Medical Billing Coding - Electronic medical billing tool and learing materials, cpt, codes
medical billing and coding forum

BC Advantage Magazine


Medical Software

New Topic  |  Search

Thread Topic: Electronic medical billing tool and learing materials
Topic Originator: Calvin Fenton
Post Date May 9, 2008 @ 11:58 AM
Electronic medical billing tool and learing materials

Calvin Fenton
May 9, 2008 @ 11:58 AM Reply  |  Email Friend   |  |Print  |  Top

There are many differnt EDI(Electronic Data Interchange) tool for manipulate and learning the 837 Professional EDI claims file, but non as low cost and easy to use as EDI Delimiter, and Segment separation tools from .

An Example of what the EDI Segment tool can do is



NM101 <=> DN (Element)

NM102 <=> 1 (Element)

NM103 <=> ROGER


NM105 <=>

NM106 <=>

NM107 <=>

NM108 <=> XX

NM109 <=> 1234567890

The EDI Delimiter tool delimits any EDI file from one continuous line into the individual segments to make an EDI file easier to read and understand.

As of end June for all who do electronic professional medically billing or is interested in leaning how the HCFA/CMS 1500 Paper Claims Form realates and mapped to the 837 EDI Professional claims file, a refenence manual will be available from An example of the content of one of the mappings is below.

(Loop ID 2010BA) Subscriber Name        
Segment NM1 Subscriber Name Usage: Required
EDI: NM1*IL*1*JONES*SAM*U***MI*MT123456789      

Item NM101 IL Entity Identity Code
     HCFA 1500: BOX 2 (Qualifier)

Item NM102 1 Entity Type Qualifier
     HCFA 1500: BOX 2 (Qualifier)

Qualifier     Description
1          Person
2          Non-Person

Table 11 Qualifier Entity Type Loop ID 2010BA

Item NM103 JONES Name Last or Organizational Name
     HCFA 1500: Box 2 (Patient Last Name)  Subscriber Last Name

Item NM104 SAM Name First
     HCFA 1500: Box 2 (Patient First Name)  Subscriber First Name

Item NM105 U Name Middle
     HCFA 1500: Box 2 (Patients Name MI)  Subscriber Middle Name

Item NM106  Name Prefix

Item NM107  Name Prefix

Item NM108 MI Identity Code Qualifier

Qualifier     Description
ZZ             Mutually Defined
MI          Member Identification Number

Table 12 Qualifier Identity Code Loop ID 2010BA

     HCFA 1500: Box 1A Insured ID Qualifier Check box option

Item NM109 MT123456789 Identification Code
     HCFA 1500: Box 1A (Insured Identification number)

Copyright © 2008 Billing-Coding Inc