Model C1A3F297 Command Line Translator 1.15B-14

Model C1A3F297 Command Line Translator 1.15B-14 offers a flexible yet practical tool for software developers, systems integrators, and medical billing professions to create solutions and solve problems they might encounter in their business processes relative to the scope of Electronic Data Interchange and health care. The Command Line Translator is a cost effective way to add HIPAA X12 electronic claims to an existing system. It can even be used to fix other X12 837 files that no longer meet an insurance carriers specific requirements.

THREE PART PROCESS

The Command Line translation process has three basic parts, an import process, a verification adjudication processing, and a compiled output process. All processes are done using the translator's database. All processes are defined out in what is called the Command File. This file can be called any eight character name followed with an extension of .CMD.

IMPORT PROCESS

The import processes available are BCU or Basic Conversion Utility, the ACU or ANSII X12 Conversion Utility, the FCU or Frame Conversion Utility, the NCU or Nested Conversion Utility used for:

PROCESSING VERIFICATION and ADJUDICATION

After an import has been completed, the processing portion of the application will begin.
The Processing portion of the translation can first be defined according to a structure of either carrier or clearing. Sub options of these structures offered are batch or release. An example of this is a CARRIERBATCH. A CARRIERBATCH is a batch that has all data in it being processed because of the primary coverage of the subscribers. There are several ways to configure this type of translation. Issues such as the absence of critical data fields such as coverage name and order of coverage may play into which design factors best deal with the data quality. Another example of a processing command is CARRIERRELEASE. This method can be used for example to import in insurance claim data containing a wide variety of insurance carriers. Once imported, the claims can be processed and output grouped by carrier thus separating the claims to go to the appropriate receiver or payer.

Some basic data elements are critical to properly translate claims. Criticality of some data elements will vary based on things like import data quality and the nature of the business application problem that is trying to be solved. If claim data that has been imported that does not meet certain minimum requirements that claim data will be removed by the processing functions from the processing stream, and placed in a suspended status and then noted in the suspend log. The file is named SUSPEND.LOG and is in the DATA DIRECTORY.

In addition to the basic system verifications some critical fields like birthdays and insurance ID's can be check presence. This is configured in the C1.INI in the DATA DIRECTORY.

COMPILING OUTPUT

There are several ways to configure the system to generate output. The import process used in conjunction with the quality of the import data can dictate how to go about configuring the system for output. The Insurance Carrier and Institution databases contain information that can be pre configured with names and IDs that are needed to generate some output formats. All import configurations can be set up using these databases and the appropriate INSURANCE CONTRACT TABLE configuration settings located in the Institution Data screen. If enough data is available, the BCU and ACU can be configured to allow for full configuration on the fly. This can allow for single folder configurations with multiple providers and carriers being processed through. 

OPERATING SYSTEM

DOS 32bit text based (Beta)

• Identical in function to Linux version.
• Supports X12 File formatting to HTML,PDF,TXT, and RTF.

Linux 32bit text based (Beta)

• Identical in function to DOS version.
• Supports X12 file formatting to HTML,PDF,TXT, and RTF.

Basic Conversion Utility (BCU) Imports a single file with multiple records and fields:

• Ideal for software developers.
• Create claims form spread sheet data.
• Add EDI to existing database applications.
• Supports DBF Files.
• Supports Comma Separated Values.
• Supports MDB, SQL and other file types via ODBC Drivers.
• Multi Pass Functionality allows multiple input conversions in one job command.
• Allows for single file input or whole directory of like files.

Frame Conversion Utility (FCU) Imports sequential text files and is ideal for:

• HCFA-1500 Image Files.
• SQL Data Files.
• Report Data Files.
• Consistently Sequential Blocked Data Files.

Nested Conversion Utility (NCU) Imports structured flat format EDI files and is an ideal conversion method for:

• National Standard Format.
• Older Proprietary Formats.
• Vendor Proprietary Formats.
• Inconsistent Sequential Blocked Data Files.

ANSII X12 Conversion Utility (ACU) Imports ANSII X12 EDI files and is ideal for:

• Converting older X12 formats into newer ones.
• Converting other X12 transactions into claims data.
• Converting X12 transactions back to NSF.
• Converting X12 claims to paper claims.

TRANSLATOR OUTPUTS

Configurable HIPAA Compliant X12 837 The C1.CFG file allows for loop, segment, element and sub-element control of the X12 format:

• Support for Solo Professional Practice.
• Support for Group Professional Practice.
• Support for Institutional Hospital Claims.(Beta)
• Support for DME and Ambulance.(Beta)

CMS-1500 Print and Image File :

• Both form revisions 0805 and 1290.
• Configurable box controls through the C1.INI file.
• Create an ASCII text image file of the CMS-1500 Insurance Form.
• Print direct to printer with artwork or with pre-printed forms (Windows Only).

(DBO) Database Output (Beta)

• Create a database output file of imported and processed data.

TRANSLATOR FILES

Some of the basic system files and their descriptions.

• .CMD Command File.
• C1.INI System Configuration File for:
  • Processing
  • CMS-1500
  • Some X12 Controls.
• C1.BCU Basic Conversion Utility for import mapping.
• C1.ACU ANSII X12 Conversion Utility for import mapping.
• C1.FCU Frame Conversion Utility for import mapping.
• C1.NCU Nested Conversion Utility for import mapping.
• C1.CFG Basic Conversion Utility import mapping.
• .TCF Transmission Claim File is the X12 or CMS-1500 output file.
• NOTE: Source files to be imported are specified in their respective import mapping file.

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