biztalkediicd

How to generate 837 DAT file with ICD10 code in Biztalk?

My 'BizTalk' application 'convert' txt file to 'DAT(EDI 837 005010X222A1)' file format.

'Now change is Need to generate DAT file with ICD10 code'

Question are

  1. How I generate DAT with like 'HI*ABK'? right now in Combined837Doc.map, 'BK' is hardcoded
  2. Should I change 'X12_00501_837_P.xsd'?
  3. How BizTalk decide ABK | ABF | ABN | ABJ HI qualifier based on passed ICD code?

BK ---> Primary Diagnosis code -->ABK

BF ---> Secondary Diagnosis code -->ABF

BN ---> External Cause of injury -->ABN

BJ ---> Admitting Diagnosis -->ABJ

PR ---> Patient Reason for Visit -->APR

BR ---> Primary Procedure code -->BBR

BQ ---> Secondary Procedure code -->BBQ

Solution

  • BizTalk will not handle this in any sort of automatic way. The 837 XSDs will give you clues about what qualifiers are valid for a particular field, but they do not get set on those fields unless you set them in the map - either in the Value property of the destination node or via the output of a link (from a source node or functoid). You should not modify the XSD unless you need to support a non-standard qualifier that you and your trading partner have agreed to use - but you should stick to the standard qualifiers and encourage/require your partners to do so as well to avoid the need of such customization, and if you do make such modifications it should be to a trading partner version of the schema that gets properly mapped to a canonical format that does use the standard codes.

    To further clarify, if you need to set the primary diagnosis code to BK and set other diagnostic codes to ABK, you have to provide that output from the map. You also have to ensure that you link to the proper HI node - only the first HI node for the Primary Diagnosis will accept BK as the qualifier (per WPC standards); subsequent ones can have ABK. I've written a couple blogs on this topic here and here.

    What you really need here is to review the WPC specification for the Professional Claim v. 5010 and your trading partner's companion guide for the claim. These will provide all of this information so you can do your mapping correctly. You will also very likely need to work with an EDI claims specialist to get this right - HIPAA transactions are particularly challenging, and the claim forms are probably the most complicated of them.