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Dummys Guide to the ANSI 837

• HIPAA Implementation Guide
• Overview

By Bob Perlitz
09/25/2003
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Types of HIPAA Data Elements

• Required data elements are those that every
  provider using the transaction must supply.
• Situational data elements are those that
  providers must supply if their situation calls
  for them. The situation depends heavily on the
  services provided and specialty of the physician,
  but may also depend on factors such as to what
  state the claim is being sent.

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Data Structure

• Related data segments are arranged in loops
• Related loops form a hierarchical level (HL)
• Loops within loops are called nested loops

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Hierarchical Level Loop Data segment
Data segment Loop Data segment Data
segment Loop Data segment Data
segment Loop Data segment Hierarchical
Level Loop Data segment
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Loops and Data Segments

• Each loop may contain several data segments.
• Example Loop 2010A BILLING PROVIDER NAME, the
  Segment NM1 is the Billing Provider Name, Segment
  N2 is Additional Billing Provider Name
  Information.
• Within each data segment, there may be several
  data elements

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More About Data Structure

• Each hierarchical level may repeat a specified
  number of times depending on the content.
• When loops are nested, an inner loop cannot exist
  without its corresponding outer loop.

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Implementation Guide Explanation

• Data elements are explained as they relate to
  each data segment within each loop.
• Each data segment contains four parts, three of
  which are shown in the following illustration.
• Fourth is the STANDARD which does not pertain to
  HIPAA

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Implementation

• Identifies
• Loop that the data segment is in (Loop 1000B)
• Usage (in this case it is REQUIRED)
• How many times the loop repeats (ONCE),
• Notes
• Example

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Diagram

• Provides picture of the data elements in the
  segment.
• Boxes outlined in bold are REQUIRED, others are
  SITUATIONAL
• Boxes with names crossed through are NOT USED

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Data Element Example

• First box represents the data element Entity
  Identifier Code.
• NM101 is the Reference Designator
• 98 is the Data Element Number
• M (or this may be O or X) is part of the
  Standard and should be ignored
• Attribute ID stands for Identifier, AN means
  Alpha-Numeric, etc.
• 2/3 refers to the minimum and maximum size of
  the data

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Element Summary

• Describes, in further detail, each data element
  in the Diagram
• For many codes, this is where valid values are
  given
• For Situational data elements, this is where the
  situation is defined

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