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Quick Reference Guide
In the previous newsletter (Preparing to Test the 837) you learned
how to get ready for the testing process:
This e-mail newsletter, Testing the 837,
is the third in the series Electronic Transactions…It's
Easier Than You Think. Electronic Transactions not only
make good business sense but they are also the law. Therefore,
IHS is producing detailed and simple-to-use training materials
to help you successfully meet the requirements for HIPAA electronic
transactions and code sets. To review the previous two newsletters,
here for Newsletter #1 or click
here for Newsletter #2.
Electronic Transactions series includes
an introductory newsletter and four topic newsletters:
- Preparing to Test the 837
- Testing the 837
- Reading 837 Error Reports and Making Corrections
- Testing and Posting the 835 Remittance
With this newsletter you will move through testing into production
- Installing the software
- Getting Implementation Guides and Addenda
- Establishing a relationship with the insurer
- Completing important forms and agreements
This newsletter is particularly relevant for people in Patient Registration,
Coding/Data Entry, and in the Business Office. To learn about testing
- Setting up RPMS
- Populating RPMS for error-free claims
- Completing the testing process
- Beginning production
You are almost ready to being submitting electronic claims in the
837 format. However, before you can submit actual claims, you must:
Don't submit the Trading Partner Agreement until
you are ready to begin testing. The agreement may
stipulate dates for beginning and completing testing.
At this point, the Business Office should have accomplished
the following (see Newsletter
#2: Preparing to Test the 837):
- Installed the required software modifications
- Obtained the appropriate ASC X12N Implementation Guides
- Established a relationship with insurers, completed any
required Electronic Data Interface (EDI) forms, obtained
a Companion Guide, and requested a Trading Partner Agreement
- Make some modifications to RPMS (Business Office).
- Correctly enter the information needed on the 837 (Patient Registration,
- Test the process to make sure that it works (Business Office).
The system parameters in RPMS (Resource Patient Management System)
must be set up correctly or you will not be able to submit claims
for the 837 transaction. This set-up involves:
- Inputting the correct provider taxonomy codes (VA Fileman New
- Inputting the correct location codes (VA Fileman Location file)
- Setting up the Location files (3P Table Maintenance)
- Setting up the Insurer file (VA Fileman Insurer file)
Input Provider Taxonomy Codes
What is a Provider Taxonomy Code?
Each provider you bill for must have a specific
code assigned to him/her in RPMS. If that code is not entered into
RPMS, the entire 837 transaction will be rejected by the insurer.
These codes are called Provider Taxonomy codes. For more important
information about the Provider Taxonomy Codes, click
here and view slide 4.
How do I find the right code?
The codes are published by Washington Publishing Company.
To find the most current code list, go to http://www.wpc-edi.com/codes/taxonomy.
Be sure to go to the drop-down menu on the right under Provider
Taxonomy Codes and read through the topics, in particular
"How do I use the On-Line list?"
The Office of Information Technology (OIT) will provide the
updates to be installed into RPMS under the AUT namespace.
This means that the Taxonomy updates will be maintained separately.
For more important information about finding the codes, click
here and view slides 5-10.
may have more than one Taxonomy code associated
to them. When determining what code or codes to
associate with a provider, review the requirements
of the trading partner with which the code(s) are
How do I input the code?
Provider Taxonomy codes need to be added manually into RPMS using
VA Fileman and the User Management options in the Kernel Menu. If
you do not have access to these options, request help from your
site manager/system manager. These codes are located in the PRV
segment, piece 4. This is a one-time procedure.
to Input Code
or Group Codes
- Set up codes for all billable providers, including secondary
providers (e.g., RN's, Pharmacists) that your facilities
may have on a claim.
- Start by inputting your most common providers.
Codes (for your general location)
- Set up codes for all billing locations.
For more important information about inputting taxonomy codes,
click here and view
See also Manually
Adding Provider Taxonomy - HIPAA Requirement.
Things to Know
- Crosswalk: A crosswalk was built into RPMS 3rd Party Billing
to alleviate sites from having to populate numerous locations.
The patch providing the crosswalk is Provider/Location Taxonomy
AUT Patch v98.1, Patch 13.
- Billing and Claims Editor: The Provider and Location Taxonomy
codes may be used as soon as they are entered. The user will not
see the codes in the claim editor. To view the codes, access the
Provider Inquiry (PRTM) option in Table Maintenance.
Set Up Location files (Third Party Billing Table Maintenance)
The Location files are set up on a one-time basis. Complete this
step for each location that is to be billed. This step provides
the physical street address to your claims, as required for the
If you have already been testing the 837 format with other insurers,
it is possible that this has already been completed for your site.
Check locally before completing this step.
For more important information about setting up the location file,
Set up Insurer file (VA Fileman Insurer
Set up each insurer in the Insurer file.
- Enter the trading partner's name.
- Enter the trading partner's Associate Operator (AO) control
number. This is the insurer's electronic identification. All sites
use the same number for an insurer.
- Enter the Electronic Media Claims (EMC) submitter identification.
This is the login information (number and password) assigned by
a particular insurer to your facility. It will be found in the
Companion Guide or will be provided by the insurer. You cannot
test the electronic claims submission process without it.
For more information about setting up each insurer file, click here.
The electronic claims submission process requires precision. If
data elements are entered incorrectly, the claim will be rejected.
- If a data element is mandatory, it must have
data in it.
- Data elements must be entered exactly as prescribed.
- There can be no special characters or punctuation.
- Data elements for a patient must be entered
the same way at every location.
This may be difficult for people who are used to entering data
in a certain way.
the name of the town is typed this way: Ft.
Defiance But the period is not allowed on an
On the 837 the name of the town
must be entered as: Ft Defiance
or Fort Defiance
For more information on common data errors that cause an 837 claim
to be rejected, click here.
Levels of Testing
There are two levels of testing. You must pass both levels. For
instance, you might pass Level 1 and have the file initially accepted,
but you could still fail the Level 2 edits with the insurer. You
must continue the testing until you pass Level 2.
Level 1: HIPAA Compliance Testing
Each site is responsible for making sure that its transactions
are compliant with HIPAA mandates. This means that the site must
be able to produce and accept HIPAA compliant transactions. Generally,
Level 1 testing is conducted with the insurer. However, it can also
be conducted using a third-party tool, e.g., Claredi.
There are six types of tests at Level 1.
- Integrity Testing
This testing validates the basic syntactical integrity of the
- Implementation Guide Requirements Testing
This testing involves requirements imposed by the HIPAA 837 Implementation
Guide, including validation of data element values specified in
- Balancing Testing
Balancing verification requires that summary-level data be numerically
consistent with corresponding detail-level data, as defined in
the HIPAA 837 Implementation Guide.
- Inter-Segment Situation Testing
Situation testing validates inter-segment situations specified
in the HIPAA 837 Implementation Guide (e.g., for accident claims,
an Accident Date must present).
- External Code Set Testing
This testing validates code set values for HIPAA mandated codes
defined and maintained outside of the HIPAA Implementation Guides.
Examples are local Procedure Codes for which states were given
waivers, NDC Drug Codes, Claim Adjustment Reason Codes, Claim
Status Codes, Claims Status Category Codes, and Remittance Remarks
Advice Codes. The last four codes and updates are published by
Publishing Company and OIT updates them.
- Product Type or Line of Service Testing
This testing validates specific requirements defined in the HIPAA
837 Implementation Guide for specialized services such as durable
medical equipment (DME).
Level 2: Insurer Testing
Level 2 testing is trading partner-specific. This involves
testing the coding and transaction requirements that are required
by the insurer but that are not specifically determined by
HIPAA. These requirements will be found in the insurer's Companion
The Testing Process
The Billing Office is now ready to batch and submit the 837 for
- Choose bills for the initial test batch.
Check each bill carefully to make sure that it is correctly
populated: the mandatory fields are filled in and the data entered
adheres to the 837 conventions.
Set the EMC Test Indicator to identify the file as a test file.
To learn how, see Test Mode.
On each claim, change the mode of export. To learn how, see
Submit different batches to the insurer, one for each 837 format.
Once the claims (3 or more) of one 837 format are approved,
export the batch in the usual process via RPMS Pub Directory.
Once you submit a batch via FTP or your usual process, e-mail
the insurer that a file has been submitted and request verification
that they received the file. If you have problems, consult your
local or Area IT contact.
Wait for a response or error report from the insurer. If you
do not hear from the insurer within 24 hours, call your insurer
contact to find out the status of the file.
If you receive an error report, fixes will be made locally either
by the Business Office or by the Patient Registration staff, depending
on the error. If you can't figure out how to fix the error, consult
with your local or Area IT contact.
Once the errors are corrected, resubmit the claims to the insurer.
Repeat this process until the claims pass with no errors.
After the initial claims go through with no errors, prepare
a larger batch (@ 25 claims) of each 837 format and test these
claims following steps 2-11.
- The bills should include a variety of the visit types that
you already bill to the insurer (e.g., Institutional, Professional,
- If appropriate, include a variety of locations.
- The Companion Guide will tell you how many bills should be
included in the test batch. If it doesn't, three of each type
- The filename for a batch cannot be more than 16 characters.
Your trading partner's Companion Guide may have naming conventions
that the partner wants to use.
Reading error reports and making corrections will be addressed
in the next newsletter.
For information on testing and Trailblazers, go to Trailblazers
Medicare Part A:837 Testing and Production Procedures and Trailblazers
Medicare Part B:837 Testing and Production Procedures.
- Be aware that completing the testing process may take a while,
depending on the amount of time your site puts into it. Testing
time varies by insurer as well as by the process used and the
number of claims that have to be tested.
- If there is a clearinghouse involved, there is another level
of preparation and testing to be worked out. It may also be more
- If you have errors in the claims, they will not be paid until
they are corrected.
- If your testing involves several locations and/or insurers,
there are more possibilities for errors. Monitor each batch submitted
and provide timely corrections.
- Evaluate your staffing needs before you begin testing. Your
staff is probably already busy. Demands on staff time will increase.
Anticipate this and assign adequate resources. For example:
- Cleaning up the patient database may require a massive effort.
- In the Billing Office, you have a double workload: 1) maintaining
the regular claims process so payments continue and 2) creating
and submitting test files.
- Be as prepared as you can before you start testing but don't
delay testing because you don't think you are prepared. The sooner
you jump in, the sooner you will be through it.
- To keep everyone informed of the progress being made in the
testing process, set up an e-mail group that includes insurer
contacts, OIT contacts, Area contacts, and Service Unit contacts.
- Keep in frequent communication with your insurer contacts.
- The insurer may be willing to provide training on what the plan
covers and what needs to be included on the 837.
- Document the process. This will be a teaching tool for you and
others. It will also show patterns that you need to address.
- If you need help, turn first to your own IT person. If you can't
figure it out locally, follow local procedures to get assistance.
- Submit batches frequently to keep them small. Remember that
you will have to correct errors and small batches are more manageable.
Once all the test claims are accepted as error free, the insurer
will place you in production status. NOTE: You may have to request
to go into production. At this point, you will need to:
- Change the "T" to "P" in the Insurer file. This must be done
for each insurer at the time you are granted approval for production.
- Change the mode of export on a permanent basis.
For more important information about changing to production mode,
For information on production and Trailblazers, go to Trailblazers
Medicare Part A:837 Testing and Production Procedures and Trailblazers
Medicare Part B:837 Testing and Production Procedures.
Guides and Addenda
IHS tracks the testing status of business transactions. To see
the current testing status, click
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.