Encounter Data System - CSSC Operations

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PrefaceThe Encounter Data System (EDS) Companion Guide contains information to assist Medicare AdvantageOrganizations (MAOs) and other entities in the submission of encounter data. The EDS CompanionGuide is under development and the information in this version reflects current decisions and will bemodified on a regular basis. All versions of the EDS Companion Guide are identified by a version numberwhich is located in the version control log on the last page of the document. Questions regarding thecontents of the EDS Companion Guide should be directed to eds@ardx.net.837 Institutional Companion Guide Version 8.0/June 20122
Table of Contents1.0 Introduction1.1 Scope1.2 Overview1.3 Major Updates1.3.1 Duplicate Logic1.3.2 EDIPPS Edits1.3.3 True COB1.3.4 EDFES Notifications1.3.5 Revised Business Case 9.10 – Bundled Institutional Encounter1.3 References2.0 Contact Information2.1 CSSC2.2 eds@ardx.net2.3 Applicable websites/email3.0 File Submission3.1 File Size Limitations3.2 File Structure4.0 Control segments/envelopes4.1 ISA-IEA4.2 GS-GE4.3 ST-SE5.0 Transaction Specific Information5.1 837-I Transaction Specific Table6.0 Acknowledgements and/or Reports6.1 TA16.2 9996.3 277CA6.4 MAO-002 – Encounter Data Processing Status Report6.5 File Naming Conventions6.5.1 Testing6.5.2 Production6.6 EDFES Notifications7.0 Front-End Edits8.0 Duplicate Logic8.1 Header Level8.2 Detail Level9.0 Institutional Business Cases9.1 Standard Institutional Encounter9.2 Capitated Institutional Encounter9.3 Chart Review Institutional Encounter – No Linked ICN837 Institutional Companion Guide Version 8.0/June 20123
Page 1: ___________________________________
Page 5 and 6: 1.0 Introduction1.1 ScopeThe CMS En
Page 7 and 8: 1.4 ReferencesMAOs and other entiti
Page 9 and 10: other entities should refrain from
Page 11 and 12: ISATABLE 1 - ISA-IEA INTERCHANGE EL
Page 13 and 14: TABLE 3 - ST-SE TRANSACTION SET HEA
Page 15 and 16: TABLE 4 - 837 INSTITUTIONAL HEALTH
Page 21 and 22: The 277CA is used to acknowledge th
Page 23 and 24: TABLE 6 - TESTING FILE NAME COMPONE
Page 25 and 26: The report format example is as fol
Page 27 and 28: TABLE 10 - 837 INSTITUTIONAL PERMAN
Page 29 and 30: 9.0 837 Institutional Business Case
Page 31 and 32: SBR*P*18*XYZ1234567******16~AMT*D*2
Page 33 and 34: HI*BG:01~NM1*71*1*JONES*AMANDA*AL**
Page 35 and 36: HI*BR:3121:D8:20120330~HI*BH:41:D8:
Page 37 and 38: HI*BE:30:::20~HI*BG:01~NM1*71*1*JON
Page 39 and 40: HI*BE:30:::20~HI*BG:01~NM1*71*1*JOH
Page 41 and 42: N3*705 E HUGH ST~N4*NORFOLK*VA*2350
Page 43 and 44: SV2*0300*HC:D0999*50.00*UN*1~DTP*47
Page 45 and 46: N4*NORFOLK*VA*235049999~REF*T4*Y~LX
Page 47 and 48: N4*NORFOLK*VA*235099999~NM1*PR*2*HA
Page 49 and 50: SBR*P*18*XYZ1234567******16~AMT*D*9
Page 51 and 52: TABLE 11 - ENCOUNTER DATA INSTITUTI
Page 53 and 54:
TABLE 11 - ENCOUNTER DATA INSTITUTI
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Encounter Data System - CSSC Operations

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