NOTE: These tables were designed around the State of Ohio's MACSIS medicaid system. Your state's use of the 837 form may vary. In particular, their use of identifiers may be different. For MACSIS specific identifiers, examples are given in brackets.
NOTE: The terms 'resident' and 'subscriber' are synonymous. I work for a residential care facility, and am used to calling them residents. I may also accidentially refer to them as 'kids' or 'children', because that is the population we serve. All are synonymous with subscriber :).
| Field | Type | Description |
|---|---|---|
| mode | char(1) | T for TEST or P for Production |
| back_url | char(120) | The URL SQL_HIPAA should go to when all processes are complete. |
| cancel_url | char(120) | The URL SQL_HIPAA should go to if there is an error during processing. This might be a clea-up routine of sorts. |
| batch | char(30) | The batch number for this file. This will be used in 837 fields GS06, GE06, ST02, SE02, and BHT03. Each batch (i.e. file) should have a unique number. It can be alphanumeric. |
| file_name | char(128) | The file name of the 837 file that SQL_HIPAA will create |
| use_autoftp | int | This indicates if the file should be FTP'd to a site automatically in the case of a successful file creation... 0 for no, 1 for yes. |
TABLE: hipaa_from - UNDER CONSTRUCTION
Contains program execution status information and/or any errors returned from SQL_HIPAA.
| Field | Type | Description |
|---|---|---|
| back_status | int | Returns 0 for successful. Anything greater than zero implies an error occured. |
| back_statustext | char(120) | Specific error results |
| total_services | int | Total number of service line items billed |
| total_claims | int | Total number of claims billed |
| total_amount | decimal (12,2) | Total charges billed |
TABLE: hipaa_orginfo
Contains information regarding the agency, contacts, and potential FTP information.
| Field | Type | Description | |
|---|---|---|---|
| agency_name | char(25) | The name of agency | |
| agency_address_1 | char(55) | Line 1 of the agency's street address | |
| agency_address_2 | char(55) | Line 2 of the agency's street address | |
| agency_city | char(30) | The city the agency is located in | |
| agency_state | char(2) | The state the agency is located in | |
| agency_zip | char(15) | The zip code the agency is located in | |
| agency_contact | char(60) | A general contact person (not necessarily EDI related) in the agency who will be contacted if a non-technical problem is found in the file. | |
| agency_contact_num | char(80) | The phone number of the person in agency_contact | |
| agency_billid | char(80) | The Billing Provider Identifier (for 837 field NM109) [MACSIS: Agency Tax ID] | |
| agency_sid | char(15) | The Billing Provider Secondary Identifier (for 837 field REF02) [MACSIS: Agency UPI] | |
| receiver_name | char(25) | The Receiver Name (for 837 field 2000A:NM103) [MACSIS: Board Name corresponding to number in next field, receiver_id] | |
| receiver_id | char(15) | The Receiver ID (for 837 fields ISA08/GS03/2000A:NM109) [MACSIS: Board Number and Type] | |
| edi_contact | char(60) | An EDI contact person who will be contacted if a technical problem is found in the file. | |
| edi_contact_num | char(80) | The phone number of the person in edi_contact | |
| ftp_site | char(80) | IF AUTOFTP TO BE USED: The IP or hostname of the host to deliver the file to upon successful creation of the 837 file. | |
| ftp_account | char(80) | IF AUTOFTP TO BE USED: The account name. | |
| ftp_password | char(80) | IF AUTOFTP TO BE USED: The password for ftp_account | |
| ftp_directory | char(120) | IF AUTOFTP TO BE USED: The directory on fy_site to place the file |
TABLE: hipaa_resinfo
Contains demographic info about residents who have services listed in hipaa_services.
NOTE: For the address fields, please check with your board. For MACSIS purposes, use the address in which the resident was enrolled into MACSIS.
| Field | Type | Description | |
|---|---|---|---|
| pri_id | char(7) | The Subscriber Primary ID (837 field NM109) [MACSIS: UCI] - Must match pri_id in hipaa_services | |
| control_num | char(38) | The Patient Control Number (837 field CLM01) [MACSIS: NOT CURRENTLY USED, USES SERVICE LINE ITEM CODE INSTEAD] - This can be a complicated field. The Implementation Guide states that this may be either a patient account number or a unique claim number. However, the Implementation Guide STRONGLY suggests that this needs to be a unique number for this claim. For MACSIS, it's recommended the line item code is used instead. For other locales, what to put here may be needed to be asked to the board! | |
| first_name | char(15) | First Name | |
| middle_name | char(15) | Middle Name | |
| last_name | char(15) | Last Name | |
| dob | date | Date of Birth | |
| sex | char(1) | The Sex/Gender | |
| ssn | char(11) | The Social Security Number | |
| address_1 | char(55) | Line 1 of the resident's street address | |
| address_2 | char(55) | Line 2 of the resident's street address | |
| city | char(30) | The city of the resident's address | |
| state | char(2) | The state of the resident's address | |
| zip | char(15) | The zip code of the resident's address | |
| diagcode1 | char(6) | An ICD-9 diagnostic code | |
| diagcode2 | char(6) | An ICD-9 diagnostic code | |
| diagcode3 | char(6) | An ICD-9 diagnostic code | |
| diagcode4 | char(6) | An ICD-9 diagnostic code | |
| diagcode5 | char(6) | An ICD-9 diagnostic code | |
| diagcode6 | char(6) | An ICD-9 diagnostic code | |
| diagcode7 | char(6) | An ICD-9 diagnostic code |
| Field | Type | Description |
|---|---|---|
| charge_amount | decimal(8,2) | The amount to be billed for this line item. |
| units | decimal(8,2) | The number of units (must be valid HIPAA units!) |
| note_date | date | The Date of Service |
| pri_id | char(7) | Must match pri_id in hipaa_resinfo |
| pos | char(2) | Place of Service |
| modifier1 | char(2) | Procedure Modifier 1 |
| modifier2 | char(2) | Procedure Modifier 2 |
| diagcode1 | char(6) | An ICD-9 Diagnostic Code |
| diagcode2 | char(6) | An ICD-9 Diagnostic Code |
| diagcode3 | char(6) | An ICD-9 Diagnostic Code |
| line_control_num | char(30) | Line Item Control Number - This is an in-house generated number used to identify this line item. |
| proc_code | char(5) | Procedure Code |
| tempbill | char(1) | RESERVED - DO NOT USE |
| temp1 | char(30) | Not used - for external program usage |
| temp2 | char(30) | Not used - for external program usage |
| temp3 | char(30) | Not used - for external program usage |
| temp4 | char(30) | Not used - for external program usage |
| temp5 | char(30) | Not used - for external program usage |