The 837P and 837D files were modified based on Health Safety Net Office (HSNO) payer requirements. The application supports primary and secondary medical and dental claims.
Set Up Options for HSNO
Set Up for the Payer master file includes:
- Select the Enable Health Safety Net EDI option on the Electronic Claimstab in the System tab.
- Enter HSNO in the Payer Alias Name field on the Payer Defaults - 1 tab.
Claim File Generation Behavior
Professional Claims
- Creates a 2300 DPT*435 (admit date) segment.
- Creates the service facility loop (even if it would be suppressed by a submitter profile option).
- Changes the qualifier to facility (FA) if it otherwise would be something else.
- Populates the SV1 place of service even if it is the same as CLM05-1.
- Overwrites the payer name at the 2010 level to Health Safety Net Office.
- Populates the SSN or a placeholder ("000000001") in the REF*SY in the subscriber and patient loops.
Dental Claims
- Populates the SV3 place of service even if it is the same as the CLM05-1.
- Creates the service facility loop even when otherwise it would be suppressed.
- Overwrites the payer name at the 2010 level to Health Safety Net Office.
- Creates a claim-level DTP*472 date of service segment.
COB Secondary Claims
- Populates claim-level DTP*573 adjudication date.
- Populates 2330 REF*2U with the other payer secondary id (plan code).
- Overwrites the 2000B SBR04 segment with the string Second.
