Dummy’s Guide to the ANSI 837

1. Dummy’s Guide to the ANSI 837 HIPAA Implementation Guide Overview By: Bob Perlitz 09/25/2003

2. Types of HIPAA Data Elements • Required data elements are those that every provider using the transaction must supply. • Situational data elements are those that providers must supply – if their situation calls for them. The situation depends heavily on the services provided and specialty of the physician, but may also depend on factors such as to what state the claim is being sent.

3. Data Structure • Related data segments are arranged in loops • Related loops form a hierarchical level (HL) • Loops within loops are called nested loops

4. Hierarchical Level Loop Data segment Data segment Loop Data segment Data segment Loop Data segment Data segment Loop Data segment Hierarchical Level Loop Data segment

5. Loops and Data Segments • Each loop may contain several data segments. • Example: Loop 2010A BILLING PROVIDER NAME, the Segment NM1 is the Billing Provider Name, Segment N2 is Additional Billing Provider Name Information. • Within each data segment, there may be several data elements

7. More About Data Structure • Each hierarchical level may repeat a specified number of times depending on the content. • When loops are nested, an inner loop cannot exist without its corresponding outer loop.

8. Implementation Guide Explanation • Data elements are explained as they relate to each data segment within each loop. • Each data segment contains four parts, three of which are shown in the following illustration. • Fourth is the STANDARD which does not pertain to HIPAA

10. Implementation • Identifies: • Loop that the data segment is in (Loop 1000B) • Usage (in this case it is REQUIRED) • How many times the loop repeats (ONCE), • Notes • Example

11. Diagram • Provides picture of the data elements in the segment. • Boxes outlined in bold are REQUIRED, others are SITUATIONAL • Boxes with names crossed through are NOT USED

12. Data Element Example • First box represents the data element “Entity Identifier Code.” • “NM101” is the Reference Designator • “98” is the Data Element Number • “M” (or this may be “O” or “X”) is part of the “Standard” and should be ignored • Attribute: ID stands for Identifier, AN means Alpha-Numeric, etc. • “2/3” refers to the minimum and maximum size of the data

13. Element Summary • Describes, in further detail, each data element in the Diagram • For many codes, this is where valid values are given • For Situational data elements, this is where the “situation” is defined

14. Questions will be taken at the end.