January 21, 2009 - Sending Claims to Medicaid/Medicare (837 Format)
(applies to Suzy Dental, Suzy Medical, and Suzy Facillity)
Many governmental agencies (NJ Medicaid, NJ Medicare, NY Medicaid, etc) require that information sent electronically be transmitted using the 837 format specifications. This is fully supported by the Suzy Dental, Medical, and Faciliy programs, however because of the way the 837 is handled some additional processing is required.
When the 837 data file is uploaded, it is immediately scanned for a few basic items such as valid account number. An error here is usually displayed immediately. Once that process is complete all the input data is scanned. This may occur immediately after the first scan (NJ Medicare) or it may be at a later time (NJ Medicaid - about an hour later). The results of this scan are contained in a file of type 997 (ie, the format specification of the file is 997).
If a major error is encountered here, the entire batch of claims is discarded. So if you submit 100 claims and one is missing a digit in a zip code, they are all thrown away. This is completely different than paper claims, where there is no interraction between one claim and another. It also requires that the unflagging of claims be handled differently.
Normally claims are unflagged after they are submitted. If errors show up at a later time, the claims with errors are fixed and resubmitted. With the 837 format, however, it is possible that all the claims will be discarded so these claims have to be handled differently. How they are handled depends on which version of Suzy you are running.
If you are using Version 3.82 dated 1/21/09 or later, you need not do anything differently. You only need to keep track of when you submitted the claims. This version keeps track of every claim submitted and groups them by batches. Batches are identified by the form type (eg, 'EWL', etc) and the date and time they were sent. This version of Suzy will allow a user to recall all of these claims from a menu with all the batches previously sent. So if we unflag the claims, and then the entire batch is rejected, the user can just recall all the claims, fix the errors, and resubmit the batch.
If you are using an earlier version of Suzy you need to do the following:
1. Do NOT unflag the claims after they are submitted.
2. If there is an error in the 997 report, simply fix the errors, resubmit the claims, and once again do not unflag the claims.
3. If there are no errors then resubmit the claims, but no NOT upload the claim file. Just disconnect from the insurance company or close the communication program without doing anything. Then unflag the claims as if they were submitted.
To determine whether the 997 report contains errors, Click Here
Return to the Main Menu