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Health Care Services Data Reporting Guide: ANSI X12N 837

The ANSI X12N 837 Health Care Service Data Reporting Guide provides a standardized format and data content for reporting health care service data that are compatible with the 837 Health Claim transaction set standards identified by the Health Insurance Portability and Accountability Act (HIPAA). This guide provides assistance in developing and executing the electronic transfer of health care systems data for reporting purposes to local, State, and Federal agencies that utilize the data for monitoring utilization rates, assessing patterns of health care quality and access, and other purposes required by legislative and regulatory mandates.

All entities who conduct quality measurement, community assessment, disease Surveillance, and other comparative studies now have a national Standard for institutional health care service information. The guide is HIPAA compatible because data elements used for both claims payment and health services reporting are defined identically, but the Guide includes data elements essential for quality measurement and public health Assessment purposes. For example, diagnosis and procedure codes are in the Claim standard and are used for both claims payment and health services studies. However, data elements such as race & ethnicity, patient county code, present on admission flag for secondary diagnoses are not now needed to pay a claim, so are missing from the industry claims standard. The Guide includes these additional data elements critical to quality, utilization, and public health studies.

The 4050 version of the Guide, which is the October 2001 view of the X12 standards, was approved as a national standard by ANSI X12. The technical name for this guide is 004050X156. This is the first version of an ANSI X12 implementation guide designed to standardize Public Health administrative data for all care in an institutional setting.

The 5010 version of the Guide, which is the October 2003 view of the X12 standards, was approved as a national standard by ANSI X12. The technical name for this guide is 005010X225.

Development of the 5050 version of the Health Care Service: Data Reporting Guide (October 2007 version of the ANSI X12 standards) is underway

The 4050 and the 5010 versions of the guide have been approved by ANSI X12 and can be purchased from Washington Publishing Company and are available at: http://www.wpc-edi.com/content/view/403/160.  There is a charge to cover the publication costs to obtain the guide. Directions on how to arrange for payment are available on the Washington Publishing Company Web site: www.wpc-edi.com

Evolution of the ANSI ASC X12N 837 Format from the UB-92 Flat File Format

Health Care Service: Data Reporting Guide Tools

Health Care Services Data Reporting Guide Committee Web Informational Forum

Road Map for Implementing the Health Care Service: Data Reporting Guide