835 Analytical Assignment
Payer Response Assignment Guidelines
Assignment: A hospital practice you work for has switched the clearinghouse the PM software uses for claim submissions and responses. Management wants to make sure that patient accounts reflect claim processing appropriately so that auto-posting may be implemented. All blanks should be completed with numerical data. Must submit your response in Excel (XLS, XLSX) format.
Purpose: Electronic data is transmitted from healthcare organizations to payers using 837 and 835 file formats to submit claim information and receive payment responses. If you completed the readings and lecture video for this module, you should have an understanding of how communication occurs and how data may sometimes be incomplete. This assignment will allow you to use the analytical skills that are necessary to be successful in healthcare to review received data when received data is missing.
Background: Total billed charges increase when labs, radiology, or other tests, imaging, or procedures are performed. These items can be applied to deductible(s) and/or co-insurance. Review the chart below and complete the missing information so that you can have complete data to compare for the EDI 835 file processing review. A base level 3 (99283) charge is $1900.
If you do not know how to use Excel, consider the BATC courses. Schedule time to discuss how to do this during my office hours so that you get the help you need to be successful.
· How to analyze payer responses with missing data.
· Use basic Excel functions to confirm math equations and data.
· Understand types of charges and relevancy of processing.
· Confirm accuracy of provided information.
· Understanding how to read an 835
Your submission must be in Excel format. Appropriate formulas should be used when warranted. Understanding types of charges, what they mean, and how patient responsibility works will allow you to complete this successfully. Use concepts learned in Week 1 and Week 2 to complete this assignment.
· Create a formula that will allow you to confirm totals. (For your understanding and to complete questions regarding patients)
· Complete Patient 1 missing data (20 points)
· Complete Patient 2 missing data (20 points)
· Complete Patient 3 missing data (20 points)
· Complete Patient 4 missing data (20 points)
· Complete Patient 5 missing data (20 points)
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