Tyler
72 lines
2.1 KiB
Markdown
72 lines
2.1 KiB
Markdown
# Colorado Medicaid — payer specifics
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Cyclone's CO Medicaid (`PayerConfig.co_medicaid()` and
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`PayerConfig835.co_medicaid_835()`) factories encode the trading-partner
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and code-set rules that the Colorado Department of Health Care Policy &
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Financing (HCPF) requires.
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## Trading Partner IDs (TPID)
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| Role | 837P | 835 |
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|---|---|---|
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| Sender | `SKCO0` | (varies; usually the clearinghouse) |
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| Receiver | `COHCPF` | (varies) |
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These appear in the `NM1*PR` (payer) and `NM1*40` (receiver) segments of
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the 837P file.
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## Payer IDs
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### 837P (claims)
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- `NM1*PR N104 = "SKCO0"` (COHCPF)
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### 835 (remittance)
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- `BPR10 = "81-1725341"` — TXIX (Medicaid) account
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- `BPR10 = "84-0644739"` — BHA (behavioral health) account
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- `N1*PR N104 = "7912900843"` — payer ID
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- `N1*PR N102` is one of `"CO_TXIX"` or `"CO_BHA"`
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## Allowed codes
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### 837P `CLM05-3` (frequency code)
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| Code | Meaning |
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|---|---|
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| 1 | Original claim |
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| 7 | Replacement claim |
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| 8 | Void / cancel |
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Cyclone raises `R030_frequency_allowed` if any other value appears.
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### 835 `CLP02` (claim status code)
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Allowed: `{1, 2, 3, 4, 19, 20, 21, 22, 23, 25}`. See the 835 reference
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note for the meaning of each.
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### Place of service (POS)
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All CMS POS codes `01`–`99` are accepted. The canonical list lives in
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`cyclone/parsers/payer.py` as `CMS_PLACE_OF_SERVICE_CODES` and is the
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source of truth for validation and any UI dropdowns.
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## Validation rules Cyclone enforces
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See [837p.md](./837p.md#validation-rules-cyclone-enforces) and the
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`cyclone.parsers.validator` / `cyclone.parsers.validator_835` modules.
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## Adding a new payer
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The pattern is:
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1. Add a `PayerConfig` (837P) and `PayerConfig835` (835) factory in
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`cyclone/parsers/payer.py` — usually thin wrappers that override only
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the differing fields (allowed codes, payer IDs).
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2. Register the factory in the `PAYER_FACTORIES` / `PAYER_FACTORIES_835`
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dicts in `cyclone/api.py` and `cyclone/cli.py`.
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3. Add a smoke fixture under `backend/tests/fixtures/` (a real or
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synthetic file matching the new payer's rules) and a parser test that
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loads it.
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4. Update this note + the 837p/835 notes with the new payer's specifics.
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