ANSI to Micromd Mapping Troubleshooting Guide

ANSI to MicroMD Mapping Troubleshooting Guide

This document contains a basic reference for those trying to troubleshoot ANSI claim files. We have organized these tables by ANSI loop and element. Users will also find directions for finding the appropriate location within MicroMD® where the system actually pulls information to create the claim file.

NOTE |Use the ANSI Ripper application developed by our programmers to help you read the ANSI file in a human-friendly format.

Overall Notes

For Tricare through ENS or PI, and for New York Medicaid direct, the system removes all leading zeros from dollar amounts on claims.

Enveloping

Element / Location in MicroMD (window and field)
ISA01 / EB Setup Screen - Author Information qualifier
ISA02 / EB Setup Screen - Author Information
ISA04 / EB Setup Screen – Password
If EB Type is ALPR or PerSe, MicroMD leaves this element blank.
ISA05 / EB Setup Screen – Sender ID qualifier
ISA06 / EB Setup Screen – Sender ID
ISA07 / EB Setup Screen – Interchng Recv ID qualifier
ISA08 / EB Setup Screen – Interchng Recv ID
ISA13 / EB Setup Screen – Submission Number
ISA14 / Claims Processing – EB –
If EB Type is MDWV, MicroMD sets this to 1. Otherwise, the system sends a 0.
ISA15 / EB Setup Screen – Submission Test
ISA16 / Defaults to ‘:’. You can change it in the eb.ini file.
GS02 / EB Setup Screen – Application Sender ID
If Application Sender ID is blank, MicroMD pulls the value from the EB Setup Screen - Sender ID field.
GS03 / EB Setup Screen – Application Receiver ID
If Application Receiver ID is blank, MicroMD pulls the value from the EB Setup Screen - Interchng Recv ID.
GS06 / EB Setup Screen – Group Control
GS08 / EB Setup Screen – Claim File Type
REF(87)02 / EB Setup Screen – Claim File Type
(If EB Type section of the eb.ini file has a key called dtest with a value of 1, and the EB Setup Screen – Submission Test field is set to Test, MicroMD adds a Dto the value. This is only to be used for Pilot Testing.)

Loop 1000A

Element / Location in MicroMD (window and field)
NM1(41)03 / EB Setup Screen – Sub Org/Last Name
If this field is blank, MicroMD uses the practice name.
NM1(41)04 / EB Setup Screen – First Name
Only if the practice name is not used.
NM1(41)05 / EB Setup Screen – MI
Only if the practice name is not used.
NM1(41)09 / EB Setup Screen – Source ID
If it exists. Sender ID otherwise
PER02 / EB Setup Screen – Contact
PER03 / EB Setup Screen – Primary Contact No. Qualifier (TE if it does not exist)
PER04 / EB Setup Screen – Primary Contact No. (Uses practice phone if it does not exist)
PER05 / EB Setup Screen – Sec. Contact No. Qualifier
PER06 / EB Setup Screen – Sec. Contact No.

Loop 1000B

Element / Location in MicroMD (window and field)
NM1(40)03 / If EB Setup Screen – Batch By Plan is checked, MicroMD pulls the value for this element from the Plan Detail – ID/Anesthesia tab, Org Name (1000B). Otherwise, the system pulls the information from the EB Setup Screen – Receiver Name
NM1(40)09 / If EB Setup Screen – Batch By Plan is checked, MicroMD pulls the value for this element from the Plan Detail – ID/Anesthesia tab, Org ID (1000B). Otherwise, the system pulls the information from the EB Setup Screen – Recv ID

Loop 2000A

Element / Location in MicroMD (window and field)
PRV03 / If EB Setup Screen – Organization is not checked, or if Taxonomy 2000a drop-down EB Setup has a selection made then this PRV segment is created. If it exists and depending on the choice in the Taxonomy 2000a drop-down, MicroMD pulls the value for this element from Provider Detail – Taxonomy field or from the Taxonomy Code column on the practice Location tab. If the client needs to have Organization checked, they can check the Taxonomy 2000a checkbox on the EB Setup window. You must also turn on Batch by Provider in this case so the loop is created for each provider.

Loop 2010AA

Element / Location in MicroMD (window and field)
NM102 / If there is a checkmark in the Non-Person Entity checkbox on the provider’s detail window, the system populates this segment with a “2”. The non-person entity whole name must also appear in the Last Name field. (Enter a dummy first name, as this is a required field.) If there is no check mark, the system enters a “1” in this segment.
NM1(85)03 / If EB Setup Screen – Organization is checked, MicroMD first looks at the name on the Practice Detail – Provider tab, Box 33 Information. If this name exists, the system uses that information. If the Box 33 information is blank, MicroMD uses the Name from the Practice Detail. Otherwise if Organization is not checked, the system uses the Rendering Provider Last Name from the Provider Detail.
NM1(85)04 / If EB Setup Screen – Organization is not checked, the Rendering Provider First Name will be used from Provider Detail.
NM1(85)05 / If EB Setup Screen – Organization is not checked, the Rendering Provider MI will be used from Provider Detail.
NM1(85)08 / If a qualifier is entered on the EB Setup Screen – Provider Qualifier, then that value is entered here. If not, then the value of the Tax Type on the Practice Detail – Practice tab is used to determine the value. If Tax Type = S, a 34 is entered here. If Tax Type = E, a 24 is entered here. If none of the above, an XX is entered here.
NM1(85)09 / If NM1(85)08 = ‘34’, the SSN from the Provider Detail will be used. If NM1(85)08 = ‘24’, then the Federal Tax ID from the Provider tab of Practice Detail will be used if it exists, otherwise, the Federal Tax ID from the Practice Detail, Practice tab will be used.
If NM1(85)08 = XX and Organization is checked on the EB Setup window, then the value will be pulled from:
Practice Detail – Practice Insurance ID Tab – NPI
Practice Detail - Providers Tab – NPI
Practice Detail - Practice Tab - Practice NPI
Practice Detail - Provider Insurance ID Tab – NPI
Provider Detail - NPI.
If NM1(85)08 = XX and Organization is not checked on the EB Setup window, then the value will be pulled from:
Practice Detail – Provider Tab - Provider Insurance ID Tab - NPI
Provider Detail – NPI
Practice Detail – Practice Insurance ID Tab – NPI
Practice Detail – Provider Tab – NPI
Practice Detail – Practice NPI
N301 / The Box 33 information on Practice Detail, Provider tab will be used if it exists to send Address line 1, otherwise, the practice address line 1 will be sent.
N302 / The Box 33 information on Practice Detail, Provider tab will be used if it exists to send Address line 2, otherwise, the practice address line 2 will be sent.
N401 / The Box 33 information on Practice Detail, Provider tab will be used if it exists to send city, otherwise, the practice city will be sent.
N402 / The Box 33 information on Practice Detail, Provider tab will be used if it exists to send state, otherwise, the practice state will be sent.
N403 / The Box 33 information on Practice Detail, Provider tab will be used if it exists to send zip code, otherwise, the practice zip code will be sent.
REF01 / If NM1(85)08 = XX then this REF segment will be created. This is the value of the Tax Type on the Practice Detail – Practice tab is used to determine the value. If Tax Type = S, then SY is entered here. If Tax Type = E, then EI is entered here.
REF02 / If NM1(85)08 = XX and if REF01 = SY then the SSN from the Provider Detail will be used. Otherwise, if NM1(85)08 = XX and REF01 = EI then the Federal Tax ID from the Provider tab of Practice Detail will be used if it exists; otherwise, the Federal Tax ID from the Practice Detail, Practice tab will be used.
REF01 / If EB Setup – Provider Qualifier is set to XX-NPI w/o Insurance ID, then this REF segment will NOT be created. Otherwise, the billing qualifier from the Practice Insurance ID tab from Practice Detail will be used first. If it does not exist, the billing qualifier from the Provider Insurance ID tab from Practice Detail will be used. If that does not exist, the Source of Payment from Plan Detail will be used to determine what qualifier to send.
REF02 / If a value is chosen in EB Setup – 2010AA, then the value from that location will be used for the ID. The values for 2010AA are Practice Insurance ID, Plan Practice ID, and Provider Insurance ID.
If none of those are chosen, then MicroMD uses IDs in the following order. If none exists in the field, then the system moves to the next field in this list:
Plan Detail, ID/Anesthesia tab – Plan Practice ID
Practice Detail, Practice Insurance ID tab – Practice Insurance ID
Practice Detail, Provider Insurance ID tab – Provider Insurance No
REF01 / A second REF segment will be created in the 2010AA loop if EB Type is BSGA (G5), ALPR (G5), MDNY (LU), ENS for payor ID NYMCD (LU), PRIN for payor ID MCDNY (LU)or PerSe (LU).
REF02 / If EB Type is ALPR or PerSe, the value is taken from EB Setup – Password (the value explicitly not put in the ISA segment). If EB Type is BSGA, the value is taken from EB Setup – Contact No. If EB Type is MDNY, the value is taken from Practice Detail – Location tab, Location Code based on the location on the sequence.

Loop 2010AB

MicroMD can create this loop if there is no checkmark in the Suppress 2010AB checkbox on the EB Setup window on the ANSI tab.

STOP |BE CAREFUL: The difference that triggers this loop can be a matter of a single character, including spaces and punctuation.
Element / Location in MicroMD (window and field)
NM1(87)03 / First, MicroMD looks at Practice Detail – Provider tab, Pay-To Name and Pay-To Address 1. If these are different than the 2010AA Name and Address 1 and EB Setup – Organization is checked, then the Provider Pay-To Name will be put in this element; if Organization is unchecked, the Provider Last Name will be entered here.
If those items are the same, MicroMD looks at the Practice Detail – Practice tab, Pay-To Name and Pay-To Address 1. If either is different than the 2010AA Name and Address 1 and EB Setup – Organization is checked, then the Practice Pay-To Name will be entered in this element; if Organization is unchecked, the Provider Last Name will be entered here. If both Name and Address 1 match, this loop will not be created.
NM1(87)04 / If Provider Last Name is entered in NM1(87)03, then Provider First Name will be entered here.
NM1(87)05 / If Provider Last Name is entered in NM1(87)03, then Provider Middle Initial will be entered here.
NM1(87)08 / If a qualifier is entered on the EB Setup Screen – Provider Qualifier, then that value is entered here. If not, then the value of the Tax Type on the Practice Detail – Practice tab is used to determine the value. If Tax Type = S, a 34 is entered here. If Tax Type = E, a 24 is entered here. If none of the above, an XX is entered here.
NM1(87)09 / If NM1(85)08 = ‘S’, the SSN from the Provider Detail will be used. If NM1(85)08 = ‘E’, then the Federal Tax ID from the Provider tab of Practice Detail will be used if it exists, otherwise, the Federal Tax ID from the Practice Detail, Practice tab will be used. If NM1(85)08 = XX, then the value will be pulled from Provider Detail – NPI field.
N301 / Address 1 from the corresponding name in NM1(87)03 will be entered here.
N302 / Address 2 from the corresponding name in NM1(87)03 will be entered here.
N401 / The city from the corresponding name in NM1(87)03 will be entered here.
N402 / The state from the corresponding name in NM1(87)03 will be entered here.
N403 / The zip code from the corresponding name in NM1(87)03 will be entered here.
REF01 / If EB Setup – ANSI tab has a value in 2010AB, then the billing qualifier from the Practice Insurance ID tab from Practice Detail will be used first. If it does not exist, the billing qualifier from the Provider Insurance ID tab from Practice Detail will be used. If that does not exist, the Source of Payment from Plan Detail will be used to determine what qualifier to send. If no value is set in EB Setup – ANSI tab in the 2010AB field, then this REF segment will not be created.
REF02 / If a value is chosen in EB Setup – 2010AB, then the value from that location will be used for the ID. The values for 2010AB are Practice Insurance ID, Plan Practice ID, and Provider Insurance ID.

Loop 2000B

Element / Location in MicroMD (window and field)
SBR01 / Patient Detail – Plan Sets tab – Plan Type. P for Primary, S for Secondary, and T for Tertiary.
SBR02 / If Patient Detail – Plan Sets tab – Relation is Self, then 18 is entered here; otherwise, this element is left blank.
SBR03 / If EB type is MCVA and SBR01 = P and, on the Source of Paymentfield on the Plan Detail is Medicare, then this element will be left blank. If EB Type is PRWA and Plan Detail – ID/Anesthesia tab Payer ID is 00882, then this element will be left blank. Otherwise, Patient Detail – Plan Sets tab – Group No (unless the EB type is ALPR. If it is, and Plan Detail – ID/Anesthesia tab, Payer Type = BNC and there is no Group Number, 999999 will be entered here).
SBR04 / If EB type is MCVA and SBR01 = P and Plan Detail – Source of Payment is Medicare, then this element will be left blank. If EB Type is PRWA and Plan Detail – ID/Anesthesia tab Payer ID is 00882, then this element will be left blank. Otherwise, if SBR03 is not empty, the Plan Name will be pulled from Plan Detail – Plan tab.
SBR05 / If Plan Detail – Source of Payment is Medicare, and SBR01 = S or T, then the value is pulled from Claim Modification – Ins Type field.
SBR09 / Plan Detail – Plan tab – Source of Payment
PAT06 / (Element created only if a self-insured claim, and if patient is deceased or patient is marked with the pregnancy indicator). If a patient deceased date exists on Patient Detail – Detail tab, it is entered here.
PAT08 / (6.0 and above) If DME CMN, Patient Weight from Claim Transactions Window
PAT09 / Segment is created when Pregnancy indicator is checked and there is no check mark in Auto Accident or Other Accident. Date must also be included in Injury/LMP field to create segment. System includes a Y in this segment when created.

Loop 2010BA

Element / Location in MicroMD (window and field)
NM1(IL)02 / If there is a checkmark in the NP Entity checkbox on the patient’s plan sets tab (in the Policyholder section if the relation is other than self), the system populates this segment with a “2”. The non-person entity whole name must also appear in the Last Name field. (Enter a dummy first name, as this is a required field.) If there is no check mark, the system enters a “1” in this segment.
NM1(IL)03 / If patient is self insured, the last name is pulled from Patient Detail, Detail tab – Last Name. If patient is not self insured, and the insured is a guarantor in the system, the last name is pulled from Patient Detail – Detail tab of the insured account. If the insured is not a patient in the system, then the last name is pulled from the Insured Box on Patient Detail – Plan Sets tab.
NM1(IL)04 / Pulls the first name from the same place as the last name is pulled for NM1(IL)03
NM1(IL)05 / Pulls the middle initial from the same place as the last name is pulled for NM1(IL)03
NM1(IL)07 / Pulls the generation from the same place as the last name is pulled for NM1(IL)03
NM1(IL)08 / Patient Detail, Plan Sets tab – Policy Qualifier
NM1(IL)09 / If EB Type is SCMI, then MicroMD first looks at Claim Transactions – Block 10D; otherwise, it uses the policy number. If EB Type is anything else, it uses Patient Detail, Plan Sets tab – Policy.
N301 / (Segment is created if the person is self-insured, or if Plan Detail – ID/Anesthesia tab – Insured Address is checked.) Address 1 is pulled from the same place as last name is pulled for NM1(IL)03.
N302 / Address 2 is pulled from the same place as last name is pulled for NM1(IL)03.
N401 / (Segment is created if the person is self insured, or if Plan Detail – ID/Anesthesia tab, Insured Address is checked.) City is pulled from the same place as last name is pulled for NM1(IL)03.
N402 / State is pulled from the same place as last name is pulled for NM1(IL)03.
N403 / Zip code is pulled from the same place as last name is pulled for NM1(IL)03.
DMG02 / (Segment is created if the person is self insured, or if Plan Detail – ID/Anesthesia tab, Insured Address is checked.) DOB is pulled from the same place as last name is pulled for NM1(IL)03.
DMG03 / Insured sex is pulled from the same place as last name is pulled for NM1(IL)03.
REF(SY)01 / This segment is only populated if the EB type is MACSIS..
REF(SY)02 / This is the patient social security number, pulled from Patient Detail – Detail tab.

Loop 2010BB

Element / Location in MicroMD (window and field)
NM1(PR)03 / Plan Detail, Plan tab – Plan Name
NM1(PR)08 / Plan Detail, ID/Anesthesia tab – Payer ID Qualifier
NM1(PR)09 / Plan Detail, ID/Anesthesia tab – Payer ID
If EB type is MDWV, then the value WV_MMIS_4UNISYS is entered here. Otherwise if EB type is THIN, a letter based on the Source of Payment for the plan is placed in front of the payer ID (C for Medicare, D for Medicaid, F for Commercial, G for Blue Shield).
N301 / Plan Detail, Plan tab – Address line 1
N302 / Plan Detail, Plan tab – Address line 2
N401 / Plan Detail, Plan tab – City
N402 / Plan Detail, Plan tab – State
N403 / Plan Detail, Plan tab – Zip code
REF01 / (Segment is only created if a value exists on Plan Detail – ID/Anesthesia tab, Claim Office ID) An FY is entered here.
REF02 / Plan Detail, ID/Anesthesia tab – Claim Office ID

Loop 2000C

(Only created if patient is not the insured)

Element / Location in MicroMD (window and field)
PAT01 / Patient Detail, Plan Sets tab – Relation
PAT06 / If a patient deceased date exists on Patient Detail – Detail tab, it is entered here
PAT09 / If claim is not accident related, Claim Transactions Window – Pregnancy indicator

Loop 2010CA

(Only created if patient is not the insured)

Element / Location (Screen – Field) in MicroMD
NM1(QC)03 / Patient Detail, Detail tab – Last Name
NM1(QC)04 / Patient Detail, Detail tab – First Name
NM1(QC)05 / Patient Detail, Detail tab – MI
NM1(QC)08 / If Plan Detail – ID/Anesthesia tab, Insured Policy is checked, this value is pulled from Patient Detail, Plan Sets tab – Policy Qualifier
NM1(QC)09 / If Plan Detail – ID/Anesthesia tab, Insured Policy is checked, this value is pulled from Patient Detail, Plan Sets tab – Policy
If the EB Type is IHNY or PRWA and the group number is 11 digits, the system places the group number in this segment.
N301 / Patient Detail, Detail tab – Address line 1
N302 / Patient Detail, Detail tab – Address line 2
N401 / Patient Detail, Detail tab – City
N402 / Patient Detail, Detail tab – State
N403 / Patient Detail, Detail tab – Zip code
DMG02 / Patient Detail, Detail tab – DOB
DMG03 / Patient Detail, Detail tab – Sex
NM101 / “QC” (Created for Texas Workers Comp)
NM102 / “1” (Created for Texas Workers Comp)
NM103 / Last Name (Created for Texas Workers Comp)
NM104 / First Name (Created for Texas Workers Comp)
NM108 / Patient Plan Policy Qualifier (should be “MI”) (Created for Texas Workers Comp)
NM109 / Patient Plan Policy (Created for Texas Workers Comp)
Ref01 / “Y4” (Created for Texas Workers Comp)
Ref02 / Claim Number (on the Extra button on the Texas Workers Comp form)

Loop 2300