X12 TCL to Remove Payors from 837 File

[Don Leutner]

I am in need of some help to manipulate an 837 file.  What I want to accomplish is to remove all of the records that DO NOT pertain to Medicare or Medicaid from the file.  Has anybody done this before?  Do you have TCL I can look at?  Even any TCL that might be close would be appreciated.  Any guesses what this might do to the integrity of the file, ie totals?

I think what I’ve determined is that I need to remove all segments from the initial HL thru to the following HL where PI not = 1434 or 1467.

We are on CL 5.6.

Topic

[Jim Kosloskey]

Don,

Are the transaction sets for Medicare (or Medicaid for that matter) in their own ST/SE set or are their multiple Payors identifed within an ST/SE set (Medicare, Medicaid, commercial insureres)?

email: jim.kosloskey@jim-kosloskey.com 30+ years Cloverleaf, 60 years IT – old fart.

[Don Leutner]

The files I have contain multiple ST/SE sets and the Medicare/Medicaid could be within each along with others payors.

[Jim Kosloskey]

Don,

I have never done this but I don’t see any reason why this could not be accomplished within an Xlate if you wanted to go that way.

Depending on the Companion Guides I would say your assumption regarding what needs to be removed is correct. Also IF there are any intra Payor totals being kept (like total dolloars repoirted or something like that) you will need to alter those segments.

As far as the SE totals, if you do this in an Xlate as I recall the Xlate (at least in Cloverleaf 5.6) will count up the number of Segments in the ST/SE set and place the result in the Se for you.

I am guessing you are splitting on ST and so you will get each ST/SE as a separate message in the Xlate.

As far as the GS totals go the hcibuildinterchange will total those for you so I don’t think you have to do anything there.

Again the Companion Guides and the Implementation Guide are the best sources to tell you what if any totals are needed.

email: jim.kosloskey@jim-kosloskey.com 30+ years Cloverleaf, 60 years IT – old fart.

[Jim Kosloskey]

Don,

I have never done this but I don’t see any reason why this could not be accomplished within an Xlate if you wanted to go that way.

Depending on the Companion Guides I would say your assumption regarding what needs to be removed is correct. Also IF there are any intra Payor totals being kept (like total dolloars repoirted or something like that) you will need to alter those segments.

As far as the SE totals, if you do this in an Xlate as I recall the Xlate (at least in Cloverleaf 5.6) will count up the number of Segments in the ST/SE set and place the result in the Se for you.

I am guessing you are splitting on ST and so you will get each ST/SE as a separate message in the Xlate.

As far as the GS totals go the hcibuildinterchange will total those for you so I don’t think you have to do anything there.

Again the Companion Guides and the Implementation Guide are the best sources to tell you what if any totals are needed.

email: jim.kosloskey@jim-kosloskey.com 30+ years Cloverleaf, 60 years IT – old fart.

[Don Leutner]

Thanks Jim, appreciate your comments.  As we don’t have an X12 variant that seems to match the file layout, I guess I was thinking it would be better to do this via tcl rather than an xlate.  But then, as you stated, the xlate may do some of the totaling for me.  

Still would like to know if anybody has attempted this before via a tcl proc and how they coded the tcl.

[Jim Kosloskey]

Don,

What releases of X12 and what version of Cloverleaf?

If you have the Implementation Guide and the Companion Guides you can build your own variant (I suspect it will be very close to one of the standard releases).

I have built X12 variants before and I don’t recall that being very difficult.

email: jim.kosloskey@jim-kosloskey.com 30+ years Cloverleaf, 60 years IT – old fart.

[Bob Richardson]

One and All,

Just a factoid for you:  Cloverleaf will update the SE counter field automatically if you add or remove X12 segments.  Discovered that feature during our testing of X12 270/271 translates when we needed to drop and add segments.   This is not documented. (We run 5.6 R2).

As Jim points out, the X12 translates are not that hard IF (!) you have good specs.  Fortunately for us we have an X12 expert (who used to train staff on the X12 standards):  he helped us to develop the X12 variants by chopping out a lot of the fluff that is in the standard Cloverleaf definitions for 270/271.

Maybe you have a resource in your company who can assist with defining the Claims X12 layout for you?

Hope this helps.

[Author]

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