Claim to exposure tracking map details

The following are inputs to the Claim837P_to_ExposureReport map:

Input 1 - HIPAA EDI claims data file
Input 2 – A list of ICD-10 CM diagnosis codes that you want to scan. You can configure this list to fit your needs.
Input 3 - a list of three control numbers used to create the EDI 148 transaction. One for the interchange envelope, one for the Functional Group envelope and one for the Transaction set envelope. In a production environment these will probably be changed to be looked up from a database or another system.
Input 4 - list of diagnosis codes and their descriptions, the ICD-10 CM data to display on reports.

The outputs are the following:

Output 1 - EDI Report – a 148 transaction, which is an EDI Report of Injury, Illness or Incident
Output 2 - Text Based Report

The X12 148, EDI Report, has one HL (Hierarchical Reporting) loop per claim that qualified for inclusion on the report. It contains basic demographic data, the name of the patient and the subscriber (if different), the patient address and the primary and any secondary diagnoses. This report only includes claims with one diagnosis code which matches one in input 2, but for a selected claim all other diagnosis codes and included.

The simple text-based report includes the same basic claim information included on the X12 148 report, but with labels and diagnosis descriptions, so it is more readable for a user not familiar with X12.

Note: This example produces a report file that contains personal health information (as does the input claim itself) so ensure that regulatory policy and company policies are followed when creating and sharing these reports.