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Procentive Knowledge Hub

X12 Summary

Overview

The X12 Summary shows what is submitted on an 837p and/or 837i electronic claim. All Procentive claims and other EDI follow the current 5010 standard.  Since some of the windows in the billing process allow edits, the X12 Summary is the place to verify exactly what travels on a specific claim.  Use the X12 Summary to verify things like  NPI,  modifiers, and  secondary insurance.


x12 summary overview.jpg  

  Name Description
A Submitter/Receiver Loop This section identifies Procentive as the submitter.  It also identifies the receiver/clearinghouse.
B Billing/Pay-to Loop This section identifies your agency.  It contains your agency's applicable billing and payment information,  such as NPI, billing address, taxonomy and tax id. 
C Subscriber Loop This section identifies the subscriber (your client).  It contains the subscriber's  insurance information,  such as patient ID, address and date of birth.  
D Claim Loop  This section provides claim information on the service(s) provided. It begins with the claim identifier (the claim number) and includes information such as total charges submitted, diagnosis, rendering provider and the rendering provider's NPI.  It will also list any secondary and tertiary insurance information that is in the client record (if this information has been entered into the Clients Module, Payer tab).
E Service Line Loop This section will list each service line associated with this claim.  Here you can verify dates of service, codes and modifiers. 

Note:  The Subscriber loop and claim loop will repeat for each client.  Notice the gray shading to help you identify the breaks.

Lines, Loops and Segments

In the electronic world of claims, payers/clearinghouses will identify issues with your claims by line, loop and segment.  These lines, loops and segments can be found on the X12 Summary.

x12 lines loops and segments.jpg

How do I get to the X12 Summary?

Prior to sending a claim
  1. In the Confirm Invoices Window.

    confirm invoices data link.jpg
     
  2. Click on the data link
    • The X12 Claim Data window will open
  3. Click on the X12 Summary radio button at top of window. 
    • The X12 Summary report will display.
After a claim has been sent
  1. Click on the Electronic Module.
  2. Click on the batch reference in the batch column.
  3. Click on the X12 Summary radio button at top of window.
    • The X12 Summary report will open.

Note:  You can find the X12 Summary from within any Invoice Window.