Payment Master to remove them See Configuring Program Options 181 Creating Image Files and PDFs Creating Image Files from EDI The HIPAA Claim Payment Master displays the EDI document in a page that makes it easy to read the 835 transactions You can create image files containing the data that you see in Screen mode The following formats are supported TIFF PDF You can create image files manually or automatically using the command line arguments and Windows Scheduler Read more in e Running the Application via Scheduler 32 e Using Command Line Arguments 30 Before creating image files make sure all settings are defined correctly Read more in e Doing Image Setupl 40 Adjusting Image Options 42 Configuring Image Index 44 e Creating the Image Index Tablel 44 2012 Creating Image Files and PDFs 39 Follow the instructions below to create an image file from EDI file Notice The image file will be created based on the pre defined settings Read more in Doing Image Setup 40 Adjusting Image Options 421 Configuring Image Index 44 1 Open an EDI file or directory containing the EDI files in the HIPAA Claim Payment Master Read more in Processing a Payment Advice Filel 51 Opening a Folder Containing EDI Files 9 gt HIPAA Claim Payment Master 64bit File DataExport CodeSets Image Setup ED
98. e to File View EDI File Help ISA segment Password ID Sender ID ID Type Receiver ID Date Time Interchange ID Ack T P 5 on 00 sl 314113 0704 286070437 Ff GS segment ST segment Sender Code Receiver Code iroup Control Version Transaction ID t Gs 20131013 0704 286070437 fx sr 835 The Create 835 Transaction Sets window 3 Before starting enter values into the empty fields Tip Once you have filled the fields out the program will store your values Next time you access the window the program will display your last configuration 4 On top see the query field Here you can enter any query Or use the query builder discussed before and carry the query over into this screen Tip Please be reasonable creating a file with many thousand records will take a few minutes 5 The next block is concerned the ISA Segment Note Some values are filled in and shaded out they are created by the program Other fields are blank and you have to fill them out e Sender ID Type Sender ID Your identifier You can select ZZ and your name up to 15 letters or your tax ID etc Fill in the sender s ID qualifier and ID e Receiver ID Type Receiver ID An identifier that you can get from your trading partner 6 In the GS Segment add the following 2012 1 The HIPAAsuite Claim Payment Master 9 1 e Sender Code Repeat your sender ID from ISA_06 e Recei
99. ed modified and distributed under the terms of the GNU General Public License We recommend Gpg4Win for encrypting of your files and emails Gog4Win supports both relevant cryptography standards OpenPGP and S MIME X 509 and is the official GnuPG distribution for Windows Gpg4Win contains Kleopatra as one of its Free Software components For more information see Gpe4Win documentation available both in PDF and HTML versions 2012 EDI Exchange 19 Import Certificates Export Certificates Hedisplay Stop Operation Lookup Certificates on Server My Certificates Trusted Certificates Other Certificates Name E Mail Valid From Valid Until Details Key ID Martin Sc Martin Schol 2011 12 10 OpenPGP CiFACACB Kleopatra a certificate manager for OpenPGP and X 509 S MIME and common crypto dialogs With Kleopatra it is easy to manage your certificates and create your own ones It seamlessly integrates with GnuPG You can manage the key that you receive from your trading partners because there is a screen to view the details of a key IPM Certificate Details User IDs and Certifications Technical Details This certificate is currently valid User ID Chiffaengine Ca lt chiffaengine gqmail caom gt Validity from 2011 08 19 12 09 until forever Certificate type 2 046 bit RSA Certificate usage Signing EMails and Files Encrypting EMails and Files Certifying other Certificates B399D4A0 Fingerprint BC3FE
100. ee varchar 25 DEFAULT NULL PayeeLast varchar 60 DEFAULT NULL Subscriber iD varchark15 DEF AULT NULL Subscriber ast varchar DEFAULT NULL SubscriberFirst varcher 35 DEFAULT NULL PatientiD varchar 15 DEF AULT NULL PatiertLast varchar 60 DEFAULT NULL PatientFirst varchar 35 DEFAULT NULL AmountCharged decimalj 10 2 DEFAULT NULL AmountPaid decimal 10 2 DEFAULT NULL ServiceDateFrom date DEFAULT NULL ServiceDateTo date DEFAULT NULL ON PRIMARY The Create Image Index Table window with the Microsoft SQL Server option selected 2012 52 The HIPAAsuite Claim Payment Master Create Image Index Table Microsoft SQL Server F MySQUGeneric ID bigint 20 NOT NULL AUTO INCREMENT EDIFilenme varchar 100 DEFAULT NULL varchar 100 DEFAULT NULL ClemMo varchar 35 DEFAULT NULL TradingPartneriD char 15 DEFAULT NULL PayDate date DEFAULT NULL Payori varchar 25 DEFAULT MULL varchar DEFAULT MULL PayeelD varchar 25 DEFAULT NULL ast varchar 60 DEFAULT NULL Subscriber ID 1 5 DEF AULT NULL SubscriberLast varchar S0 DEFAULT NULL SubscriberFirst varchar 35 DEFAULT NULL Patienti varchar 15 DEFAULT MULL PatierdLast varchar DEF AULT MULL PatientFirst varchar 35 DEF AULT MULL AmouritCharged decimal 10 2 DEFAULT NULL AmounitPait decimal
101. ekly e Monthly e One time only e When my computer starts e When log on Click Next Scheduled Task Wizard name for this task The task name can be HIPAACIaimPaymentMaster The Scheduled Task Wizard window 6 Enter the name and password of a user The task will run as if it were started by that user Click Next 2012 36 The HIPAAsuite Claim Payment Master Scheduled Task Wizard password at ee TIGER not run The Scheduled Task Wizard window 7 In the last screen make sure you have specified all data correctly Click Finish to save your task Scheduled Task Wirard The Scheduled Task Wizard window 8 The scheduled task has been added to the system Now lets edit the new task and add the desired command line arguments with the appropriate options Double click the newly created task in the Scheduled Tasks window 2012 2012 Configuring the Application scheduled Tasks Edt Vew Favortss Took Advanced Heb Ges 7 J Search 7 Folders Run Te Se Fun Folder Tasks E a L207 PM every 12 07 00 PM Newer Could nok start Rename this item et a a HIP AACIaimP aymentidaster Run at user logon At user logon Newer Gy Move this tem Copy this item Delete this item The Windows Task Scheduler 9 Enter parameters to the field after the ap
102. elect None 3 Choose fields to be exported by selecting checkboxes in front of the fields in the following tables Tip We recommend to select all fields This makes it possible to reassemble all the information in the EDI file and create the image of the claim payment e Payment e Claims Claim Lines e Line Level Adjustments Claim Level Adjustments Provider Level Adjustments Tip Sometimes it might be necessary to rename a field or fields Some legacy database want upper case only or lower case only field names The HIPAA Claim Payment Master allows you to rename any field in any table Click twice not double click on a field and you are in Edit mode 2012 The field selection list in Edit Mode 4 Once you have made your selection or selected all you have to test your setup click on the Test Configuration button The program will go through each table and check if the selected field exists 5 Ez File Level Data 7 TradingPartneriD E Statistics Dur EDIFie Name 7 Provider D 7 FileDate 2 oe E E FinancialData BPR Segment ne PaymentiD Key of Payment Table or Payer ID SOLIS E ProwideriD E FiecalPerodDate 7 PayerAddress2 Price Auth 7 PayerCity mination Num 7 earn Ez Payerzip v PayerlD Number 7 Submitter D 7 ClaimlD Key of Claim Table v djustmentGroup
103. ell as it is also known is deemed to be the most secure method of file transport There are 3 methods of authentication in Sftp 1 with a user name and password 2 with a user name and a private key cryptographic certificate and 3 with a user name a certificate and a password 2012 EDI Exchange 151 When you select SFTP as the FTP protocol you will see two check boxes appear SFIP User password Auth private Key Auth The sub choices when you select SFTP Leaving both check boxes unchecked will result in the first option Authentication with user name and password You can also check just the user name and password with the same result In order to use the certificate based authentication you need to create and link to your own certificate The certification module that HIPAAsuite employs uses a so called private key SSH2 certificate in pem format How do you create such a certificate Here is one way The free secure shell program putty has the necessary tools Download putty from www putty org When you install the program you will see several program installed on your computer 2012 Organize Include in library Share with 7 Burn New folder di Mozilla Maintenance Service Mame Date modified Type Size LICENCE 8 6 2013612PM File 2 KB Js ua T pageant exe 8 6 2013 6 12 PM Application 144 KB b pubs 8 plink exe 8 6 2013 6 12PM Application 304 KB pscp exe
104. enses incurred prior to coverage Smene ba End of Summary Range summary range ending with a bracket End of Summary information block 2 5 Requesting a Trial Extension Once your trial period has expired the application will stop working If you need to continue your trial of the product then you will need to send your request to the support team Follow the instructions below 1 Launch the application 2 Click on the Ask for trial Extension link on the displayed window 2012 16 The HIPAAsuite Claim Payment Master HIPAA Claim Payment Master 2 0 D ap s remaining for trial 0 This full functional evaluation You free to evaluate this demo You will have to purchase this software if you wantto continue using it after a free evaluation haz expired PEDE 123466789 m The Ask for trial extension link 3 Clicking on the Ask for trial Extension link will create an email to HlPAAsuite with the registration number so they can then create the extension key For example this will open Outlook with the following data inserted e To infoeHIPAAsuite com e Subject HIPAA Claim Payment Master 123456789 Request for trial extension key e Message Volume ID 123456789 HIPAA Claim Payment Master 233AEF7A Request for trial extension key Message HTM Ex Message Volume ID 123456789 The trial extension request email 4 The response from the
105. equirements specific to this trading partner Read more in Setting up Trading Partners e File Transport EDI Exchange has a built in FTP client that can securely connect to your trading partners FTP servers If you employ your own FTP server you can utilize the folder structure that EDI Exchange uses to manage incoming files users home directories and permissions so that your Trading Partners can drop off and pick up EDI files Supported are e Simple FTP e FTP Secure 2012 EDI Exchange e Implicit FTPS e Explicit FTPS Secure Shell FTP or sFTP Read more in Using FTP Client 44 e Encryption Many healthcare related companies use encryption to cloak the content of their EDI files The prevalent method of encryption is PKI Private Key Infrastructure that uses the product of two incredibly large prime numbers as cipher EDI Exchange supports PGP Pretty Good Privacy the leader in products as well as the open source GPG project with its Windows sub project PGP4Win Both are implementations of the same encryption mechanism Read more in Using Encryptionl 53 File Management EDI Exchange uses a clear directory structure to store EDI files The structure is based on root directories for incoming files outgoing files processed files and suspended files Below these root directories there are subdirectories for each trading partner and then each transaction set Read more in Defining Root Directoryl
106. erything checks out Initialization failed because of SQL connection problems Read more in Setting up Database Connection eal 2 Once the connection is established the program checks if the correct tables exist in the database See Creating Database Tables Once the SQL part checks out you will see the following message 2012 EDI Exchange Checking SQL settings and tables Connection settings are checked Trading Partners table is checked TRANS LOG table is checked TRANS LOG ERRORS table is checked SEND LOG table is checked 3 The next step of the initialization processes the program checks and if necessary creates the root directory and five sub directories Within these root directories there will be folders for each Trading Partner and type of transactions The location and names of the sub folders are handled in the Trading Partner setup The root folder is specified via the EDI Exchange Setup screen Read more in Defining Root Directory 12 The sub directories that EDI Exchange creates are as follows re G p Computer W52008 C 3 Organize Indudeinlbrary Share with New folder r Favorites 1 31 2013 5 56PM folder jal Libraries 1 31 2013 5 56 PM File folder 1 31 2013 5 56 File folder Compu Computer 1 31 2013 5 56PM File folder ws2008 C 1 31 2013 5 56 PM File folder Data D The directory structure of EDI Exchange 4 The
107. es with the Windows Scheduler to allow the automation of the EDI file exchange process You can set up EDI Exchange to go out to the trading partner s FTP server download files decrypt and compliance check them and further process them with the appropriate HIPAAsuite application for example load claims into a SQL 2012 EDI Exchange 12 2012 database Follow the instructions below to schedule the EDI files exchange process 1 Select Automatic Scheduler under the EDI Exchange menu EDI Exchange Check EDI File Trading Partners Inbox Manager FTP Client SEF Files EDI Exchange Setup Encryption Setup Create EDI Exchange Tables Create 999 Files Tables Autoprocess Setup Automatic Scheduler EDI Log EDI Send Log Request EDI Exchange License EDI Exchange License Information The Automatic Scheduler menu item 2 In the opened window right click and choose the Scheduled Task menu item File Action View BE 9 Task Scheduler Local 4 i Task Scheduler Library gt Microsoft MySQL C HIPAASuite Status Triggers Next Run Time Last Run Time LastRun Result Author Created Create Basic Task Create New Task Import Task Refresh Task Scheduler in Windows Vista onwards 18 Create Basic Task Create Task Import Task tz Display All Running Tasks 5 Enable All Tasks History New Folder Delete Folde
108. ew DataExport CodeSets Image Setup EDI Exchange gt iia rm compliance check Checking For updates 2 The HIPAA Claim Payment Master main window Tip If the left pane is not displayed then select View k Info Bar to show it Once the main program window is opened the normal operation now would be to open an EDI file See e Processing a Payment Advice Filel 51 e Opening a Folder Containing EDI Files 9 2 2 Processing a Payment Advice File Follow the instructions below to open a single EDI file and display its details on screen in 2012 6 The HIPAAsuite Claim Payment Master easy to read table format 1 Go to File Open in the main menu HIPAA Claim Payment Mz Open Directory Select Prinber Exit The Open menu Alternatively click on the Open Document icon shortcut located on the program toolbar HIPAA Claim Payment Master 64bit File DataExport Image Setup EDlExchange i 5 Open Document button 2 Browse through the folders and select file with eai extension Click Open Note Only claim files in ANSI 835 format can be opened via the Claim Payment Master The program will display an error message if you select a file in a different format Reference ANSI 835 is the American National Standards Institutes Health Care Claims Payment
109. file If the trading partner does not exist you have the opportunity to create a rudimentary new trading partner record Now you have the choice to either create this new record process the file without the trading partner record or to abort the operation New Trading Partner The sender of this file with the ID of HDSCRIPTS is not setup as Trading Partner Do you wantto create a new record The New Trading Partner dialog box If you abort the process you still will get the EDI file analysis 150 The HIPAAsuite Claim Payment Master 7 4 4 Inbox Manager Loading EDI Files into Inbox Processing Inbox Download from FTP Server All files in Inbox have been processed Activity Log and Warnings Filename keyhealth 837 SEF file HIPAAClaimMaster SEF_Files 837_X098A1_SemRef SEF loaded for transaction set 004010 098 1 The Transaction type is 837 Version 004010X098A1 The Trading Partner with the ID MDSCRIPTS is not set up The file s further processing is suspended 346 warning messages were given The following Warnings with the X12 implementation were found Warning in Line 2 gt GS HC MDSCRIPTS KEYHEALTH 20121012 1607 0000 1 X 0040 10X098A1 at Position 6 DESCRIPTION Lea Warning in Line 6 gt REF Z2Z 264101398 DESCRIPTION Unexpected data segment REF encountered in transaction set message Warning in Line 11 gt NM1 85 2 KEY HEALTH DEMO at Position 8 DESCRIPTION No data in mandatory
110. g acted D Payment data from an EDI file into its proprietary 1 EDIFileN ame data object It can translate and export this data Fiebate into ODBC compliant database such as FinancialData Segment Microsoft SQL Server AS400 Oracle and so z o hii ii flee The default fields that come with the product oltre ud be extended Customizations are possible Ask Vendor for details PaymentMethod Connection Properties SendingBankNo Database Type SendettccountNa CE a PayerDivision Database Server Name C ReceivingBankNo Receives amp ccountMo ElfectiveD ate Database CheckNumber or EFT Number Username ProductionDate Payer Information Password PayerName PlaelD e Payer ID Payment Table sdi claimpayment Payerhddressl HUP Payer amp ddress2 Claim Table edi paidclaims 00 PaverCay Line Table ledi_pai delaimlines PayerState Claim Adjustments edi_claimleveladjustments PayerlD Number SubrmitedD Line Adjustments 91 pai dclaimlineadi B Provider Level Adj gnac PayerContact Pe Tbe elefon Save Connection Information Test Connection Connection not checked Cancel Help Select O PayerF ax The Database and Field Export window Test Configuration Claims Claim Lines Payment Key
111. g Command Line Arguments CLI In order to run the HIPAA Claim Payment Master from the command line or have it invoked through another program it is necessary to pass command line arguments to the program to instruct it to perform the desired tasks Command line arguments are separated by commas 1 The first command line argument is the filename or the directory path The program will automatically decide if this argument denotes a directory or a single file 2 The second argument is concerned with data export to another database If the argument is Y then the data will be exported according to the settings 3 The third argument decides whether image file will be created A Y will cause the program to create image files 2012 Configuring the Application 5 4 The fourth argument will send the images to the printer 5 The fifth argument can contain the printer name if a printer other than the default printer is specified It is important to use exactly the same name as it is listed in Windows under printers Example A typical command line would be for example C Program Files HIPAAsuite HIPAA Claim Payment MasterMHIPAAClaimPaymentMaster exe C EDI Inbox 835 Y Y Lexmark X500 Series 1 In Quotes you can see the path to the executable The quotes are necessary in Windows whenever you have a file name with a blank space in it such as Program Files Tip Sometimes you need quotes for the file name so it is
112. ge has not been initialized yet 3 Under EDI Exchange Directory Setup specify the following setting 2012 114 The HIPAAsuite Claim Payment Master Root Directory Path Define the root path in the Root Directory Path text field The root path is the folder where all your EDI files reside EDI Exchange will later create sub directories required to operate EDI Exchange Directory Setup Root Directory Path The root communications directory setup 4 Click Save Root Directory Path pAEDI Browse Email Server Information Email Notification SMTP Server Sender s email address Send email notice of newly arrived Files User Name Password E SMTP server requires Logon Connectto the SMTP server via the SSL protocol Use Port Outgoing Files Other options O Validate outgoing files 1 Reject Incoming Files with more errors than set Count below Halt records if EDI compliance warnings are found EDI Hles with Other Type in Inbox Leave file for other program Hep E E The Save button Q EDI Exchange is NOT yet initialized Initialize EDI Exchange After setting the root directory you can click the Initialize EDI Exchange button Read more in Initializing EDI Exchangel 114 7 2 6 5 Initializing EDI Exchange Before you can use EDI Exchange and after you have configured the obligatory settings you have to perform the initialization
113. hange Setup window 3 Specify the following email options 122 HIPAAsuite Claim Payment Master Email Server Information e SMTP server e Sender s email address e SMTP server requires logon e Username e Password e Connect to the SMTP server via the SSL protocol e Use port meos S im EDI Exchange Directory Setup Root Directory Path D EDI Email Server Information SMTP Server smtp gmail com Sender s email address example gmail com User Name Password Outgoing Files Validate outgoing files Halt records if EDI compliance warnings are found SMTP server requires Logon user Connectto the SMTP server via the SSL protocol Use Port Other options Reject Incoming Files with more errors than set Count below Q EDI Exchange is NOT yet initialized Setting up the email server Email Notification Send email notice of newly arrived Files Recipients EDI Files with Other Type in Inbox Leave file for other program Auto process if other program is available Note If you do not have this information please ask your administrator to set this portion up for you 4 To configure email notifications specify the following options Email Notification e Send email notice of newly arrived files Use this checkbox to define if you want to send email notice once new files have arrived e Recipien
114. his 01 Example 83511_4 pae e Patient Last Name Claim ID The result file name will combine the patient name 2012 4 The HIPAAsuite Claim Payment Master with Claim ID Example 985019 e Bill Provider ID Claim ID The result file name will combine the billing provider s ID with Claim ID e Image Format Choose whether to create PDF or TIFF files e Color on Images You can select red or black color e Image Folder Options When you create a lot of images it is important not to place them all in the same folder Microsoft Windows has issues handling more than 1000 files in a folder That is the reason why the HIPAA Claim Payment Master can hash the image files over many sub folder You have the following choice to use e None Default value e Sub folders for Year Month and Day The sub folders will be created within the Image File Location Example 2012 rebruary 29 23 PaidClaimImages 4 2009 E 2010 C3 February D 04 C 19 20 The folder structure in Year Month and Day mode e Sub folders for Year and Week The sub folders will be created within the Image File Location Example 2012 9 e Sub folders for Year and Day The sub folders will be created within the Image File Location Example 2012 20120229 4 3 Adjusting Image Options The size of image files is largely determined by the image quality The better the quality the more
115. ialize EDI Exchange module Click the Initialize EDI Exchange button to accomplish the process Root Directory Path jAEDI Email Server Information Email Notification SMTP Server Sender s email address Send email notice of newly arrived Files User Name Password HUE SMTP server requires Logon Connectto the SMTP server via the SSL protocol Use Port Outgoing Ales Other options Validate outgoing files 1 Reject Incoming Files with more errors than set Count below Halt records if EDI compliance warnings are found EDI Ales with Other Type in Inbox Q EDI Exchange is NOT yet initialized Auto process if other program is available The Initialize EDI Exchange button Leave for other program Once the Initialize EDI Exchange button is clicked the system checks if all settings have been configured correctly 1 The first thing the initialization process checks is the connection to the database and the presence of the necessary tables EDI Exchange relies on the database connection that is part of the HIPAAsuite application that you are using EDI Exchange needs Database Connectivity licensed and enabled If this part is not yet set up then you will get an error like this Processing Results EDI Exchange inibalization started Checking SQL settings and tables Could not establish connection EDI Exchange encountered the above errors EDI Exchange is not operational until ev
116. icare Inpatient Adjudication Remark MAO If you do not agree with this determination you have the right to appeal You must file a written request for an appeal within 180 days of the date you receive this notice Decisions made by a Quality Improvement Organization must be appealed to that within 60 days Claim Disproportionate Share Amount 1 Claim Capital Amount PPS Capital FSP ORG Amount Cost Report Day Count Claim Indirect Teaching Amount Medicare Inpatient information from the MIA segment On the following screen shot the Procedure Code is in the first top cell on the left The stands for HCPCS codes which includes all HCPCS ICD 9 and CPT codes Other possible codes are AD for dental claims or IV for Home infusion codes and N4 for NCPDP drug codes 2012 14 The HIPAAsuite Claim Payment Master Adjustment Codes are translated into their descriptions making it easy to understand the reasons behind any adjustments Adjustment Group Res qe qu Patient Responsibility 31500 Serice Date 05012002 Date DAD i Proc 21000 Fs O Chase 88 500 Paid 1500 Dale 99244 charge 7500 Paid 60 00 S2500 400 00 Fad Unis mgusinentoroup Remon 22222 4 Tw Payor Initiated Reductions Payment adjusted because caverage program guidelines were not met or w OMAR The line level information for a claim with 3 lines Summary information contained i
117. ies fields To create tables in your database click on the You can create the tables through a separate screen link For instructions refer to Creating Tables e2 2012 um Database and Field Setup HIPAA Provider Printer Extract Capabilities The HIPAA Provider Printer natively treats payment advice record as single Object The Payment data from an EDI file into its proprietary data object It can translate and export this data Microsoft SQL Server 5400 Oracle and so Ask Vendor for details Database T ODBC Connection Claim Table Line Table You can create the tables Vert SERT A link to create tables Once the connection parameters have been entered click Save Connection Information 2012 The HIPAAsuite Claim Payment Master um Database and Field Setup HIPAA Provider Printer Extract Capabilities The HIPAA Provider Printer natively treats payment advice record as single Object The Payment data from an EDI file into its proprietary data object It can translate and export this data into any ODBC compliant database such as Microsoft SQL Server IBM 5400 Oracle and so can be extended Customizatons are possible ODBC Connection Payment Table ledi_claimpayment Claim Table Jedi _paidelaims Line Table edi paidclaimlines Claim Adjustments edi claimleveladjustments Line Adjustments edi paidclaimlineadj
118. imple text files one for each day that are stored in date hashed folders Alternatively access the togs folder in the following directory Windows XP c Documents and Settings All Users Application Data HIPAAsuite HIPAA Claim Payment Master Logs Windows 7 Vista C ProgramData HIPAAsuite HIPAA Claim Payment Master Logs 8 C Documents and Settings All Users Application Data HIPAAsuite HIPAA Claim Payment Master Logs aloj x File Edit View Favorites Tool Help B p e is roses E Address C C Documents and Settings All Users Appkeation Data 2 Desktop E My Documents Compuber E H A 315 Floppy E SYSTEM Documents and Settings C3 Administrator 3 All Users C3 Application Data B C3 HIPAAsuite E C3 HIPAA Claim Payment Master Configuration E G Logs EB ey 2012 March Samples C3 scripts The Logs folder in Windows XP HIPAAsuitelHIPAA Claim Payment MasterlLogsl2012 March Go 20120314104 Text Document Ww Tip The folder is hidden by default Tip The ProgramData folder contains all your application data like program settings user data etc for all of the installed programs on the computer The ProgramData folder holds the same files that were contained in the Documents and Settings All Users and Documents and Settings 11 Users Application Data folders in XP 2012 Configuring the Application Within the
119. information is stored in the image file You can define the quality of the image and the image size in the Image Options Select Image Image File Options the main menu to access the Image Options window 2012 Creating Image Files and PDFs 43 HIPAA Claim Payment Master 64bit File View Export Code Sets Image Setup EDI Exchange Help M Image Viewer Image Setup Dutput Mode Pula Image Index File Options Screen Create Image Index Table The Image File Options menu You can define the image options described below Once the options have been set click Save Options for TIFF e Color Depth You can change color depth of the image black white 4 bpp 8bpp 24bpp 32bpp Note TIFF in Window s GDI library does not work with 16 bpp bits per pixel Color depths set lower then 16 bpp results in some losses in image quality Reference The black and white bi level image means that for each pixel picture element in the image we do not need three bytes as in the true color image over 16 7 million colours but only one bit that is 1 24 part of the pixel size from the true colour image The one bit pixel can express only black or white colors nothing more e Compression Algorithm You can use compression with TIFF files LZW and Packbits are used for all Colors CCITT4 for black and white e Pho
120. ing Exported Datal 76 5 2 Setting up Database Connection The HIPAA Claim Payment Master natively treats a payment advice record as a single 2012 The HIPAAsuite Claim Payment Master object The application extracts the complete payment from an EDI file into its proprietary data object It can translate and export this data into any ODBC compliant database such as Microsoft SQL Server Oracle etc Tip The default fields that come with the product can be extended customizations are possible 1 Select Data Export 835 Connection and Data Fields in the main menu HIPAA Claim Payment Master 64bit 835 Payments and Paid Claims 635 Table Creation 635 Database Schema Create 835 EDI Files The 835 Connection and Data Fields menu 2 You will be confronted with the following screen where you can set up the database connection and enter the names of the database tables Database and Field Setup HIPAA Provider Printer Extract Capabilities Fields to be exported The HIPAA Provider Printer natively treats a Payment Claims Claim Lines payment advice record as 4 single Object The Fie Level Data PaymentiD Key of Payment table Kep of Claim Table HIPAA Provider Printer extracts the complete TradingP 0 E 0 Statistics T53 ProcedureCode Payment data from an EDI file into itz proprietary EDiFileH
121. ion e EDI Identifiers and Qualifier e ISA Identifier and Qualifier Record Key The ISA Identifier and Qualifier are the unique key to the trading partner database file The ISA identifier can be up 2012 136 The HIPAAsuite Claim Payment Master to 15 bytes long the qualifier has to be 2 bytes Approved qualifiers are e 01 Duns Dun and Bradstreet e 14 Duns Plus Suffix e 20 Health Industry Number HIN e 27 Carrier Identification Number as assigned by HCFA e 28 Fiscal Intermediary Identification Number as assigned by HCFA e 29 Medicare Provider and Supplier Identification Number as assigned by HCFA e 30 U S Federal Tax Identification Number e 33 National Association of Insurance Commissioners Company Code NAIC e ZZ Mutually Defined Many organizations use the ZZ qualifier with their name as the ID for example ZZ and HIPAASUITE ETIN number The Electronic Transmitter Identification Number established by a Trading Partner Agreement This number occurs only in the 837 transactions Often the ETIN is same as the ISA ID Application Receiver Code GS 02 A code identifying a part that sends a transmission or the specific application within the sender s organization Codes are agreed by Trading Partners Again usually this code is same as the ISA ID This code is placed in the GS 02 element in the Functional Group Header GS Some Trading Partners want to send a specific co
122. iver EDI Identifiers Options Remote Contact Encryption Folders CORE CORE Settings UserName Batch Password MIME Submission Address Tet SSL Certificate MIME Retrieval Address Real Time 2 MIME Address a SOAP Submission Address SOAP Address SOAP Retrieval Address CORE settings tab e UserName UserName portion of the username authentication token Used to verify a Trading Partners Username token s Username or in your own Username token authenticate yourself to a Trading Partners CORE compliant servi e e Password Password portion of the username authentication token Used to verify a Trading Partners Username token s Password or in your own Username token to authenticate yourself to a Trading Partners CORE compliant service e SSL Certificate Instead of Username tokens use an SSL certificate to verify a Trading Partners identity or access a Trading Partners CORE compliant service Not currently implemented e RealTime 2012 HIPAAsuite Claim Payment Master 7 4 2 o MIME Address Trading Partners web address for MIME Real Time transactions o SOAP Address Trading Pertners web address for SOAP Real Time transactions e Batch o MIME Submission Address Trading Partner s web address for MIME Batch transactions o MIME Retrieval Address Some Trading Partners may use a different address to submit or retrieve batch transactions Use this field for a ret
123. lIExchange gt in The Open document button HIPAA Claim Payment Master 64bit Fie View DataExport CodeSets Open Sample File Select Printer Exit The Open Directory menu 2 Select the Image File option in the Output Mode block Output Mode Printer C Screen image Fie The Image File option 3 Click on the button 2012 4 The HIPAAsuite Claim Payment Master HIPAA Claim Payment Master amp 4bit The buttons 4 The Processing Results window displays the report You can find the resulting TIFF or PDF files in the specified folder Processing Results Processing of the file 93511 3 46 58 1 Poymer with 1 claims have be en mat Processing of the file 83511 ended at FROY of th fi 83512 edi began at 2 29 012 3463 racessing of the file edi began 212932 Result Files Processing ofthe file 83512 edi ended at 2 The Processing Results window 4 2 Doing Image Setup Before proceeding with image export do the image setup as described below Select Image Image Setup in the main menu to access the Image Setup window 2012 Creating Image Files and PDFs 41 2 HIPAA Claim Payment Master G4bit Fie View DataExport Code Sets Image Setup Image Viewer EDI Exchange Help Output Mode Image File Options 6
124. mage file options new options for bitonal and grayscale TIFF images Changes in version 2 2 4 1403 fed bug in Export if file has different transaction sets with the same Trace Number changed way to manage currency amounts in exported files in order to produce them in EDI format fixed bug with queries for file creation when sgl table names are cate sensitive The Changes in Versions screen with highlighted Update button Then you will need to re certify the application Specify a location on you local PC where to download the new version Save in 7 My Compute Of t 4 35 Floppy i we C SYSTEM My Recent D eL dcus E Local Disk E s Local Disk 4 G CD Brive Deskbop My Documents E oe My Compuler File nae xl AD iF Sune rit ss bers The Save as window with the Save button highlighted Then the program will start downloading 2012 Bug Reporting and Program Update 185 Downloading HIPAACLimP apmentM asters The Downloading HIPAAClaimPyamentM aster32 popup Then you will need to install the application 5 HIPAA Claim Payment Master Welcome to the HIPAA Claim Master Setup Wizard The application installation window with the Next button highlighted Manual Updates To switch off automatic updates and stick with the version you have go select Setup gt
125. n TS3 and TS2 segments can extend over multiple claims The HIPAA Claim Payment Master will begin a summary range with a bracket and then show the summary information before listing the claims Provider Summary Information for the following 7 Claims Provider ID 1154377166 Facility Type Code 11 h S Fiscal Period End Date 06 30 2008 Total Claim Count 7 Total Claim Charge Amount 43 266 25 Total Covered Charge Amount 43 Total Provider Payment Amount 16 367 74 Total Contractual Adjustment Amount 23 Summary range Total Non Lab Charge Amount 37 391 25 Total Deductible Amount 52 5 rris 2 a acke Total DRG Amount 19 343 74 Total Federal Specific Amount Total Hospital Specific Amount 3 468 66 Total Capital Amount Total Indirect Medical Education Amoun 766 10 Average DRG Length of Stay Total Discharge Count 1 Total Cost Report Day Count Total Covered Day Count 5 Average DRG weight Total PPS Capital FSF DRG Amount 1 183 82 Total PPS DSH DRG Amount 109 49 es aim 2 Beginning of the summary information block Summary information is started with a bracket At the end of a summary range is another bracket 2012 Getting Started 15 Patient Responsibility Service Date 11 13 2009 7 i Proc NU 0300 Paid 0 00 dusmen Reason Group WdusumenReason oO Patient Responsibility 2b Expenses incurred prior to Coverage 2 678 00 Senice Date roc NU 0450 26 Exp
126. n you choose 997 or 999 acknowledements e Send e mail notification when sending files This option allows sending a file to the Trading Partner notifying them that a file has been created for them e Reject Files with Compliance Errors This option will reject files that have compliance warnings and move them into the suspended files directory It also determines whether the TA1 and 999 indicate acceptance or the 999 lists all the errors and warning e Create a 277 for 837 claims This option only applies to 837 Claims Checking this option will produce a 277CA Claims Acknowledgment report for received 837 Claim files e One ST SE loop per claim This option separates all claims into individual transactions enclosed by their own ST and SE segments Remote FTP Tab If your trading partner has an FTP Server then you can set up here the connection 2012 138 The HIPAAsuite Claim Payment Master information Read more in Using Built in FTP Client 24 EDI Identifiers Options Remote FIP Contact Encryption Folders CORE e FIP Remote Connection and Directories Differ Secure FTP FTP Address Download Server Explicit FTPS ftp healinghospital com plicit 5 User Mame 3 Implicit FTPS SFTP Password User password Auth dd private Key Auth Port After Download 21 Delete Fil Put Directory Get Directory Delete Files DropOff PickUp Move to Folder R Test Upload Connection Te
127. nce rules The EDI Exchange is an EDI pre processor that handles FTP transport encryption HIPAA compliance check trading partner management etc Outgoing EDI files can be checked for compliance individual records that do not pass the check can be withheld 2012 92 The HIPAAsuite Claim Payment Master HIPAAsuite products with EDI Exchange module have a main menu item called EDI Exchange with sub menus to call the module s functions HIPAA Enrollment Master 32bit File View Database CodeSets Image Setup Log EDI Exchange Help Ae Check EDI File Em gt 3 Trading Partners Screen Inbox Manager FTP Client Printer SEF Files daa ED Exchange Setup ASCII File Encryption Setup Image File 45 Create EDI Exchange Tables Create 999 Files Tables Data Export Autoprocess Setup Automatic Scheduler EDI Recerve Log EDI Send Log Request EDI Exchange License Run B 1 De EDI Exchange License Information The EDI Exchange menu in HIPAA Enrollment Master EDI Exchange performs the following functions e Trading Partners Management The following Trading Partners parameters can be stored and transparently managed with the help of EDI Exchange name address EDI identifiers delivery methods encryption parameters FTP servers CORE Compliant server addresses and credentials communication numbers and folders to keep files separated special r
128. ncryptionl 53 You can set up the encryption parameters for a Trading Partner on the Encryption tab EDI Identifiers Options Remote Contact Encryption Folders CORE Encryption Setup Asymetical Encryption O Private Key Infrastructure Key email address of key owner No Encryption The Encryption tab Encryption Setup e Asymmetrical Encryption e Private Key Infrastructure PGP Key email address of key owner e No Encryption Folders Tab Within the HIPAAsuite Communications Directory each Trading Partner has his own folder This keeps files finely separated and in order Here is where you can set this up Read more in Defining Communications Directory nal 2012 142 The HIPAAsuite Claim Payment Master EDiidemiers Options Remote FTP Contact Emcnp on Folders core Local Directory Settings Outgoing Files Root Trading Partner s Outbox a DAED Outbox TXEBS Processed Files Root Trading Partner s Repository D EDI ProcessedFiles TXEBS i Hle Naming Convention Create Folders Using Trading Partner ID CMS Folders tab e Outgoing Files Root This field has a pre generated path You can change this path by changing the EDI Root Directory e Trading Partner s Outbox Mandatory setting Click on the three dots button to access the Select Folder window There you choose an existing folder or create a new one
129. nd need a final license key you should request an EDI Exchange license Follow the instructions below to request a trial or final license key 1 Select Request EDI Exchange license under the EDI Exchange menu item HIPAA Enrollment Master 32bit File View Database CodeSets Screen Printer 7 Spreadsheet File ASCII File Image File Data Export Run with A menu item to request a license key Image EDI Exchange Check EDI File Trading Partners Inbox Manager FTP Client SEF Files EDI Exchange Setup Encryption Setup Create EDI Exchange Tables Create 999 Files Tables Autoprocess Setup Automatic Scheduler EDI Recerve Log EDI Send Log Request EDI Exchange License 2 Once you have clicked this menu item your default email application appears In our case it is Microsoft Outlook All information necessary to produce the key is automatically filled out 2012 EDI Exchange 9 From Martin Scholl HIPAAsuite com info i HIPAAsuite com Send Bcc Subject EDI CECINIT ER Request for License Request for License Product EDI Exchange Volume ID 78DCFB8BF Current Key Key es Email message created by EDI Exchange 3 You can add a trial extension or a final key after purchasing or relocating
130. neric 1 CREATE TABLE SegmentErrors 2 ID int IDENTITY NOT NULL TS ID int NOT NULL Ack ID int NOT NULL SegmentlDCode char 3 NULL SegmentPosition int NULL LooplD varchar 4 NULL ErrorCode varchar 9 NULL PFCTX CTX1 ContextName varchar 35 NULL CTX1 ContextReference varchar 35 NULL CTX1 SegmentlD char 3 NULL CTX1 LooplD varchar 4 NULL CTX1 SegmentPosition int NULL CTX1 ElementPosition int NULL CTX1 ComponentDataElementPos int NULL CTX1 RepeatingDataElementPos int NULL CTX1 ElementReference1 varchar 4 NULL CTX1 ElementReference 2 varchar 4 NULL CTX2 ContextName varchar 35 NULL CTX2 ContextReference varchar 35 NULL 2 SegmentlD char 3 NULL CTX2 LooplD varchar 4 NULL The Execute Sc ript button Notice Creating tables means clicking the Execute Script button in all four tabs of the Create Tables for 999 Files window Then close this window 7 Once the table has been created successfully you will see the following notification The Create Table sc ript success message Warning Double execution of a script wipes out the previous table you have created A prompt will warn you before deleting an existing table To Add Remove fields use the Compare Script button Remove the script files once you have created the tables so nobody can destroy the tables by accident 2012 EDI Exchange 109 Caution The double executi
131. next step of the initialization the program checks if the HIPAA EDI compliance engine is properly installed 5 The last thing checked by the system is if the Automatic File Processing options have been set up Read more in Defining Auto Processing Options ol The options are important for the hand over from EDI Exchange to the other HIPAAsuite program that hosts EDI Exchange Once all verifications have been completed successfully you will see the following message 2012 The HIPAAsuite Claim Payment Master Processing Results EDI Exchange initialization started Checking SQL setings and tables Connection settings are checked Trading Partners table is checked TRANS LOG table is checked TRANS LOG ERRORS table is checked SEND LOG table is checked COMPANY SETUP table is checked COMPANY SETUP data is validated Checking for Required Directories Inbox Directory is checked Outbox Directory is checked Processed Directory is checked Crypt Directory is checked Suspense Directory is checked Checking for EDIDev EdiDev is found EDI Exchange has been successfully initialized and is ready for use Successful initialization of EDI Exchange After that your EDI Exchanse is initialized EDI Exchange Directory Setup Root Directory Path AED Browse SMTP Server Sender s email address O Send email notice of newly arrived Files User Name Password Recipien
132. ng Inbox Select and Check EDI File Download from FTP Server Process Inbox Activity Log and Warnings _ _ 1 SSS _ The Inbox Manager window Read more in Downloading EDI Files From FTP Server Processing EDI Files e Selecting and Checking EDI Files 61 Checking EDI Files EDI file analysis based on the HIPAA standards Compliance with HIPAA EDI rules is an essential part of the exchange of EDI documents The standards are the only agreed upon rules that sender and receiver use to exchange data from completely different backend systems Strict adherence is therefore necessary to guarantee frictionless operation Unfortunately HIPAA compliance is difficult and the truth is that many HIPAA EDI files are truly bad Syntax errors omitted loops missing elements wrongly formatted elements these are the most common EDI errors Without a true analysis it is difficult to say what data ends up in your system EDI Exchange has a built in compliance engine that analyzes each incoming and outgoing EDI transaction Line by line element by element error reporting provides a powerful tool to determine the quality of the incoming and outgoing EDI files All HIPAA file versions are supported The compliance check creates a detailed report that lists every 162 The HIPAAsuite Claim Payment Master compliance issue Outgoing files can also be checked
133. ns Trading Partner Selecting a Trading Partner for FTP transfer 5 Highlight the trading partner that you want to connect to 6 Click on the Upload button to connect to the Put directory that you set up in the trading partner screen Trading Partner The Upload button Or click on the Download button to connect to the Get directory that you set up in the trading partner screen 2012 EDI Exchange Trading Partner xl List of Trading Partner Pamer 1 gt The Download button 5 Once you have chosen a trading partner the following fields will contain values derived from the trading partners properties You can change them manually if you need e FTP server IP Address or URL of the FTP server e Username e Password e Directory If you leave this value blank the FTP root directory will be opened e Secure FTP If you enable this option then you can select between implicit and explicit FTPs See Setting up Trading Partners s for an explanation of the two secure methods e Explicit FTPS Connection e Implicit FTPS Connection Note You can also fill in the connection information manually In this case the entered credentials will not be saved once you close the FTP client window Click on the Connect button to establish connection to the FTP server Directory FTP SecureFTP C SFTP 4
134. nsaction The location and names of the sub folders are handled in the Trading Partner Setup See Setting up Trading Partners Follow the instructions below to specify EDI communications root directory 1 Select EDI Exchange Setup under the EDI Exchange menu item 2012 EDI Exchange 113 Check EDI File Trading Partners Inbox Manager FTP Client SEF Files EDI Exchange Setup Encryption Setup Create EDI Exchange Tables Create 999 Files Tables Autoprocess Setup Automatic Scheduler EDI Receive Log EDI Send Log Request EDI Exchange License EDI Exchange License Information La E The EDI Exchange Setup menu item 2 The following window will appear Nu EDI Exchange Directory Root Directory Path SMTP Server Senders email address Send email notice of newly arrived Files User Name Password Recipients SMTP serverrequires Logon bs Connectto the SMTP server via the SSL protocol Use Port Validate outgoing files Reject Incoming Files with more errors than set Count below Halt records if EDI compliance n warnings are found EDI Ales with Other Type in Inbox EDI Exchange is yet initialized E n Leave file for other program Auto process if other program is available The EDI Exchange Setup window Note The icon in the lower left corner indicates that EDI Exchan
135. nt Master e Name e mail for Public Key Enter name or e mail that will be used to encrypt files for you by your trading partners e Pass Phrase for Private Key Enter passphrase here to decrypt files encrypted previously with the pass phrase Note The keys are identified by the email address of their owner e Crypto Program e GnuPG Select this option if you have already installed the GnuPGI s software and want to use it Crypto Program lGnuPG PGP Desktop A The configuration using GnuPG Note When you select GnuPG the program checks if the executable gpg exe gpg2 exe is present on your computer If it is not found you will have to specify the path manually or install the program first e PGP Desktop Select this option if you have already installed the PGP Desktop 7 program and want to use it You will see a different lower half of the screen where you can indicate the location of the keys PGP Desktop uses key rings encrypted folders that contain all your keys The location of these two files is very important for PGP Desktop C GnuPG Desktop Key Rings Pubic 2 a Phe Of amp d The configuration using PGP Desktop 4 Once the settings are done click the Save button 2012 7 5 3 2012 EDI Exchange The Save button 5 The following notification will appear Click
136. ocumentation 1 e D hd iS T The Report an Issue menu Alternatively you can use the ctr shortcut on your keyboard to call the Issue Tracker Some screens do not give you access to the menu while they are open but the key combination ceci will call up the issue tracker report screen 2 Click on Capture to snap a picture of your screen BugTracker NET Screen Capture Copy to Clipboard Draw with mouse while pressing any key red arrow Undo Line Current screen Delay o Seconds Description four email Address Create new bug Update esting bug Bug ID Send Help Exit The Capture button 3 Using the mouse select the area to make a screen shot of and to attach to the bug report 2012 182 The HIPAAsuite Claim Payment Master Selecting the area 4 Once you release the mouse button the screen capture image appears the program You can enhance your screen shot with drawings By pressing any key and holding down the mouse while over the canvas you can highlight in yellow free draw in red or make red arrows You can highlight sections as shown further High lighting a section You can draw circles as displayed on the following screen shot 2012 Bug Reporting and Program Update 183 Draw with mouse while pressing any key Unde Circling a section You can point arrows to pinpoint your
137. of Payment table Key of Claim T able 2 Statistics T53 ProcedureCode RevenueCiode SubmittedProcedureCode FiscalPenodD ate Charged amp mount ClaimCount Paid mount L Position nS L UnitsPaid CI TotalCharges Units Charged Claim Data 0 SeniceD ate Gani PrevideiContiolo ClanP sition File Clam5tatus AttachmentCode Claem amp mount LoestionMurnber O ClamPaid Prod amp uthiHo PatiertResponsbilty Healthcare Policy D L1 Insurance ype AllowedAmount zl PaversClaiml D Pitan CI FaciityT ypeCode Select All Select None Li Provider Level Adjustments H GrouperPokeyhum o of Payment Table E Memberidentilum Li ProvideriO PriorchuthiNum oO FiscalPenodD ate u AdiustmerniFieason PreDeterminationNum EST Adiustmentldenhfier RepicedClaimNum AdiustmentAmount AutherizationiHum x Select SeeciNone Selecta SelectNone Claim Level Adjustments of Claim T able AduetmentGroup L Adustmenthmount amp dpistmentty Select All Select None Save Field Configuration Line Level Adjustments Rey of Claim Line Table AdjustinentGreup AdjustnentRiesson Adiustment amp mount Adiustment ty Select All S
138. omatic Scheduler EDI Receive Log EDI Send Log Request EDI Exchange License EDI Exchange License Information The encryption setup menu 2 The following window will appear 2012 EDI Exchange 155 Original Unencrypted Outbound Files Key Pair Information Name e mail for Public Key 8 Keep a copy in an UnEnCrypted Folder Delete the original File Pass Phrase for Private Key Crypto Program GnuPG GnuPG Path to gpg exe The program didn t ind GnuPG executable Please specify path manually or download GnuPG installation from http www gnupg org SFTP Client Path to private key file Pass Phrase for Private Key The encryption setup screen 3 In this window define the following options General Encryption Options e Original Unencrypted Outbound Files e Keep Copy in an Unencrypted Folder When the HIPAAsuite program creates an EDI file for a trading partner that has selected encryption you can keep an unencrypted copy in the Outbox tradine partner Unencrypted folder This is useful when you need to go back to the file and check on problems Note Once you encrypt a file with the public key of your trading partner you will not be able to open it again Only the owner of the private key can decrypt it and read it e Delete the Original File If you do not want to keep the unencrypted copy select this option e Key Pair Information 2012 16 The HIPAAsuite Claim Payme
139. on via Scheduler 32 Troubleshooting Badly Formatted EDI File 2 22 38 Creating Image Files and PDFs 38 Creating Image Files from ooi ea coe ox 38 40 Image ODUOLS eiae MERI SR NR MUNERE 42 Configuring Image INGO ceo pras oops TE DA 44 Creating the Image Index Table 49 Using the Database 53 Dalal me 53 Setting up Database eines 55 Creating TaDle S e 62 Viewing the Database Schema airan 70 selecting Fields to sercicssccccnssesesccssesesenasvccsaseoaeetaussuarseaspancscneseoccunescseseusseesseaseacesineoeeds 71 zi el SING EXpo rted Data sits hice eee ie elit 76 De IG Nunying Data mm 78 Autoprocessing 83 2012 Contents 1 2 3 4 5 Part VII 1 Part VIII 1 2 3 Part IX 2012 Running the Application from the Command Line
140. on warning message Make sure there are no error messages and the table creation has been completed successfully Compare Script with existing Table HIPAAsuite products go through continual development and improvements Often these changes lead to new fields in the database While it is easy to drop a table and regenerate it with the new fields you will loose all the data in the table To avoid this trouble there is the button Compare Script with existing Table you click this the table structure in your database will be compared with the script There are two possible outcomes Your table is up to date You have all the fields in your table There is nothing to do Table is up to date or if your table is missing recently added fields you will see a window pop up that shows an Alter Table script with which you can add those fields to the table without interfering with existing data In the latter case you can click the Execute Script button and the field will be added and a message will confirm your changes 2012 The HIPAAsuite Claim Payment Master 7 2 4 Alter Table statement successfully executed 3 Defining Auto Processing Options In the Auto Process Setup you can instruct the program on what to do after analyzing and decrypting the received files in the Inbox Manager The auto processing enables you to combine and run multiple fulfillment steps together for example export saving printing
141. orts new files to the database e Print If selected the module prints files using the selected printer e Create Auto Response If selected the module creates an auto response to the received files e Save to If selected the system automatically saves files as e Image e Excel e ASCII 4 Click Save 2012 112 The HIPAAsuite Claim Payment Master 7 2 5 Automatic Processing Options Get Ales from Trading Partners Check FTP servers for new files and place them into Inbox Default Automatic Processing Options Export in Database W Print Use printer Fax Saveto Ml Image W Excel W ASCII The Save button Once you have saved the auto processing options the files will not only be analyzed but also processed according to the defined settings Proceed to the next step Defining Communications Directoryl na 4 Defining Communications Directory EDI file directory is an obligatory setting you need to set up before starting using the EDI Exchange In order to keep track of the thousands of EDI files that accumulate over time EDI Exchange uses a folder structure which we call the HIPAAsuite Communications Directory or HlPAAsuiteCommbir in short In it you will find all your EDI files sorted into several categories e Inbox e Outbox ProcessedFiles e EncryptedFiles e SuspendedFiles Within these directories there will be folders for each Trading Partner and type of tra
142. ox Manager FTP Client SEF Files EDI Exchange Setup Encryption Setup J GewetDIbehageTaber Create 999 Files Tables Autoprocess Setup Automatic Scheduler EDI Receive Log EDI Send Log Request EDI Exchange License EDI Exchange License Information v ad yx E Za gt The menu item to create the necessary tables 2 The Create Tables for EDI Exchange screen will appear Table creation and or modification for your database is handled here 2012 The HIPAAsuite Claim Payment Master Database Microsoft SQL Server TRANS LOG TRANS LOG ERRORS SEND LOG COMPANY SETUP TradingPartner Table script 1 CREATE TABLE dbo TradingPartner TradingPartnerlD varchar 15 NOT NULL TradingPartnerID_QUAL char 2 NULL ETINNo varchar 15 NULL varchar 40 NULL Contact varchar 100 NULL Phone varchar 15 NULL Extension varchar 10 NULL Email varchar 75 NULL Fax varchar 15 NULL LocalFtpUser varchar 20 NULL LocalFtpPassword varchar 20 NULL Address 1 varchar 100 NULL Address 2 varchar 100 NULL City varchar 30 NULL State char 2 NULL Zip varchar 10 NULL FtpAddress varchar 50 NULL PutDirectory varchar 50 NULL GetDirectory varchar 50 NULL FtpArchive varchar 20 NULL FtpUserName varchar 40 NULL FtpPassword varchar 40 NULL IFTPPort varchar 12
143. p Name 98910 at Position 9 DESCRIPTION Maoe mum length of Waming in Line 41 gt DMG D2 19330706 F R5 E2 at Postion 5 DESCRIPTION Non composte data Warming in Line 41 gt DMG D8 19330706 F R5 E2 at Position 5 D Load Date Load Time Operator 8 0 Records from to fe 310747539 TEST 5010 bd C 411479417 71 0308 Details of the EDI Receive Log uus Specify the time period in which the file Time Period From 2 26 2013 Receive Date To 2 26 2013 LoadDate Find Log Files If the records have been exported to the database you can see the time date and record count Accessing EDI Send Log This page contains instructions on how to access the EDI Send Log window It becomes available once EDI Exchange has been initialized 1 Select EDI Send Log under the EDI Exchange menu 170 The HIPAAsuite Claim Payment Master EDI Exchange Check EDI File Trading Partners B Inbox Manager FTP Client SEF Files EDI Exchange Setup Encryption Setup Create EDI Exchange Tables Create 999 Files Tables Autoprocess Setup Automatic Scheduler EDI Receive Log EDI Send Loq Request EDI Exchange License EDI Exchange License Information The EDI Send Log menu 2 The following window will appear The EDI Send Log screen Specify the time period in which the file was processed Time Period From 8 5 20
144. plication path and click Refer to Command Line Arguments ao for more information Example C Program Files HIPAAsuite HIPAA Claim Payment Master HIPAAClaimPaymentMaster exe HIPAACimPa ymentMaster Task Schedule Settings A CWINDOW S Tass Payment Master job aster HIP AACTaimPayment Master Inbox Y Y Run only logged o v Enabled scheduled task runs at specified time The HIPAAClaimPaymentMaster task window You can see the path to the executable is in quotes and then the arguments follow In this example the directory c EDI Inbox will be processed The first Y indicates that the data will be exported The second Y in 4th position indicates that the images will be printed The HIPAAsuite Claim Payment Master 3 7 4 1 Logs may be helpful when running the program automatically through the scheduler See Log 25 Troubleshooting Badly Formatted EDI File After clicking on the Process button you see a message with the following error message This is most likely caused by a badly formatted EDI file Processing will stop There are a few reasons why this can happen 1 The file is not an EDI file You can open the file in Notepad and check if it starts with ISA When the first 3 characters are not ISA then it is not an EDI file 2 The file could still be encrypted 3 The fil
145. port EDI is a very non intuitive format and designed around computer efficiency and not human readability Below is an example of an EDI file you can recognize only few words in this garble The HIPAA Claim Payment Master takes the cryptic EDI files parses out the information translates the codes back to English and allows one to print and display the information so that it can be viewed understood interpreted and entered into an accounting system The software can also export the payment information contained in 835 Remittance Advice files into any ODBC aware database such as Microsoft SQL Server Microsoft Access MySQL Oracle and so on This way the information is searchable and it will be easy to write programs to import the data into existing systems EDI is increasingly adopted in the health care industry and mandated by the HIPAA act of 1996 EDI is ideal to exchange information between computers but it is inherently hard to read for humans Many complex properties are represented as two letter abbreviations 2012 2 The HIPAAsuite Claim Payment Master ISA 00 ff 123456 89 20 510442 020518 1601 U 00401 223800002 0 T 7 GS HP 9398887766 387654 70021026 1135 223800002 x 004010X091 51 835 229800002 BPR C 175 00 C CHKP eee 00205 18 TRN 1 16588 1521685100 DTM 405 20020509 HT PR Great Benefit Plan N3 100 MAIN STREET NA KANSAS CIT Y M0 64 108 MARCUS J WELBY FI 09 654322 N3 55 HIG
146. r View Refresh 4 Help 1 The HIPAAsuite Claim Payment Master In Windows XP the Scheduled tasks directory looks like this iB scheduled Tasks 7 3 4 7 4 7 4 1 File Edit View Favorites Tools Advanced E 2 Search Folders Hl GA nanen Address Scheduled Tasks Go Last Result Cre Add Scheduled Task ee Bims Every 2hourts From 12 00 for 8 00 00 PM 2 00 00 AM 1 Could nat start 142 Ad ariel Ea 2 Control Panel EG My Documents Shared Documents Icons By My Network Places eae she Paste Shartr ELEC 1009 c a l gt The Scheduled Task menu item in Windows See Running the Application via Scheduler in the help of the host HIPAA application for detailed instructions on how to schedule a task Using the Command Line Arguments CLI The only EDI Exchange specific command line argument is Auto The Auto processing options are defined in another 5 and with the command line argument Auto they will be exercised Make sure that you have configured them according to your needs Working with Trading Partners Setting up Trading Partners With EDI Exchange you can keep track of your trading partners You can set up their i
147. result messages for the operation The details are displayed in the Activity Log and Warnings area Loading EDI Files into Inbox Processing Inbox al Activity Log and Warnings Filename 140123142208h x12 SEF file HIPAAClaimMaster SEF Files 837 005010X222A1 SemRef loaded for transaction set 005010X222A1 The Transaction type is 837 Version 005010X222A1 Passed No Errors No Warnings The file has 1 Interchanges 1 Functional Groups and 1 Transaction Sets The file contains 4 Claims The Activity Log and Warnings area displaying log messages 7 6 3 Downloading EDI Files From FTP Server EDI Exchange Inbox Manager allows you to load EDI files into the Inbox folder and process these files Be sure you have setup FTP settings in the Remote FTP tab of the Trading Partner window see Setting up Trading Partners Follow the instructions below to upload EDI files into the Inbox folder 2012 HIPAAsuite Claim Payment Master 1 Access the Inbox Manager by clicking the Inbox Manager under the EDI Exchange menu EDI Exchange Check EDI File Trading Partners Inbox Manager FTP Client SEF Files EDI Exchange Setup Encryption Setup Create EDI Exchange Tables Create 999 Files Tables Autoprocess Setup Automatic Scheduler EDI Receive Log EDI Send Log Request EDI Exchange License EDI Exchange License Information The Inbox Manager menu item 2 Click the Downlo
148. rieval specific address SOAP Submission Address Trading Partners web address for SOAP Batch transactions o SOAP Retrieval Address Some Trading Partners may use a different address to submit or retrieve batch transactions Use this field for a retrieval specific address Using Built in FTP Client EDI Exchange has a built in FTP client This utility allows you to drop off and pick up files from a trading partner that you have defined in the Trading Partners menu see Setting up Trading Partnersl 20 Follow the instructions below to exchange EDI files with your Trading Partner 1 To access the FTP client select Client under the EDI Exchange menu item 2012 EDI Exchange 145 EDT Exchange Check EDI File Trading Partners Inbox Manager FTP Client SEF Files EDI Exchange Setup Encryption Setup Create EDI Exchange Tables Create 999 Files Tables Autoprocess Setup Automatic Scheduler EDI Receive Log EDI Send Log Request EDI Exchange License EDI Exchange License Information The Client menu item 2 The following window will appear Password e FTP Secure FTP SFTP 2012 we The HIPAAsuite Claim Payment Master The built in FTP client 3 Click the Connect to Trading Partner button on the FTP client window Password Directory Secure FTP SFTP The Connect to Trading Partner button 4 The following screen ope
149. rocess all files present in the EDI inbox directory 2012 166 The HIPAAsuite Claim Payment Master Inbox Manager Check EDI File Processing Inbox Select and Check EDI File Download from FTP Server Download from FTP Server Activity Log and Warnings Checking FPT servers at 3 40 15 PM 1 Trading Partners are set up for FTP transfer Checking for files at Trading Partner PARTNER T Successfully connected to PARTNER 1 s directory File test test edi deleted on server 1 Files moved from FTP Servers into Inbox CAProgramDats HIPAAsuiteHIPAA Enrollment W 1 Files moved from Servers into Inbox The Process Inbox button 2 Once the processing is completed review the Activity Log and Warnings information Inbox Manager Ioj X Check EDI Filie 3 3 gt Leading EDI Files into Inbox 77 M Processing Inbox Scloct ond Check ED Fis tom FIP Sever M Alflesin Inbox have been processed Actmity Log and Warnings Filename 834 09 edi SEF file HIPAAEnrolimentMaster SEF Files 834 XD95A1 SemHReft SEF loaded for transaction set DOAQ010X095AT1 test test edi The file was not recognized as a valid EDI file Parser Error Segment ISA Error ISA segment has not enough elements It will not be processed The file was moved C 3 SuspendedFiles Otheritest_test edi on 2 15 2
150. rs Output Mode Inbox Manager Printer FTP Client Screen SEF Files Image File EDI Exchange Setup Encryption Setup Data Import Create EDI Exchange Tables Create 999 Files Tables jn mm Autoprocess Setup hi iR Automatic Scheduler 7 Institutional Dental EDI Receive Log 7 Reporting a EDI Send Log Counter r Request EDI Exchange License EDI Files Lees EDI Exchange License Information Total Amount The EDI Exchange menu with menu items disabled You can register the product by clicking on the EDI Exchange License Information option under the EDI Exchange menu 2012 EDI Exchange EDI Exchange Help Check EDI File Trading Partners gt Inbox Manager FTP Client SEF Files EDI Exchange Setup Encryption Setup Create EDI Exchange Tables Create 999 Files Tables Autoprocess Setup Automatic Scheduler EDI Receive Log EDI Send Log Request EDI Exchange License EDI Exchange License Informat EDI Exchange License Information option under the EDI Exchange Then the license screen appears In the lower left corner you can find the unique registration number needed to create either trial extensions or final licensing EDI Exchange 1 0 Day s remaining for trial 8 This software is for evaluation purposes only and has limited functionality You will have to purchase this software if you want to continue using
151. s of subscribers such as MedicAid government agencies or large employers 2012 EDI Exchange 135 e Payers Entities that pay for health care benefits such as health insurers The next block on the form lists the communication methods and preferences e EDI File Exchange Method Obligatory setting HIPAAsuite supports three communication methods Choose a preferred mode of sending EDI communications to the trading partner FTP Allows you to transmit files actively to the Trading Partner or his Clearinghouse Outbox All files for Trading Partner are stored locally The Trading Partner is responsible for picking up files in his special directory of the local FTP or HTTP server e Email Addresses Enter the email address es into the text field EDI Identifiers Tab This tab relates to the EDI identifiers and EDI Version EDI Identifiers Options Remote Contact Encryption Folders CORE EDI Identifiers and Qualifier eS TTE EDI Version ISA Identifier and Qualifier Record Key 4010 e 5010 ETIN Number and Qualifier Application Sender Code G502 to use Application Recerver Code G503 to use Trading Partner Assigned ID CCHMP The EDI Identifiers tab e EDI Version There are two standards for HIPAA e 4010 This standard was introduced in the original transaction from 2003 to 2011 e 5010 From 2012 on all HIPAA transactions must be conducted in the 5010 vers
152. st Download Connection The Remote FTP tab The file transfer protocol FTP is one of the first internet protocols and goes back to the 1960 s Transporting electronic files was one of the great achievements of the internet During the last 50 years a lot of improvements to this protocol have been made mainly to increase the security of the transfer e FTP For security reasons EDI Exchange supports secure FTP or FTPs e Explicit FTPS Connection The explicit method is a legacy compatible implementation where FTPS aware clients can invoke security with an FTPS aware server without breaking overall FTP functionality with non FTPS aware clients In explicit mode also known as FTPS an FTPS client must explicitly request security from an FTPS server and then step up to a mutually agreed encryption method If a client does not request security the FTPS server can either allow the client to continue insecure or refuse limit the connection Implicit FTPS Connection The implicit method requires that all clients of the FTPS server be aware that SSL is to be used on the session and thus is incompatible with non FTPS aware clients Negotiation is not allowed with implicit FTPS configurations A client is immediately expected to challenge the FTPS server with a TLS SSL ClientHello message If such a message is not received by the FTPS server the server should drop the connection In order to maintain compatibility with existing non TL
153. support team should includes an activation key 5 Once you have the activation key click Register on the program welcome window 2012 Getting Started 17 License Registration Form EDI Exchange License Key o pr evaluation version expires in 14 days The Register button 6 Paste the activation key into the field on the Registration Form and then click Register Registration Form L m m The Registration Form window with entered license key and highlighted Register button 7 The success message will appear in the Result border 2012 18 The HIPAAsuite Claim Payment Master Q Registration Form License Registration Form Dcensekey 11111 11111 1111 1111 Thank you for evaluating HIPAA Clam Payment blasten This is a full functional version of HIPAA Claim Payment Master for evaluation only This evaluation version expires 15 days EDI Exchange component is not registered The license activation result Click Close 8 Once the license key has been entered click Try on the welcome window to continue using the program for another 15 days D ay s remaining for trial 15 This fully functional evaluation You free to evaluate this demo You will have to purchase this software if you wantto continue using it after a free evaluation haz expired Hegistiabon Number
154. ter on a scheduler and automate the processing of files or directories The following is the list of the command line arguments they must be separated by commas 1 The first command line argument is the filename or the directory path If not applicable leave blank 2 The second through fourth arguments following a filename or directory path are reserved for processing options and are triggered by a Y as followss e 2nd argument Export to database C o Program Files HITPAAsuite HIPAA Claim Payment FER HELLE CD EHE EU V UT Thu ER Eb E D 5EDI5835Ii edi Y Using the Export to Database option as a Command Line Argument e 3rd argument TIFF PDF File The payment order remittance advice will be saved as a TIFF image file See Creating Image Files from EDII 381 for details on how to set up the Image printing capabilities Be sure that you have tested the Image printing before trying the command line mode C Program Files HIPAAsuite HIPAA Claim Payment Master HIPAACLaimPaymentMaster e Using the TIFF PDF Image option as a Command Line Argument e 4th argument Print If the fourth argument following a filename or directory 2012 The HIPAAsuite Claim Payment Master path is filled with a Y the 820 file will be printed without ever being displayed G 5 Program Files HIPAAsuite HIPAA Claim Payment Master gt HIPAACLlaimPaymentMaster e 1 83511
155. that the data is not to be replaced and the original data must remain intact Otherwise if there is replacement data in that element the replacement data will be used instead of the original and if the replacement data is a single tilde then the element will be blanked out Blanking out with tildes should rarely be used as it distorts the original data If the original did not have data in an element the output will not have data in that element even if the replacement data exists If the replacement data starts with then the replacement only takes place if there was no data for that element If there was any data in it the replacement does not take place If the replacement data starts with then the replacement takes place every time even if there was no data for that element 2012 Using the Database The configuration file accepts only as the element delimiter and does not use segment terminators Composite data elements are replaced as a whole at this time and individual components of a composite are not replaceable at this time The BIN segment is not handled yet Even though the configuration file only accepts the as the delimiter the data itself may have any valid X12 delimiter 6 Autoprocessing 6 1 Running the Application from the Command Line The HIPAA Claim Payment Master can also accept command line arguments This is a very important feature if you want to put the HIPAA Claim Payment Mas
156. the command line requires that you check the log 251 In the log you may see a message like following Processing of C EDI Inbox 835 started at 3 12 2012 9 21 11 AM Printer is not found in system Processing stopped at 3 12 2012 9 21 11 AM So the log will help you to debug the command line Running the Application via Scheduler The HIPAA Claim Payment Master can be automated through a scheduler A scheduler is software that can be programmed to execute a certain task at a certain time repeatedly Windows has such a scheduler built in The Windows scheduler can be used to let the HIPAA Claim Payment Master execute in regular intervals without user intervention Usually one would let the HIPAA Claim Payment Master scan a directory and then print create image files or export the data and remove the files to prevent duplicate processing 1 If the task scheduler is installed on your system you will find it in the Control Panel To open Scheduled Tasks click Start Control Panel Scheduled Tasks Note In different Windows versions the way to access the Task Scheduler can differ Consult your Windows version documentation 2012 Configuring the Application 33 6 Scheduled Tasks lOl Fle Edt View Favoktes Took Advanced i ae O d Dawe Eee HPE ESE Other Places GGoogeUpdateTaskiserS 1 5 Ati2 07PM every 12 07 00 PM Never Could not start G Control Panel C My Documents
157. the replacement only takes place if there was no data for that element If there was any data in it the replacement does not take place If the replacement data starts with then the replacement takes place every time even if there was data for that element The configuration file accepts only as the element delimiter and does use segment terminators Composite data elements are replaced as a whole at this time and individual components of a composite are not replaceable at this time The BIN segment 15 not handled yet Even though the configuration file only accepts the as the delimiter the data itself may have any valid x12 delimiter This configuration file has a lot more than what you need and in most cases all you have to do 15 remove the at the beginning of a line in order to put that line into effect At this time only patient and subscriber information is de identified and provider IHR left intact That is easily changed by removing the at the beginning of some of the lines amp 4 The configuration file The lines have two parts separated by one or more spaces or tabs e The first part is the for the segment to replace or de identify e The second part is the replacement data In the replacement data any empty data element will indicate
158. tion subdirectory Windows XP c Documents and Settings All Users Application Data HIPAAsuite HIPAA 2012 22 The HIPAAsuite Claim Payment Master Claim Payment Master Configuration Windows 7 Vista C ProgramData HIPAAsuite HIPAA Claim Payment Master Configuration 8 C Documents and Settings All Users Application Data HIPAAsuite HIPAA Claim Payment Master Conf El j My Computer 31 Floppy S C SYSTEM Cj Documents and Settings Administrator C All Users 3 Application Data El C3 HIPAAsuite 3 3 HIPAA Claim Payment Master Configuration C Logs Samples Scripts The Configuration folder in Windows XP Tip The folder is hidden To view edit transaction code sets in HIPAA Claim Payment Master follow the instructions below 1 Go to the Code Sets item in the main menu HIPAA Claim Payment Master 64bit File View DataExport Code Sets Las La EDI Image Setup EDI Exchange Help d Cid Facility Types Output Mode Filing i Printer Frequency rere GenderCode Image File The Code Sets menu 2 From the sub menu select a code set name The following menu items are available via the Code Sets menu 2012 Configuring the Application 23 AtoE e AdjustmentReason e AdjustmentReasonCode e AdjustmentReasonGroup e AmountQualifier e ClaimStatusCategoryCode e ClaimStatusCode
159. tometric Interpretation For the black and white and grayscale images when Black White or 4 bpp options are selected as color depth you can specify the intended interpretation of the image pixel data Select one of the following options e White is Zero The minimum sample value is displayed as white e Black is Zero Default value The minimum sample value is displayed as black e Image Resolution You can change horizontal and vertical resolution of images from 96 to 300 dpi dots per inch Default resolution is 200 dpi Note Theoretically we could use even higher resolutions but it will slow down processing significantly result in approximately the same result in quality Options for PDF e Use Content Compression Checking this option does result in considerably smaller 2012 The HIPAAsuite Claim Payment Master 4 4 files Image Options Options for TIFF lor th Compression Photometric Image Resolution C Blackiwhite LZw Interpretation Horizontal resolution 200 dpi C 4bpp Packbits NIRE EICETO C 8bpp EE V Vertical Resolution Horisontal Resolution 24 bpp C COIT aree 4 Vertical resolution 200 dpi 32bpp CCITT Options for PDF Set default values Help Use content compression The Image Options window Configuring Image Index Document Management Systems with image libraries often require some
160. ts SMTP server requires Logon ELI Connectto the SMTP server via the SSL protocol Use Port Validate outgoing files 1 Reject Incoming Files with more errors than set Count below Halt records if EDI compliance L warnings are found 9 EDI Ales with Other Type in Inbox Leave file for other program Auto process if other program is available The EDI Exchange is successfully initialized message on the bottom of the EDI Exchange Setup window Troubleshooting Initialization 2012 EDI Exchange owe When you are going through the Initialization process of the EDI Exchange you can encounter the following message in the Processing Results window Checking for EDIDev EDIDev is not installed Processing Results EDI Exchange initializatian started Checking SOL settings and tables Connection settings are checked Trading Partners table is checked TRANS LOG table is checked TRANS LOG ERRORS table is checked SEND LOG tabla is checked COMPANY SETUP table is checked COMPANY SETUP data is validated Checking for Required Diractones Inbox Directory is checked Outbox Directory is checked Processed Directory is checked Crypt Directory is checked suspense Directory is checked Checking for EDIDew FdiDev is not installed EDI Exchange encountered the above errors EDI Exchange is not operational until everything checks aut The EdiDev component is not installed
161. ts You can add your staff s email s and the processing messages will be sent to these emails Enter an email address and click Add 2012 EDI Exchange 123 Email Notification Send email notice of newly arrived Files example email com Recipients EDI Files with Other Type in amp Leave file for other program 2 Auto process if other program is available Setting up the email recipients The email address will appear in the list 2012 12 The HIPAAsuite Claim Payment Master Email Notificatior send email notice of newly arrived Files Recipients example email com EDI Ales with Other Type in Leave file for other program 2 Auto process if other program is available Added email recipient 5 Click on the Test button to verify your settings 6 Click on the Save button Root Directory Path Email Server Information Email Notificatior SMTP Server Sender s email address Send email notice of newly arrived Files smip gmail com example amp gmail com User Name E Recipients SMTP server requires Logon user example email com Connectto the SMTP server via the SSL protocol Use Port Fl Other opti Validate outgoing files Reject Incoming Files with more errors than set Count below Halt records if EDI compliance Ale warnings are found EDI Files with Other Type in Inbox Evi Exchange is
162. ts To keep our attomey s blood pressure in check we must remind you that this is being distributed with no warranty us The information window 4 Specify the following e File to de identify Click on Dots button to browse for a resource HIPAA file on The HIPAAsuite Claim Payment Master your local PC e Save de identified file to Click on Dots button to select a destination file on your local PC X12 De Identification Utility File to de identily Save de identified to claredi The X12 De Identification Utility window 5 Click on the De identify now button to process the file As the result you will receive a sucess message like this click OK De Identification Result The De ldentification Result popup You may be informed about error notification messages generated by the utility Click Yes to access them De Identification Information 1 One or more messages were generabed while de identifying Would you like bo view the messages The De ldentification Information popup Changing Configuration To change the De identifying Utility configuration click on the Configuration button E X12 De Identification Utility alm x File to de iderilily Save deidenifiedfieto E claredi The Setting button on the utility window 2012 Using the Database st Click on Edit to open a configuration file
163. ty of EDI Exchange lies beyond the most basic setup that the initialization checks for For this feature to work properly you need to set up an email server which EDI Exchange communicates with You can do this in the Email server Information frame of the setup screen Follow the instructions below 1 Select EDI Exchange Setup under the EDI Exchange menu item 2012 EDI Exchange 121 2012 Check EDI File Trading Partners Inbox Manager FTP Client SEF Files EDI Exchange Setup Encryption Setup Create EDI Exchange Tables Create 999 Files Tables Autoprocess Setup Automatic Scheduler EDI Receive Log EDI Send Log Request EDI Exchange License EDI Exchange License Information i The EDI Exchange Setup menu item 2 The following window will appear EDI Exchange Directory Root Directory Path SMTP Server Senders email address Send email notice of newly arrived Files r Man Pas l PE User Name bd Recipients SMTP server requires Logon Connectto the SMTP server via the SSL protocol Use Port Validate outgoing files Reject Incoming Files with more errors than 4 set Count below Halt records if EDI compliance m warnings are found EDI Ales with Other Type in Inbox 9 m Leave file for other program Auto process if other program is available The EDI Exc
164. uest EDI Exchange License EDI Exchange License Information The SEF Files menu item 2 The SEF Files window will appear a SEF Files Available Standard Exchange Format SEF Files 834 005010K220A1 SemRef SEF 834 XD95 SEF 834 X095A1 SemhHeftSEF 997 4010 SEF 999 005010X231A1 SEF list of SEF files 8 Creating 835 EDI Files 8 1 Setting up Company When you create EDI files there are a few elements needed to identify your company as 2012 Creating 835 EDI Files 173 the sender the producer of this EDI file For this matter use the company setup screen You can specify your company information and other setting related to your company there Note You need to configure the database first See Setting up Database Connection 58 1 To configure the program options select Setup Company Setup in the main menu HIPAA Claim Payment Master 64bit View DataExport CodeSets Image Setup EDI Exchange Output Mode The Company Setup menu Create Comparry Setup Table 2 The following screen will appear Company Setup Indicates Mandatory Fields Company Information Name 3 ISA Segment Sender Identifier Address Qualifier ff E Addess2 Application Sender s Code G52 City ID es State 524 6 PlaniD PayrID f Zip Plus 4 Three letter identifier to prepend 2 ta all outgoing EDI files EDI Version
165. up EDI Exchange TENUES Setup Root Directory Path yiEDn SMTP Server sender s email address smtp gmail com example gmail com User Name Password SMTP serwer requires Logon user te Connectto the SMTP server via the SSL protocol Use Port Validate outgoing files Reject Incoming Files with more errors than set Count below Halt records if EDI compliance warnings are found y Q EDI Exchange is NOT yet initialized The Reject incoming files with more errors than option 5 Click on Save Browse Email Motification C Send email notice of newly arrived Files Recipients example email com EDI Hles with Other Type in Inbox Leave file for other program Auto process if other program is available ee EDI Exchange Directory Setup Root Directory Path DED SMTP Server Sender s email address smtp gmail com example gmail com User Name Password SMTP server requires Logon user E Connectto the SMTP server via SSL protocol Use Port Validate outgoing files Reject Incoming Files with more errors than set Count below Halt records if EDI compliance M warnings are found y Q EDI Exchange is NOT yet initialized Running the Application via Scheduler 1 Send email notice of newly arrived Files Recipients example email com EDI Files with Other Type in Inbox Leave file for other program Auto process if other program is available EDI Exchange integrat
166. up Click on 2012 Using the Database 75 the Test Configuration button If the program finds errors the ODBC Error screen will come up and tell you exactly which fields caused errors inl x Table edi paidclaims oe ee EE ERROR 42322 MySQLJODBC 5 1 Drrver mysqld 5 5 21 Unknown column MIA in field list The ODBC error window You can study the errors and the message usually is precise enough to understand what is wrong In the above case an access database is missing the fields in error When you click the Uncheck Fields in Error button then all those fields will be unchecked and excluded from the data export 2012 The HIPAAsuite Claim Payment Master E j Fie Level Data PaymentiD Key of Payment table TradingPartneriD E E Statistics T53 ED FileName 7 Provider D 7 File Date Type E FinancialData BPR Segment Ez FiscalPeriodDiate TransactionHandlingCode 4 ClaimCount Payment mount v Pasitionin Summary Ez DebtCredt z TotalCharges Payment Method E Claim Data SendingBankNo Ez CiaimiD SenderhccountNo Ez ClaimPostioninFile PayeriD Claim Status AttachmentCode PayerDivision Ez ClaimAmount Ez LocationNumber A RecevingBank No Ez ClaimPasd Ez Prior amp uthiNo ReceiverAccountNo Patient Fieponsiblty v HeakthcarePolicylD CheckNumber or EF
167. uration The Test Field Configuration button You will receive a message like this Click The success message When ready click on the Save Field Configuration button 2012 Creating Image Files PDFs 49 Fields to be included Image Index File y EDFilename imager ilename TradingPartnerD 7 PayDate PayoriD C PayorName PayeeLast SubscriberLast SubscriberFirst Subscriber PatientLast v PatientFirst Patient v AmountCharged AmountPaid e Test Field Configuration The Save Field Configuration button Once all image index options have been defined and saved click Close The Close button 4 5 Creating the Image Index Table To create the table for the image index follow the instructions below 1 Select Image Create Image Index Table in the main menu gt HIPAA Claim Payment Master 64bit File View DataExport Code Sets Image 3 Image Viewer Image Setup Output Mode Image File Options S ous Image Index File Options C Screen The Create Image Index Table menu 2 The following window will appear 2012 so The HIPAAsuite Claim Payment Master E Create Image Index Table Microsoft SQL Server C MyS L Generic L 4 1 ID bigint IDENTITY 1 1 NOT NULL EDF lenire var
168. ureCodeDesc 80 default NULL 2 UnitsCharged varchar 5 default NULL 23 Save Execute Script The Claim Lines tab 2012 Payment Claims Claim Level Adj Claim Lines 1 CREATE TABLE edi_paidclaimlinead 2 ID NOT NULL auto increment 3 LinelD bigint 20 NOT NULL 4 AdjustmentGroup 2 default NULL 5 AdjustmentReason char 3 default NULL AdjustmentAmount char 10 default NULL 7 AdjustmentOty char 5 default NULL 8 UNIQUE KEY ID 7107 9 ENGINE InnoDB DEFAULT CHARSETlatin1 The Claim Line Adj tab 2012 The HIPAAsuite Claim Payment Master 5 4 Gl Create Tables Database Microsoft SOL Server mysavceneric Claims ClaimLevelAd Claim Lines Claim Line Adj Provider Level Adj y 1 CREATE TABLE edi_providerleveladjustments ID bigint 20 NOT NULL auto_increment PaymentID bigint 20 NOT NULL Provider D varchar 50 default NULL FiscalPenodDate varchar 12 default NULL AdjustmentReason char 3 default NULL Adjustmentidentifier varchar 50 default NULL AdjustmentAmount decimal 15 2 default NULL UNIQUE KEY ID 7107 10 ENGINE InnoDB DEFAULT CHARSET wtf8 lata HIPA A Suite HIPAA Claim Payment Master ScriptsProviderlevelAdi MySOL sql The Provider Level Adj tab Viewing the Database
169. user The task will run as if it were started by that user Click Next 2012 Autoprocessing Scheduled Task Wizard Enter the name and passy run as it were started by that user Enter the user name Enter the password TET Confirm password 3000 f a password is not entered scheduled tasks might nat run The Scheduled Task Wizard window 7 In the last screen make sure you have specified all data correctly Click Finish to save your task 8 The scheduled task has been added to the system Now lets edit the new task and add the desired command line arguments with the appropriate options Double click the newly created task in the Scheduled Tasks window 9 Enter parameters to the field after the application path and click OK Tip Logs may be helpful when running the program automatically through the scheduler See Accessing Logs 25 7 71 Getting Started 7 1 1 About EDI Exchange EDI Exchange is a module available in most HIPAAsuite EDI applications It is an option that you can purchase for an additional cost Some of our products such as HIPAA Claim Master process EDI files but do not receive or send EDI files to and from your trading partners EDI Exchange is created to do that EDI Exchange is designed for those organizations that have a large volume of EDI files need more order and automation and adhere to tougher complia
170. ustments 10 bigint 20 NOT NULL auto increment ClaimlD bigint 20 NOT NULL AdjustmentGroup 2 default NULL AdjustmentReason char 3 default NULL AdjustmentAmount char 10 default NULL AdjustmentOty char 5 default NULL 8 UNIQUE KEY ID g 9 ENGINE InnoDB DEFAULT CHARSET latin1 The Claim Level Adj tab 2012 e The HIPAAsuite Claim Payment Master ES Create Tables PE C Microsatt SOL Server 1 CREATE TABLE edi paidclaimlines 2 ID bigint 20 NOT NULL auto increment 3 CleimlD bigint 20 NOT NULL 4 PSvc s 5 ProcedureCodeQual char 2 default NULL ProcedureCode varchar 30 default NULL 7 1 char 2 default NULL 8 ProcedureModifier2 char 2 default NULL 9 ProcedureModihier3 char 2 default NULL 10 ProcedureModiher4 char 2 default NULL 11 ChargedAmount varchar 10 default NULL 12 PaidAmount varchar 10 default NULL 13 RevenueCode varchar 10 default NULL 14 UnitsPaid varchar 5b default NULL 15 SubmittedProcedureCodeQual 21 default NULL 16 SubmittedProcedureCode varchar 30 default NULL 17 SubmittedProcedureModifierl char 2 default NULL 18 SubmittedProcedureModifier2 2 default NULL 19 SubmittedProcedureModifiers char 2 default NULL 0 SubmittedProcedureModifier4 char 2 default NULL 4 SubmittedProced
171. ver Code Your trading partner should tell you the Receiver Code If you are in doubt repeat 15 08 7 Click the Go button 8 If some information is still missing you will see an error message The information you put in the screen is now saved for future transactions and will come up the next time you bring up this screen 9 The EDI transaction is now displayed in the text box below 10 The transaction exists only in memory To save it to the disk click on the Write to File button A dialog box will pop up and ask you for a file name Provide a filename and save the EDI file 11 Now you can click on View EDI File to see it in the EDI editor Read more in Using the EDI Editor 271 Bug Reporting and Program Update Reporting an Issue HIPAAsuite likes to make bug fixes fast and transparent For this purpose we include n Bug tracker with the HIPAA Eligibility Responder btnet Bugtracker in ASP Net is an open source project HIPAAsuite implemented Bugtracker Net in all its products to track bugs and enhancements One of the reason we liked btnet was the screen capture capabilities We adapted and included this facility 1 You can reach the Issue Tracker under the Help menu Click on Help gt Report an Issue in the main menu 2012 Bug Reporting and Program Update tet HIPAA Claim Payment Master amp 4bit Fie DataExport CodeSets Image Setup EDI Exchange Help AF o XM D
172. view Explanation of Payment Payer Great Benefit Plan Payee DR MARCUS J WELBY 100 MAIN STREET 55 HIGH STREET KANSAS CITY MO 64108 SEATTLE WA 98123 Pay Method Check Bank ID Account Account Chk Iss EFT Date 05 18 2002 Total Amt 175 00 Payer ID Check EFT No 16588 Patient Name JOHN DOE Member ID Number 11122333301 Provider Name JOHN WELBY Federal ID 987121234 Claim Identifier 885019 Status Processed as Primary DRG Code Total Charge Amt 305 00 Facility Office Control 229800001 Payment Amt 175 00 Frequency DRG Weight PatientResp Amt 15 00 Filling Provider Organization Discharge Fraction Received 05 04 2002 Claim details assembled from the database If you have previously selected all fields to be exported then you will have all the information from the source EDI file But for the largest part you can completely reassemble the payment details as they came in on the EDI file De Identifying Data De identifying Utility can be used to de identify X12 HIPAA transactions You can replace Private Medical Information PMI with random numbers and names This should facilitate the testing of the HIPAA transactions without compromising individuals privacy The software is free for all users Read more on http www claredi com It is your responsibility to make sure the configuration file meets your de identification requirements 1 Go to Help De identifying Utility in the main menu
173. y Defined 2012 2012 Creating 835 EDI Files 175 Indicates Mandatory Fields ISA Segment Senderldentiler 0000 Qualifier Duns amp Bradstreet Application Sender s Code GS 2 Duns Plus Suffix Tax ID 20 Health Industry Number Camer Number Plan 10 Payor ID Fiscal Intermediary ID Nurr Three letter identifier to prepend 2 Medicare Provider and Sup to all outgoing EDI files 30 U S Federal ID Company Coda 15 14 and 15 EDI Files will be y C Test Production FP Acknowledgement req Cancel The Qualifier drop down menu e Application Sender s Code GS_2 The option represents the program or machine that created the file Usually the same as the ISA Segment Sender Identification You can select other ID if you need Obligatory option e Tax ID Obligatory option Also called an Employer Identification Number EIN e Plan ID Payor ID Fill in your Payer ID and Plan ID if you have one this is only important for the 271 and 277 transactions Optional setting e Three letter identifier to prepend to all outgoing EDI files Optional setting Makes your files easily identifiable EDI version Specify EDI version e only 4010 e only 5010 Contact Information 176 The HIPAAsuite Claim Payment Master The contact information goes into the PER segment of outgoing transactions Contact Person e

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