Date: Wed, 28 Aug 2002 14:21:30 -0700
Reply-To: Bish <sean_hussey@HOTMAIL.COM>
Sender: "SAS(r) Discussion" <SAS-L@LISTSERV.UGA.EDU>
From: Bish <sean_hussey@HOTMAIL.COM>
Organization: http://groups.google.com/
Subject: Re: Hello all...I'm seeking direction for a State medicaid
project
Content-Type: text/plain; charset=ISO-8859-1
wwvierg@ATTGLOBAL.NET (William W. Viergever) wrote in message news:<5.1.0.14.2.20020823160639.00ab0c18@pop3.attglobal.net>...
> At 10:45 AM 8/23/2002 -0700, Bish wrote:
> >Hi all...this is the first time I've posted on this board, and I'd
> >like to make an introduction :)
> >
> >I'm fairly new to SAS and the HealthCare Industry, but day by day
> >things get a bit easier.
>
> Day by day we get smarter.
>
> >I have a tendency to be active with good community boards and try
> >to contribute as much if not more than I recieve.
>
> I contribute more wine than I drink ... usually <g>
>
> >I've recently be presented with a project that involves converting
> >flat files recieved from the State that were created under HIPAA 835
> >requirements.
>
> Who bid this project? ... you, an employer? ... where are/were the job
> specs or RFP?
>
> >Now typically, this wouldn't be a big deal b/c I could
> >simply look at the spec for the files being sent and import the
> >information then format it into a workable SAS dataset. The problem
> >is that the state will not supply a spec or sample text file for us to
> >work with...likely b/c they haven't gotten the thing put together yet
> >:)
>
>
> I'm assuming you mean they haven't written a set of user docs/data
> dictionary/layout/etc. for this 835 data; I've had similar experience
> getting data before docs were ready - from the state of Calif.
>
> In which case, see if they can provide you w/ the COBOL (most likely)
> program that created the data tape w/. That *may* provide you w/ enough to
> write a SAS input statement ....
>
> On the otherhand it probably will not, for the nature of the 835 data is
> one of many small "segments" that are part of bigger "records" (or
> "transaction sets"), and the COBOL pgm wll probably simply say it's
> bringing in *something* from way over here and writing it out, way over
> there in such & such buffer <g>, i.e., you still won't know what's in that
> particular "something", field-wise.
>
> Bottom line, you will most likely have to pour over the Guidelines for the
> "835: Health Care Claim Payment/Advice" files, see:
>
> http://hipaa.wpc-edi.com/HIPAA_40.asp
>
> and construct your own set of input statements for the HEADER, DETAIL, and
> SUMMARY segments *and* all their variants and "loops".
>
> In particular, you'll need to go through the entire Appendix A, the "ASC
> X12 Nomenclature".
>
> Note: This stuff ain't easy; it's why folks are charging BIG BUCKS to do
> HIPAA stuff. Get ready for a slew of conditional INPUT statements --
> trailing @ signs, baybee!
>
> Implicit in all this is how you will plan your SAS dataset(s); i.e., what
> is the "unit of observation" that your desired SAS dataset(s) will have?
> ... claim level?, line item? ... provider level? ... i.e., as you read
> these data from the flat files, how do you want to output them?
>
> This issue is pervasive in the health care data world, and as the MVS-Maven
> Mmmmiiiikkkkeeee pointed out, is addressed nicely in the Scerbo, Dickstein,
> & Wilson's BBU: "Health Care Data and the SAS System".
>
> If you score this book (recommended), pay attention to their "Chapter 3
> Data Forms, Layouts, and Files" and "Chapter 7 Combining the Data" where
> they get into data structures and terminology.
>
> Unfortunately, HIPAA is relegated to their "Chapter 10 The Future of Health
> Care Data" so you'll probably not find anything canned.
>
>
> >Anyway, we know that the State will likely run us pretty much out of
> >time before we get what we need..so we want to get a jump start on
> >them. Has anyone out there had to recieve remitance files from the
> >state that follow the HIPAA 835 guidlines, and then convert those
> >files into a SAS dataset? If so, would you be willing give me a nudge
> >in the right direction?
>
> See nudge above.
>
> >About all I have for resource materials are SAS and the Health Care
> >Claim Payment/Advice 835 tech manual.
>
> Repeat 10 times ... real quick: X12, X12, X12 ...
>
>
> >Thanks,
>
> Good Luck
>
> ------------------------------------------------------------
> William W. Viergever Voice : (916) 483-8398
> Viergever & Associates Fax : (916) 486-1488
> Sacramento, CA 95825 E-mail : wwvierg@attglobal.net
> ------------------------------------------------------------
> --
William,
you're too funny :) and too correct too. I've burried my face in
this Health Care Claim Payment/Advice (835 ASC X12N) pub and am
chugging along. As you mentioned, I've spent a good deal of time in
Appendix A...but the one thing I'm absolutly not getting is THE BIG
BUCK TO PUT THIS TOGETHER! hehe
anyway, I've ripped out a couple sample transactions from the manaual
and will using them as a baby sample. The State has hired EDS to set
up the transmittal from their end, and we're not expected to see
anything until next Oct. sometime, so this is gonna have to due.
Well..thanks for the laugh, when I get this done (I have this project
and a few others...so it will take at least a month or so) I'd be
happy to distribute it for use and refinement. Or hell...maybe I'll
try to sell it :)
Wave,
Bish
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