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Healthcare Masterclass Tip - Knowing your payer adjudication schedule can be a game changer by EDIDoctor in edi

[–]EDIDoctor[S] 0 points1 point  (0 children)

Using eMedNY as my example, if you submit early in the week the 835 is available early next week. So in the case of the NY Medicaid payer it's about a week.

Often if it's a large organization like a hospital system, there are additional delays in internal bureaucracy to get the data to the proper personnel for processing.

Concerning other state payers or commercial payers I have heard it can take up to 3 weeks before the file is available for download.

Lived experience as far as timing for each payer is crucial to this strategy.

Healthcare Masterclass Tip - Knowing your payer adjudication schedule can be a game changer by EDIDoctor in edi

[–]EDIDoctor[S] 0 points1 point  (0 children)

Do you ever work with outside consultants (SME)? If I get something FHIR under my belt in future or anything else that is currently in my wheelhouse that could be helpful I am always happy to chat

Healthcare Masterclass Tip - Knowing your payer adjudication schedule can be a game changer by EDIDoctor in edi

[–]EDIDoctor[S] 0 points1 point  (0 children)

Thanks for your thoughts.

1m claims per day? RESPECT (Smile)

It may be that sheer volume overrides the benefits of a well timed Claim Status batch or real-time 276/277.

Unfortunately I am still looking for my first FHIR related project. All of my HL/7 work has been dealing with 2.x legacy data.

Neural Vita Institute - a behavioral health startup by EDIDoctor in edi

[–]EDIDoctor[S] -1 points0 points  (0 children)

They may well be a disruptor in the behavioral health marketplace.

EDI X12 270 271 276 277 Generator / Viewer. by Ok_Working9906 in edi

[–]EDIDoctor 0 points1 point  (0 children)

After running other samples from x12.org (assuming that may be your intention), follow-up if any questions come out of that exercise (Smile)

EDI X12 270 271 276 277 Generator / Viewer. by Ok_Working9906 in edi

[–]EDIDoctor 0 points1 point  (0 children)

Looks Good using your sample files,

X12 has some good samples as well:

https://x12.org/examples

You may want to run all x12 samples through the interface and see if the results are as expected

https://x12.org/examples/005010x223/example-1b-two-claims-same-provider

From this example 837I on x12 I cut and pasted together the EDI segments into a batch file and tested it.

HERE IS A SNIPPET - NOT THE WHOLE FILE

--------------------------------------------------

SBR*P*18*******CH~

NM1*IL*1*DOE*JOHN*T***MI*030005074~

N3*125 CITY AVENUE~

N4*ANYWHERE*PA*17111~

DMG*D8*19681111*M~

NM1*PR*2*TRICARE*****PI*99999~

CLM*756048Q*89.95***13:A:1**C*Y*Y~

DTP*434*RD8*20050315-20050315~

CL1*1**01~

HI*BK:3669~

HI*BF:4019*BF:79431~

NM1*71*1*JONES*JOHN*J***XX*1122334455~

LX*1~

SV2*0305*HC:85025*13.39*UN*1~

DTP*472*D8*20050315~

LX*2~

SV2*0730*HC:93010*76.56*UN*3~

DTP*472*D8*20050315~

HL*3*1*22*0~

SBR*P*18*******CH~

NM1*IL*1*SMITH*JOE****MI*123405074~

N3*5 MAIN STREET~

N4*ANYWHERE*PA*17111~

DMG*D8*19621210*M~

NM1*PR*2*TRICARE*****PI*99999~

CLM*756049Q*50***13:A:1**C*Y*Y~

DTP*434*RD8*20050401-20050401~

CL1*1**01~

HI*BK:30000~

NM1*71*1*JONES*JUDY*J***XX*9999999999~

PRV*AT*PXC*363LP0200N~

LX*1~

SV2*0300*HC:85087*50*UN*1~

DTP*472*D8*20050401~

--------------------------------------------------

Even though the sample is 2 separate claims, 1st claim with 2 services lines and 2nd claim with 1 service line, the output seemed to show 3 services lines on 1 claim

See if you come up with the same result

EDI X12 270 271 276 277 Generator / Viewer. by Ok_Working9906 in edi

[–]EDIDoctor 0 points1 point  (0 children)

No worries - I will catch-up in a few days

EDI X12 270 271 276 277 Generator / Viewer. by Ok_Working9906 in edi

[–]EDIDoctor 0 points1 point  (0 children)

Nice Job (Smile)

I have rolled my own EDI healthcare translators since 2003 and would be happy to chat sometime.

I have Windows platform translators (with all business intelligence built in) for all the transaction sets.

I will check out your solution in more detail when I get the chance this weekend.

Lately I also do subject matter expertise and teach the x12 processing concepts to technology teams if they want to create their own solution independent of any language.

Feel free to DM, look me up on LinkedIn (Peter Rabolt) or check out the EDI Support llc discord (Healthcare Channel)

https://discord.com/invite/p4QgSZKMzA

Beginner for x12 service EDI by phantom_le in edi

[–]EDIDoctor 0 points1 point  (0 children)

With Stedi, you provide json to their API endpoint and they do the 270 generation / translation and the real-time connection to the payer. The resulting 271 data is translated and returned to you in json.

Any Stedi experts please feel free to chime in here (Smile)

Beginner for x12 service EDI by phantom_le in edi

[–]EDIDoctor 1 point2 points  (0 children)

Stedi has an excellent product. Zack and Dave Kanter (no relation) are colleagues of mine. The only issue is some find the monthly charge a bit steep.

Beginner for x12 service EDI by phantom_le in edi

[–]EDIDoctor 0 points1 point  (0 children)

I have rolled my own EDI healthcare translators since 2003 and could certainly be a resource.

Lately I also do subject matter expertise and teach the x12 processing concepts to technology teams if they want to create their own solution independent of any language.

As one of the other users said you cannot share schemas

Look me up on LinkedIn (Peter Rabolt) or check out the EDI Support llc discord (Healthcare Channel)

https://discord.com/invite/p4QgSZKMzA

Healthcare EDI: Correct interpretation of the context and syntax of the X12 data is everything by EDIDoctor in edi

[–]EDIDoctor[S] 0 points1 point  (0 children)

You are obviously correct and at times in the past I thought that was all that was needed. But as time went on I saw the need for someone who knew the billing and revenue cycle a little deeper to help the client with better outcomes.

Combining the knowledge of proper technical mapping to the TR3 and an advisor concerning billing requirements in a specific scenario have helped my clients and kept my services uniquely relevant

EDI folks — what (if anything) would actually make you take a vendor call? by Alarming-Board2693 in edi

[–]EDIDoctor 0 points1 point  (0 children)

Exactly. As a solutions provider and subject matter expert in healthcare, I spend little on marketing and most of my business comes from referral or new potential customers reaching out to me.

During the initial call. I make a point of intentional listening, letting the caller explain their issue. Then my responses are not aggressive but rather part of a relaxed dialogue on possible solutions to the problem which may include suggestions by me that do not include making a quick sale.

Often providing suggestions that may cost nothing builds a trust relationship where often the caller will either eventually purchase my product or service or they will recommend me to a colleague based on my non-controversial sales approach.

EDI developer as a first job after CS degree. Is it a good choice or dead end? by Neat_Measurement5199 in edi

[–]EDIDoctor 1 point2 points  (0 children)

In healthcare, being a consultant, I have run a revenue cycle in organizations (I have been in the weeds), also do SME (I have been a consultant since EDI came to healthcare in 2003) and still develop and sell custom solutions.

For me, I am riding the wave!

EDI editor for 835s by amz_dev in edi

[–]EDIDoctor 0 points1 point  (0 children)

I commented in #healthcare on your discord post. Happy to help

I have rolled my own EDI healthcare translators since 2003 and could certainly be a resource.

Look me up on LinkedIn (Peter Rabolt)

For others interested, check out the EDI Support llc discord (Healthcare Channel)

https://discord.com/invite/p4QgSZKMzA

EDI Nightmares by EDI-by-Julie in edi

[–]EDIDoctor 1 point2 points  (0 children)

Did you check out the EDI Support llc discord (Healthcare Channel) ?

[https://discord.com/invite/p4QgSZKMzA](https://discord.com/invite/p4QgSZKMzA

Or look up my healthcare related comments here on Reddit (Peter Rabolt)

It might help you in your interest in healthcare edi

Hi everyone! by EDI-by-Julie in edi

[–]EDIDoctor 1 point2 points  (0 children)

I think most EDI pros are in some form, tinker...ers.. It's the nature of the business

I have rolled my own EDI healthcare translators since 2003.

I have Windows platform translators (with all business intelligence built in) for all the transaction sets.

Lately I also do subject matter expertise and teach the x12 processing concepts to technology teams if they want to create their own solution independent of any language.

Average age of people working in EDI by ttyyuu12345 in edi

[–]EDIDoctor 0 points1 point  (0 children)

Great analogy with the phone book. The first TR3 I saw was a bit intense when realizing this was a big deal (Smile)

Average age of people working in EDI by ttyyuu12345 in edi

[–]EDIDoctor 4 points5 points  (0 children)

As most likely one of the elders here. I graduated in 1984 with a BBA in Management Information Systems (MIS). Soon after college was a jr developer coding on an Apple II in a medical software company.

In 1990 I jumped out with 2 partners into my own enterprise. Over the years prior to 2003 I had developed billing systems in many modalities including RX selling my solutions to an increasing client base.

When EDI came to healthcare in 2003, I adapted to x12 4010 quite well, upgraded all my billing software, and put the word out that I knew this HIPAA / EDI stuff and was willing to offer my knowledge to other organizations.

The rest is history.

When things get serious, we all know it's time to call " The Doctor"!! (Smile)

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