Tyler
69 lines
2.3 KiB
Markdown
69 lines
2.3 KiB
Markdown
# X12 naming conventions
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A short glossary of the names and indices used throughout Cyclone's parsers.
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## Segments
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Two- or three-letter codes that identify a row type. The codes are mnemonic:
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`CLM` = claim, `NM1` = name, `BPR` = beginning segment for payment
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order/remittance advice, `SVC` = service, `DTM`/`DTP` = date/time/period.
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## Elements
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Inside a segment, elements are separated by `*` and are 1-indexed. So
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`CLM01` is the first element of the `CLM` segment — the patient control
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number on 837P. `CLM02` is the second element — the total claim charge.
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## Composite elements
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A single element can carry sub-fields, separated by `:`. The sub-fields are
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also 1-indexed, suffixed to the element index:
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- `CLM05-1` = place of service (Facility Type Code)
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- `CLM05-2` = facility code qualifier
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- `CLM05-3` = claim frequency code
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In the Python code, this is `claim.place_of_service`,
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`claim.facility_code_qualifier`, and `claim.frequency_code` on the
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`ClaimHeader` model in `cyclone/parsers/models.py`.
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## Loops
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Four-digit numeric IDs, hierarchical:
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- 2000A (Billing Provider hierarchy) contains
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- 2000B (Subscriber hierarchy) which contains
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- 2300 (Claim) which contains
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- 2400 (Service line)
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In `cyclone.parsers`, the `parse_837` walker descends through these loops
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explicitly.
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## Common qualifiers Cyclone cares about
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| Qualifier | Meaning | Where |
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|---|---|---|
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| `ABK` | ICD-10 principal diagnosis | `HI01-1` |
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| `ABF` | ICD-10 diagnosis | `HI01-1` |
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| `B` | Facility code qualifier (CMS POS) | `CLM05-2` |
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| `MC` | Medicaid (claim filing indicator) | 835 `CLP06` |
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| `PR` | Payer | 835 `N1*PR` |
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| `PE` | Payee | 835 `N1*PE` |
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| `G1` | Prior authorization | 837P `REF01` |
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| `TJ` | Federal taxpayer ID | 837P `REF01` (rendering provider TIN) |
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| `1` | Original claim | 837P `CLM05-3` |
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| `7` | Replacement claim | 837P `CLM05-3` |
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| `8` | Void/cancel claim | 837P `CLM05-3` |
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## The four delimiters
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All four are declared in the `ISA` segment (positions 103–106 in the ISA
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fixed-width header) and reused throughout the file. Cyclone's tokenizer
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in `cyclone/parsers/segments.py` reads the ISA first, then splits the
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rest of the file by those characters.
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- `*` — element separator
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- `:` — component (sub-element) separator
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- `~` — segment terminator
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- `^` — repetition separator
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