Each segment contains data elements. Data elements are the same as the data provided by each individual Form Locator position on the UB-92 or the HCFA-1500 claim forms. The number of elements varies depending on the segment's purpose. Data elements are separated by asterisks (delimiters). In the example below, the ST segment has two elements and the BHT segment has six elements.

Counting Data Elements

In order to correct errors in an 837, you need to know how to count the data elements. Element counts begin to the right of the segment. In the above example:

Get to Know the Implementation Guides and Addenda

Three Different Guides/Addenda

There are three versions of the Implementation Guides and Addenda. Each has an alphanumeric code. The last two digits distinguish one 837 file from another.

Required or Situational

Loops, segments, and elements can be required or situational. If required, it is mandatory that this information is included. The claim will be rejected if the information is not included.

Situational information is information that may or may not be needed depending on the claim's criteria.

Each Implementation Guide explains what information is required and what is situational.

Loops Are Important

Each 837 file is broken into sections of data. These sections are called loops. Each loop has a particular focus, e.g., Submitter Name, Billing Provider Name, Claim Level Information, Service Line. The data stored within loop sections are similar to that stored in Patient Registration or Fileman files.

Some data segments repeat. For example, there could be several address lines - for the Billing Provider, the Subscriber, the Patient, etc. The segment identifier for every address is N3.

However, each of these address lines will be in a different loop:

Note: Not all the loops will be the same for all three Implementation Guides and Addenda.

The loop number tells you which address caused an error and which section of the claim needs to be edited. The loop number has four digits and often is followed by one or two alphabetical characters: 2400, 2010BB.

The Error Report

997 Format

The 997 format is somewhat different from the 837 format. On a 997 file, the segments after the header all begin with AK. The data elements are counted in the same way they are for an 837 file.

The AK Segments (below in bold) indicate whether the file was accepted or rejected.

• If the file passed, it contains an "A" for accepted in the first element of the AK5 and AK9 segments.
• Files that have only AK5 and AK9 segments are error free and need no further attention.

• If the file is rejected, it contains an "R" for rejected in the AK5 and AK9 segments.
• Files that have been rejected are the only files that display the AK3 and AK4 segments.
• AK3 and AK4 segments occur for each error found. There are two errors below.
• The AK3 and AK4 segments on the 997 report show the user the location (loop, segment, element, line) of the error on the matching 837 file.

In order to confirm whether batches were accepted or rejected by an insurer, you must be able to identify which batches passed and which batches failed. You must also be able to match the rejecting 997 to the 837 file. Here are some key things to learn to look for.

1. Batch number
   The 837 is assigned an individual batch number when the batch is created. The corresponding 997 file will contain the same batch number.
   • On an 837 file, BHT03 contains the batch number.
   • On a 997 file, AK102 contains the batch number.
2. 837 or 997
   On both an 837 and a 997, ST01 identifies the type of file (837 or 997).
3. Dates and times
   Dates and time of file transmissions are stored in the Header elements of each file. This information can also be used to identify file batches.
4. Type of file
   The files can also be identified as institutional (…096), professional (…098), or dental (…097) by the alphanumeric code that corresponds to the Implementation Guides.

These two files match: same batch number, same date and time, and same type of file.

• Incorrect formats
• Missing information
• Incomplete information

See the Quick Reference Guide (Download Acrobat Reader) for common data errors that cause an 837 claim to be rejected.

The AK3 and AK4 Segments

Remember that the AK3 and AK4 segments on the 997 report show the user the location (loop, segment, element, line) of the error on the matching 837 file. The table below shows what information can be found in the first error for the 997 report below.

Data Element	Data	What It Tells You
AK301	DTP	Segment that contains an error on 837
AK302	242	Line number of 837 file where DTP segment will be located
AK303	2300	Loop where the DTP segment will be found
AK401	03	Actual element where the error is found
AK404	20040419-	Copy of the data in error

Tip: The combination of AK301 and AK401 show the segment and element where the error will be found on your 837 file.

Use the HIPAA Implementation Guide and the 837 to Identify the Error and Error Reason

This is what you know so far about the example above:

• There are two DTP03 errors.
• The errors occur on lines 242 and 253 of the 837 file.
• Both errors occur in the 2300 loop, the Claim Information loop.
• You also know what the incorrect data look like.

Here's the bottom line: You will not be able to identify the error and the reason for the error without the HIPAA Implementation Guide and the 837.

To identify the error in a 997 and to determine how to fix it:

1. In the HIPAA Implementation Guide, find the Transaction Set listing.
2. Scan through the tables to find the right loop.
   (In this case, it is 2300.)
3. Find the segment listing with the error.
   (In this case, it is DTP.)

   
   NOTE: In some cases, there is more than one segment with the same name. The 997 does not provide detail on which one is causing the error.
   (In Loop 2300 for the 837-I there are three DTP choices. DTP stands for "date or time period.")



4. On the 837 file that matches the 997, locate the segment on the line indicated.
   (In this case, you know that the segments are on lines 242 and 253.)

5. Find the data in the first element of the segment line. This code will direct you to which type DTP segment contains the error. This step will only occur in cases where there are multiples of the segment name within the same the loop.
   (In this case, it is element 434.)
6. In the HIPAA Implementation Guide, move ahead several pages to the details showing segments and their elements. Scan down the list until you find the segment you are looking for that contains the code you are looking for in the first element.
   (In this case, the segment is DTP and the first element data is 434. DTP*434 relates to Statement Dates.)
7. The data in AK404 on the 997 will be a copy of the error data from the identified element on the 837. That is the data that needs to be corrected.
   (In this case, it is the date. Dates and times must be in the correct format [CCYYMMDD] and must be complete to avoid rejection.)
8. The Implementation Guide explains the correct format for the data.
   (In this case, the Statement Date only has the "from statement date." "Through date of service" is also required for this field. The claim was rejected for incomplete information.)

The final step is to correct the rejected claim and resubmit it.

Correct Errors in RPMS

Since the 837 file includes multiple claims run together, the first step is to locate the claim number for the problem claim. Here is what you need to know to find the claim number:

1. The value in HL01 element provides a count for each HL segment and will increment by 1 for each HL segment found. The Header contains the first HL segment and begins the count for each HL segment afterwards.
2. To find a claim number, locate the CLM segment within the claim data that contains the error.
   (For this example, the CLM segment is in the claim that includes line 242.)
3. The claim number is provided in the first element (CLM01).
   (For this example, the claim number is 906311A-BE.)

Make the correction to the identified claim in RPMS.
(In this example, the "through date of service" needs to be added.)

Recreate and Resubmit the Batch

Once all errors have been identified and appropriately corrected, recreate the batch(es) and resubmit the files to the insurer in the next submission. The process for recreating batches remains unchanged. It is important to remember that changes made to the claims will not reflect on the new 837 transmission unless the batch was recreated prior to transmitting the new file.

Tips

• As you become more acquainted with the 837 and 997 files and the Implementation Guides, the process will speed up. You will learn to recognize common and recurring errors and be able to quickly resolve them.
• The error correction process is not simple but it can be mastered. Some sites have found it expedient to designate one person to correct all errors.
• Each recreated batch gets a new RPMS number.
• Make sure to only include corrected claims in a recreated batch.
• Monitor your error reports carefully. Check every batch in a report. Resubmit all errors. Until a claim is submitted correctly, the insurer has no record of the claim.
• If 20 claims are rejected for one patient, it could be as simple as a name entered wrong in one place. The error must be corrected at the source as well as on the claim so that it doesn't repeat.
• It is important to note the differences between insurers when resubmitting previously rejected claims.
• Medicare: Only the rejected claims do not pass. Therefore, only resubmit the rejected claims, not the entire batch.
  For example: 100 claims sent, 2 rejected means that Medicare has accepted 98 claims. After correcting, resend the 2 rejected claims. If the entire batch were resent, there would be 98 duplicated claims to Medicare.
• Medicaid: Any rejected claim causes the entire batch to fail. Correct the rejected claim(s). Recreate and resubmit the entire batch.
• Private Insurance: This will be insurer specific. Ask each insurer how they will process files with rejects. Determine if an entire batch will fail, or if only the rejected claims fail.

This newsletter is one in a series of six on the topic "Electronic Transactions . . . It's Easier Than You Think." Each of the newsletters is associated with a PowerPoint presentation expands on the contents of the newsletter in a format that supports self-paced or group training. Even greater technical detail is presented in two Quick Reference Guides: "Working with the 837 Transaction" and "Working with the 835 Remittance Advice." Electronic versions of these materials are available on the IHS Electronic Transactions website at www.ihs.gov/AdminMngrResources/HIPAA/index.cfm. A training resources binder includes printed copies of these materials and a CD-ROM with electronic copies of the files.