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e-mail newsletter, Reading 837 Error Reports and Making
Corrections, is the fourth 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 three newsletters, click
here for Newsletter #1, click
here for Newsletter #2, or click
here for Newsletter #3.
Electronic Transactions series includes
an introductory newsletter and four topic newsletters:
to Test the 837
837 Error Reports and Making Corrections
and Posting the 835 Remittance
the previous newsletters you learned how to get ready for the testing
process and then how to complete testing and begin production. In
this newsletter you will learn how to read error reports and make
corrections so that your claims will be processed.
This newsletter is particularly relevant for people in the Business
Office. To learn about reading error reports and making corrections:
837 Transaction file is the file that you submit to
an insurer. It contains all the claim information. This
includes all of the claim data of a created batch. In
order to identify errors in the 837, you need to be
familiar with the 837 format and how to interpret it.
presentation accompanying Newsletter #2, Preparing
to Test the 837, the components of the 837
were described: data element, data segment, loop, transaction
set, header, and trailer. Delimiters are the characters
that separate two elements and terminate a segment.
this newsletter you will:
familiar with the data layout of the 837.
how to read an error report rejecting a claim.
how to correct the error and resubmit the claim.
data layout of an 837 file may look confusing at first due to the
electronic format, but the data are the same data you are accustomed
to seeing in the UB-92 or the HCFA-1500 forms. The overall data
stream of an 837 file is known as a Transaction Set.
Transaction Set is divided into sections. Each section provides
a specific kind of information. The sections are:
Segments and Elements
section of the Transaction Set contains data segments. Segment names
begin each line of detail. A segment name is two or three alphabetical
characters. In the example below, the segments names are in bold.
contains data elements. Data elements are the same as the data provided
by each individual Form Locator position on the UB-92 or the HCFA-1500
claim forms. The number of elements varies depending on the segment's
purpose. Data elements are separated by asterisks (delimiters).
In the example below, the ST segment has two elements and the BHT
segment has six elements.
In order to
correct errors in an 837, you need to know how to count the data
elements. Element counts begin to the right of the segment. In the
|STØ1 is the
first set of data between asterisks. STØ1 is "837."
BHTØ3 is the third set of data between asterisks. BHTØ3
Your best friends in interpreting the 837 are the
Guides and Addenda. By now you should have downloaded
them, printed them out, and put them where you are
going to need them.
Reference Guide (Download
Acrobat Reader) shows a typical billing scenario and how
it looks when presented in the 837 format. The 837 data string
is broken out line-by-line so you can see the loops, segments,
and data elements.
When viewed on screen, the 837 file is one long data stream.
This can be very difficult to read. The Quick Reference Guide
explains how to convert this file into line items that are
easier to troubleshoot.
There are three
versions of the Implementation Guides and Addenda. Each has an alphanumeric
code. The last two digits distinguish one 837 file from another.
Segments and elements may be different in each guide.
Use the correct guide for your batch type. To learn what elements
are required for a segment:
the segment listed in the appropriate Implementation Guide's Table
to the given page.
will find the loop name, whether the segment is required or situational,
the data elements required in the segment and how to enter them,
and the order of the elements.
and elements can be required or situational. If required, it is
mandatory that this information is included. The claim will be rejected
if the information is not included.
information is information that may or may not be needed depending
on the claim's criteria.
Guide explains what information is required and what is situational.
Each 837 file
is broken into sections of data. These sections are called loops.
Each loop has a particular focus, e.g., Submitter Name, Billing
Provider Name, Claim Level Information, Service Line. The data stored
within loop sections are similar to that stored in Patient Registration
or Fileman files.
Some data segments
repeat. For example, there could be several address lines - for
the Billing Provider, the Subscriber, the Patient, etc. The segment
identifier for every address is N3.
of these address lines will be in a different loop:
N3 of loop 2Ø1ØAA has the Billing
Segment N3 of loop 2Ø1ØBA has
the Subscriber address.
Note: Not all
the loops will be the same for all three Implementation Guides and
The loop number
tells you which address caused an error and which section of the
claim needs to be edited. The loop number has four digits and often
is followed by one or two alphabetical characters: 2400, 2010BB.
The 997 Functional Acknowledgement is the generally recognized
response to the 837 electronic transaction. It indicates whether
the file was accepted or rejected.
In some instances, other error report formats are used. Arizona
Medicaid has adopted a format called the 824. There are also
other report formats used by clearinghouses and private insurers.
Do You Get the Error Report
for retrieving the error report can be found in
the Companion Guide. If you are working with a clearinghouse,
it will provide instructions.
The 997 format
is somewhat different from the 837 format. On a 997 file, the segments
after the header all begin with AK. The data elements are counted
in the same way they are for an 837 file.
The AK Segments
(below in bold) indicate whether the file was accepted or rejected.
- If the file
passed, it contains an "A" for accepted in the first element of
the AK5 and AK9 segments.
- Files that
have only AK5 and AK9 segments are error free and need no further
- If the file
is rejected, it contains an "R" for rejected in the AK5 and AK9
- Files that
have been rejected are the only files that display the AK3 and
- AK3 and AK4
segments occur for each error found. There are two errors below.
- The AK3 and
AK4 segments on the 997 report show the user the location (loop,
segment, element, line) of the error on the matching 837 file.
In order to confirm whether batches were accepted or rejected by
an insurer, you must be able to identify which batches passed and
which batches failed. You must also be able to match the rejecting
997 to the 837 file. Here are some key things to learn to look for.
- Batch number
The 837 is assigned an individual batch number when the batch
is created. The corresponding 997 file will contain the same batch
- On an 837 file, BHT03 contains the batch number.
- On a 997 file, AK102 contains the batch number.
- 837 or 997
On both an 837 and a 997, ST01 identifies the type of file (837
- Dates and times
Dates and time of file transmissions are stored in the Header
elements of each file. This information can also be used to identify
- Type of file
The files can also be identified as institutional (…096), professional
(…098), or dental (…097) by the alphanumeric code that corresponds
to the Implementation Guides.
These two files match: same batch number, same date and time, and
same type of file.
Errors can result from one or more of the following:
- Incorrect formats
- Missing information
- Incomplete information
See the Quick
Reference Guide (Download
Acrobat Reader) for common data errors that cause an 837 claim
to be rejected.
The AK3 and AK4 Segments
Remember that the AK3 and AK4 segments on the 997 report show the
user the location (loop, segment, element, line) of the error on
the matching 837 file. The table below shows what information can
be found in the first error for the 997 report below.
It Tells You
that contains an error on 837
of 837 file where DTP segment will be located
the DTP segment will be found
element where the error is found
the data in error
Tip: The combination of AK301 and AK401 show the
segment and element where the error will be found on your 837 file.
Use the HIPAA Implementation Guide and the 837 to Identify
the Error and Error Reason
This is what you know so far about the example above:
- There are two DTP03 errors.
- The errors occur on lines 242 and 253 of the 837 file.
- Both errors occur in the 2300 loop, the Claim Information loop.
- You also know what the incorrect data look like.
the bottom line: You will not be able to identify the error
and the reason for the error without the HIPAA Implementation
Guide and the 837.
To identify the error in a 997 and to determine how to fix it:
- In the HIPAA Implementation Guide, find the Transaction Set
- Scan through the tables to find the right loop.
(In this case, it is 2300.)
- Find the segment listing with the error.
(In this case, it is DTP.)
NOTE: In some cases, there is more than one segment with the
same name. The 997 does not provide detail on which one is causing
(In Loop 2300 for the 837-I there are three DTP choices.
DTP stands for "date or time period.")
- On the 837 file that matches the 997, locate the segment on
the line indicated.
(In this case, you know that the segments are on lines 242
- Find the data in the first element of the segment line. This
code will direct you to which type DTP segment contains the error.
This step will only occur in cases where there are multiples of
the segment name within the same the loop.
(In this case, it is element 434.)
- In the HIPAA Implementation Guide, move ahead several pages
to the details showing segments and their elements. Scan down
the list until you find the segment you are looking for that contains
the code you are looking for in the first element.
(In this case, the segment is DTP and the first element data
is 434. DTP*434 relates to Statement Dates.)
- The data in AK404 on the 997 will be a copy of the error data
from the identified element on the 837. That is the data that
needs to be corrected.
(In this case, it is the date. Dates and times must be in
the correct format [CCYYMMDD] and must be complete to avoid rejection.)
- The Implementation Guide explains the correct format for the
(In this case, the Statement Date only has the "from statement
date." "Through date of service" is also required for this field.
The claim was rejected for incomplete information.)
The final step is to correct the rejected claim and resubmit it.
Correct Errors in RPMS
Since the 837 file includes multiple claims run together, the first
step is to locate the claim number for the problem claim. Here is
what you need to know to find the claim number:
- The value in HL01 element provides a count for each HL segment
and will increment by 1 for each HL segment found. The Header
contains the first HL segment and begins the count for each HL
- To find a claim number, locate the CLM segment within the claim
data that contains the error.
(For this example, the CLM segment is in the claim that includes
- The claim number is provided in the first element (CLM01).
(For this example, the claim number is 906311A-BE.)
Make the correction to the identified claim in RPMS.
(In this example, the "through date of service" needs to be
Recreate and Resubmit the Batch
Once all errors have been identified and appropriately corrected,
recreate the batch(es) and resubmit the files to the insurer in
the next submission. The process for recreating batches remains
unchanged. It is important to remember that changes made to the
claims will not reflect on the new 837 transmission unless the
batch was recreated prior to transmitting the new file.
- As you become more acquainted with the 837 and 997 files and
the Implementation Guides, the process will speed up. You will
learn to recognize common and recurring errors and be able to
quickly resolve them.
- The error correction process is not simple but it can be mastered.
Some sites have found it expedient to designate one person to
correct all errors.
- Each recreated batch gets a new RPMS number.
- Make sure to only include corrected claims in a recreated
- Monitor your error reports carefully. Check every batch in
a report. Resubmit all errors. Until a claim is submitted correctly,
the insurer has no record of the claim.
- If 20 claims are rejected for one patient, it could be as
simple as a name entered wrong in one place. The error must
be corrected at the source as well as on the claim so that it
- It is important to note the differences between insurers when
resubmitting previously rejected claims.
- Medicare: Only the rejected claims do not
pass. Therefore, only resubmit the rejected claims, not the
For example: 100 claims sent, 2 rejected means that Medicare
has accepted 98 claims. After correcting, resend the 2 rejected
claims. If the entire batch were resent, there would be 98
duplicated claims to Medicare.
- Medicaid: Any rejected claim causes the
entire batch to fail. Correct the rejected claim(s). Recreate
and resubmit the entire batch.
- Private Insurance: This will be insurer
specific. Ask each insurer how they will process files with
rejects. Determine if an entire batch will fail, or if only
the rejected claims fail.
Guides and Addenda
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.
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