Administrative Healthcare Data

Chapter 6: Professional and Ancillary Claims

Introduction

Medical Claim Submission

CMS-1500 Claim Form

837P Electronic Claim Format

Data Elements Unique to CMS-1500/837P

Demographic Information

Diagnosis Codes

Diagnosis Pointer

Provider Identifiers

Procedure Codes and Modifiers

Place of Service

Provider Specialty

Payment Methodologies

Case Study: Identifying Children Who Miss Their Checkups

Identify Currently Enrolled Children under Six Years of Age

Import Excel Data

Identify Appropriate Professional Claims

Create Outreach Report

Create Internal Report

Case Study: Automating Reports with Macro Variables

Extract Code from Enterprise Guide Tasks

Import Data Code

Query Builder Code

Automate Code

Conclusion

Introduction

While they provide different ...