EDI 837 Institutional Quiz

EDI 837 Institutional Quiz: Test your EDI knowledge

Try an EDI 837 Institutional Quiz to check the level of your Health Care EDI knowledge. This practical exercise gives you a possibility to practice real-world example and find out gaps in your EDI knowledge.

Patient Inpatient Face Sheet

A young female Dora Max was a driver involved in a car accident on 5/22/2015 when she rear-ended by another driver. She was seen in ER complaining of pain in the arm and neck. She was brought to “Help Me” hospital. She was evident that compound fractures were present. She was admitted to the hospital for open reduction, internal fixation of the type II fractures of radius and ulna. The patient had internal bleeding and lost unknown amount of blood.

Patient Name and address:

Dora Max

1 Test Lane, Will NY 10148

Patient Hospital/Account Number aka CLAIM ID: 123456789

DOB: 09/09/1955

Primary insurance and Guarantor information:

Policyholder: Patient (Self-insured)

Primary carrier name: Blue of Florida

Policy number/ Member ID: FL1443119

Admission Date: 05/22/2015 2pm

Source of admission: Admitted thru Emergency (CL101,02)

DOS: 05/22/2015

Attending Physician: Ahi, Ama,NPI: 1999955501

Billing Provider: Radiology Specialists, Group NPI: 0199999999, TAX ID: 133333333

TAXONOMY CODE 282N00000X

Service Facility: Help Me, 900 Hospital Ave, Island NY 10300

Admission Diagnosis: S52.201B

Discharge Diagnosis (principal Diagnosis) :S52.201B

Principal Diagnosis: S52.201B (POA=Y)

Patient reason for visit diagnosis: S52.301B,S13.4XXA

External Cause of Injury diagnosis: V43.52XA (POA=N)

Secondary (other) Diagnosis: S52.301B(POA=Y), S14.0XXA (POA=Y), R58 (POA=N)

Procedure Code for blood work requested by attending physician: 85027

Attending Physician ordered a complete CBC with automated Hgb, Hct, RBC count, WBC count and platelet count – cpt code 80027.

EDI trading partner information:

Group Control Number: 111111111

Submitter Name: Billing Company 1, Trading partner (submitter id) : 222222222 ALSO GS02

Receiver Name : WEBMD, Receiver ID: 111111111 ALSO GSO03

Payer: Blue of Florida, Payer ID: SB590

Billing company “Billing Company 1” is submitting an institutional claim for doctor Ahi, Ama for lab work her ordered to “Blue of Florida” thru a clearinghouse “WebMD”.

ISA*00* *00* *ZZ*222222222 *ZZ*111111111 *150521*0007*^*00501*000000001*1*P*:~

GS*HC* 1 *111111111*20150521*0007* 2 *X*005010X223A2~

ST*837*0001*005010X222A1~

BHT*0019*00*00000001*20160523*000437*CH~

NM1*41*2* 3 *****46*222222222~

PER*IC*MATT BILL*TE*9999999999~

NM1*40*2*WEBMD*****46* 4 ~

HL*1**20*1~

PRV*BI*PXC* 5 ~

NM1*85*2*RADIOLOGY SPECIALISTS*****XX* 6 ~

N3*1 LOST LANE 1~

N4*MAINE*NY*112050000~

REF*EI* 7 ~

HL*2*1*22*0~

SBR*P*18*******BL~

NM1*IL*1*MAX*DORA****MI* 8 ~

N3*1 TEST LANE~

N4*WILL*NY*10148~

DMG*D8*19550909*F~

NM1*PR*2* 9 *****PI* 10 ~

N3*PAYER ADDRESS~

N4*HOUSE OF BLUES*FL*37419~

CLM* 11 *152***21:A:1**A*Y*Y~

DTP*434*RD8*20150522-20150522~

DTP*435*DT* 12 13 ~

DTP*096*TM*1130~ -> Discharge hour needed if CLM05-3 = 1(Final)

CL1*1*7*09~

NTE*ADD*Emergency Case~

HI*ABK: 14 :::::::Y~

HI*ABJ:S52201B~

HI*APR:S52301B*APR:S134XXA~ -> Not allowed on inpatient claims, only for outpatient

HI*ABN:V4352XA::::::: 15 ~

HI*ABF:S52301B:::::::Y*ABF:S140XXA:::::::Y*ABF: 16 :::::::N~

NM1*71*1*AHI*AMA****XX* 17 ~

PRV*AT*PXC*281N00000X~

NM1*77*2* 18 ~

N3*900 HOSPITAL AVENUE~

N4*STATEN ISLAND*NY*103001664~

LX*1~

SV2*0311*HC: 19 *152*UN*1~

DTP*472*RD8* 20 ~

REF*6R*123456789001~

SE*40*001~

GE*1*1~

IEA*1*000000001~

Continue test and select the best answer for each question

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