EDI X12 835 Parsing

The Problem

  • You are doing your best and your part in helping to address the needs of the pandemic caused by the COVID-19 virus and need to make sure your Coronavirus claims are being paid properly to ensure that you can pay your staff and other related expenses to stay in business. 
  • Your an atypical provider and don't have the resources for an enterprise EDI platform and need a simple, cost effective, and reliable tool to read the 835 remittance advice.
  • You are a provider and want to focus on providing quality services and not spend critical time in deciphering the 835 remittance advice in order to understand how claims have been processed. 
  • It's after normal business hours and you're a business analyst responsible for reporting back to upper management the results of a recent payor adjudication cycle. 
  • You have the 835 remittance advice in hand and need a utility to quickly parse the file into a easily readable file so that you can include it in your report to upper management. 
  • It's the last hour and your team is trying to finalize the cost for for responding to a request for proposal (RFP) and needs the financial information located in the 835 remittance advice in order to properly respond. 
  • You need to translate/parse an 835 EDI remittance advice and don't know how. 
  • Your IT team is overbooked and can't get to it right away, and you need some pertinent information in the file right away. 
  • You don't have an IT team that understands the format. You don't have an IT department or staff. 
  • Someone or something has parsed the file for you but you are not sure that the results are correct and you'd like to parse the file with a different utility to compare the results. You're a software developer/EDI consultant working on a parsing utility and need to validate your results against a third party utility. 
  • You want to focus on providing service and not having to worry about figuring out how to read an 835 remittance advice and keeping up with the changes to the format. 
  • You are a start up provider and need a low cost way to parse the 835 remittance advice. You simply want your remittance advice data in a human readable format quick. 
  • Your an attorney's office and need the claims cost and other service information contained within an 835 remittance advice to prepare for a case. 

The Solution 

  1. Complete and email back to cecilio.thomas@dorightsolutions our Business Associates Agreement, DRS BA or send us a copy of yours to complete if needed. 
  2. Email cecilio.thomas@dorightsolutions.com for a link to the download page for the utility. 
  3. Download and install the utility to your local machine. 
  4. Start parsing your 835 remittance advice to Excel to see how your claims are being paid as soon as possible.  Which is extremely important during these unprecedented times. 
  5. It's that simple. 

If you have any questions or concerns don't hesitate to email Cecilio (Tony) Thomas at cecilio.thomas@dorightsolutions.com. Additional details regarding the service can be found below. 

Parsing Constraints 

  • Service line adjustments override claim adjustments if they exist, and If no services exist for a claim it will not be written to the output file. 
  • Files must be 5MB or less. 
  • The following information will be returned: 
  • Total Amount Paid on the Remit 
  • ABA number of the bank the payment is coming from 
  • Account number of the bank the payment is coming from 
  • Payers Federal Tax ID ABA number of the bank the payment is going to 
  • Account number of the bank the payment is going to 
  • Check Issue or EFT Effective Date 
  • Files Batch Number 
  • Payer Name 
  • Payer City 
  • Payer Address 
  • Payer State 
  • Payer Zip Code 
  • Payee Name 
  • Payee Provider Number 
  • Rendering Provider Number 
  • Patient ID Patient's Last Name 
  • Patient's First Name 
  • Patient's Middle Name 
  • Patient's Medicaid Number 
  • Claim/Encounter Status Code 
  • Total Claim Charges 
  • Paid Amount 
  • Co Insurance Amount 
  • Transaction Control Number 
  • First Claim Adjustment Group Code 
  • First Claim Adjustment Reason Code 
  • First Claim Adjustment - Adjustment Code 
  • First Claim Remark Code 
  • Second Claim Adjustment Group Code 
  • Second Claim Adjustment Reason Code 
  • Second Claim Adjustment - Adjustment Code 
  • Second Claim Remark Code 
  • Third Claim Adjustment Group Code 
  • Third Claim Adjustment Reason Code 
  • Third Claim Adjustment - Adjustment Code 
  • Third Claim Remark Code 
  • Fourth Claim Adjustment Group Code 
  • Fourth Claim Adjustment Reason Code 
  • Fourth Claim Adjustment - Adjustment Code 
  • Fourth Claim Remark Code 
  • Fifth Claim Adjustment Group Code 
  • Fifth Claim Adjustment Reason Code 
  • Fifth Claim Adjustment - Adjustment Code 
  • Fifth Claim Remark Code 
  • Begin Date of Service 
  • End Date of Service 
  • Procedure Code 
  • Units 
  • Interchange Date, this is usually translated as the Remit Date 
  • Interchange Control Number 
  • Biller Reference Number, the unique ID of the claim sent to the payer 
  • Receiver ID 
  • First Provider Adjustment Amount
  • First Prompt Pay Amount
  • First Provider Adjustment Id
  • First Provider Adjustment Reason Code
  • First Provider Adjustment Reason Id

 

Is there anything else I should know? Nothing other than if you have any questions, take a look at our FAQ, download the tool DRS EDI Parser, or email us at cecilio.thomas@dorightsolutions.com. We learn as much or more from simply talking with clients and better understanding there unique challenges.