1 / 8

CALIFORNIA DIVISION OF WORKERS’ COMPENSATION MEDICAL DATA TRAINING

CALIFORNIA DIVISION OF WORKERS’ COMPENSATION MEDICAL DATA TRAINING. WCIS Medical Data Collection. Workers’ Compensation Information System. WCIS . Division of Workers’ Compensation. www.dir.ca.gov. Workers’ Compensation Information System (WCIS) California EDI Implementation Guide for

axl
Download Presentation

CALIFORNIA DIVISION OF WORKERS’ COMPENSATION MEDICAL DATA TRAINING

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. CALIFORNIA DIVISION OF WORKERS’ COMPENSATIONMEDICAL DATA TRAINING WCIS Medical Data Collection

  2. Workers’ Compensation Information System WCIS Division of Workers’ Compensation

  3. www.dir.ca.gov Workers’ Compensation Information System (WCIS) California EDI Implementation Guide for Medical Bill Payment Records Version 1.0 December 2005

  4. California Implementation GuideTable of Contents • EDI service providers • Events that trigger required medical EDI reports • Required medical data elements • Data edits • System specifications • IAIABC information • Code lists and state license numbers • Medical EDI glossary and acronyms • Standard medical forms Page 3

  5. Section LRequired medical data elementsPage 69

  6. Step 1 Mandatory Segments (BSRC = 00) BHT*0080*00*0123*19960618*0932~ NM1*10*2******FI*123456789~ N4***751230064~ NM1*40*2******FI*987654321~ N4***751230064~ DTP*582*RD8*19970201-19970228~ NM1*CA*2*PREMIEREINSURANCE COMPANY OF NORTH*****FI*111223333~ H DTP*558*D8*19920101~ NM1*CC*1*DOE*SALLY*J***34*012345678~ REF*Y1*528779999~ CLM*A37YH556*500**MO*11:B*Y**********P***00~ DTP*050*D8*19970115~ DTP*666*D8*19970115~ REF*DD*13579~ REF*2I*TJ98UU321~ NM1*82*1*WELBY*MARCUS*C**SR*FI*123456789~ PRV*PE*S3*203BP0400Y~ N4***751230064~ REF*OB*PSY00001574~ LX*1~

  7. Step 2 Hierarchical Segments (BSRC = 00) BHT*0080*00*0123*19960618*0932~ NM1*10*2******FI*123456789~ N4***751230064~ NM1*40*2******FI*987654321~ N4***751230064~ HL*1**20*1~ DTP*582*RD8*19970201-19970228~ NM1*CA*2*PREMIEREINSURANCE COMPANY OF NORTH*****FI*111223333~ HL*2*1*EM*1~ MN1*36*2~ HL*3*2*CL~ DTP*558*D8*19920101~ NM1*CC*1*DOE*SALLY*J***34*012345678~ REF*Y1*528779999~ CLM*A37YH556*500**MO*11:B*Y**********P***00~ DTP*050*D8*19970115~ DTP*666*D8*19970115~ REF*DD*13579~ REF*2I*TJ98UU321~ NM1*82*1*WELBY*MARCUS*C**SR*FI*123456789~ PRV*PE*S3*203BP0400Y~ N4***751230064~ REF*OB*PSY00001574~ LX*1~

  8. Step 3 (continued) Conditional Data Elements/Segments (BSRC = 00) • Professional 837 Office visit with drugs dispensed • Institutional 837 Hospital/Surgical Scenario • ICD_9 Diagnosis and Procedure Codes • Multiple Group Codes • Bill & Line Level Denials • Bill & Line Level Multiple Group Codes • Bill Level Aggregations across group Codes

More Related