Crosswalk

---

Overview

837-P
837-I
837P-DME

---

Sheet 1: 837-P

September 2011 (old version)	May 2014 (new version)	Type of Change	Reason for Change	Burden Change
Preface	Preface	Rev	Email address to submit questions changed from [email protected] to [email protected].	No
Introduction	Introduction	Rev	Updated content through this section to more fully define the scope and overview of the 837-P EDS Companion Guide	No
	1.3 Major Updates	New	Added section to identify significant updates made to each new release of the monthly 837-P EDS Companion Guides	No
1.4 References	1.4 References	Rev	Removed sentence (For example, the edits contained in a spreadsheet version of EB20113V01 are effective January 1, 2013 and implemented on January 7, 2013.) because dates do not coincide with quarterly updates. Detailed explanation documented in CG to instruct submitter how to access CEM Edits Spreadsheet.	No
2.0 Contact Information	2.0 Contact Information	Rev	Updated this section to include additional resources and new information regarding availability of resources	No
2.2 Applicable Websites/Email Resources	2.2 Applicable Websites/Email Resources	Rev	Updated Resource listing to identify new EDS inbox email address from [email protected] to [email protected]	No
	3.0 File Submission	New	Added section to desciribe requirements for EDS file size limitations and file structure	Yes (system change)
3.2 File Structure	3.2 File Structure – NDM/Connect:Direct and Gentran/TIBCO Submitters Only	New	Added Note to NDM/Connect:Direct Users: If a submitter has not established a sufficient number of Generated Data Groups (GDGs) to accommodate the number of files returned from the EDFES, not all of the EDFES Acknowledgement reports will be stored in the submitter’s system. To prevent this situation, NDM/Connect:Direct submitters should establish a limit of 255 GDGs in their internal processing systems.	Yes (system change)
4.0 Control Segments/Envelopes	4.0 Control Segments/Envelopes	Rev	Section 4.2, Table 2 – Provided additional guidance to ensure accurate formatting of encounter data files, including specific requirements for specific segments and transaction evenlopes. Note: The tables within this section are updated as needed.	Yes (system change)
	5.0 Transaction Specific Information	New	Separated information from section 4.0 to provide detailed guidance and specific data elements required for submission of 837-Professional encounters Note: The tables within this section are updated as needed.	No
5.0 Acknowledgements and Reports	6.0 Acknowledgements and/or Reports	Rev	Updated guidance to more accurately reflect the purpose and logic for generation and distribution of EDFES reports	Yes (system/staffing change)
	6.4 MAO-001 Encounter Data Duplicates Report	New	Added section to describe requirements and guidance for EDPS MAO-001 Encounter Data Duplicates Report	Yes (system/staffing change)
	6.5 MAO-002 Encounter Data Processing Status Report	New	Added section to describe requirements and guidance for EDPS MAO-002 Encounter Data Processing Status	Yes (system/staffing change)
	6.6 Reports File Naming Conventions	New	Added section to identify EDFES and EDPS File Naming Conventions for Test and Production files	No
	6.6 Reports File Naming Conventions	Rev	Updated FTP Mailbox Naming Convention in Table 5 - Testing EDFES Reports File Naming Conventions and Table 8 - Production EDFES Reports File Naming Conventions	No
	6.7 EDFES Notifications	New	Added guidance and an associated table listing notifications submitted to MAOs and other entities that identify errors with encounter file submission	No
	6.7 EDFES Notifications	Rev	Updated Table 10 - EDFES Notifications to identify new and updated notifications for testing and production	No
	7.0 Front-End Edits	New	Added section to identify deactivated EDFES CEM edits (temporary and permanent deactivation) Note: The tables within this section are updated as needed	Yes (system change)
	8.0 Duplicate Logic	New	Added section to provide purpose and editing logic for EDS duplicate logic validation	No
	9.0 Business Cases	New	Added ten (10) business case scenarios, including data strings for each, to provide comprehensvie submission guidance for commonly submitted encounter types	No
	10.0 Encounter Data Professional Processing and Pricing System Edits	New	Added section to identify edits used by the EDPS to validate and process encounters. Subsections for section 10.0 include a table outlining the error codes, error descriptions/messages, and editing categories; EDPPPS Enhancements Implementation Dates; and Edits Prevention and Resolution Strategies Note: This section is updated as needed.	No
	10.0 Encounter Data Professional Processing and Pricing System Edits	Rev	Updated EDPPPS Error Codes and Error Code Descriptions to remove deactivated edits and add new edits	No
	10.1 EDPPPS Edits Enhancements Implementation Dates	Rev	EDPS Edits Enhancements Implementation updates for new, revised, or deactivated edits.	No
	10.2 EDPS Edits Prevention and Resolution Strategies	Rev	Added overview information and a list of edits generated in the EDPS to provide EDPPPS Edits Prevention and Resolution and Prevention Strategies to assist MAOs and other entities with reconciliation of encounter submission.	No
	11.0 Submission of Default Data in a Limited Set of Circumstances	New	Added section to provided guidance for MAOs and other entities' submission of default data . Subsection 11.1 added to list the actual default data descriptions and default data reason codes. Note: Default Data Reason Codes were previously identified as Proxy Data Reason Codes, but revised to better identify the purpose for the codes.	Yes(System Change)
	11.1 Default Data Reason Codes (DDRC)	Rev	Updated description title from “Proxy” Data to “Default” Data; and description of PDRC to DDRC to more accurately reflect purpose of coding	No
	12.0 Tier II Testing	New	Added section to provide guidance for MAOs and other entities to submit test data to the EDS for verfication of encounter accuracy prior to submission of producation data	No
	13.0 EDS Acronyms	New	Added section to identify acronyms frequently used in the EDS. Note: This section is updated as needed.	No
	Revision History	New	Added section to identify revisions history for monthly 837-P EDS Companion Guides (identifies version number, date of release, and description of revisions occurring for each release	No

---

Sheet 2: 837-I

September 2011 (old version)	May 2014 (new version)	Type of Change	Reason for Change	Burden Change
Preface	Preface	Rev	Email address to submit questions changed from [email protected] to [email protected].	No
Introduction	Introduction	Rev	Updated content through this section to more fully define the scope and overview of the 837-I EDS Companion Guide
	1.3 Major Updates	New	Added section to identify significant updates made to each new release of the monthly 837-I EDS Companion Guides	No
1.4 References	1.4 References	Rev	Removed sentence (For example, the edits contained in a spreadsheet version of EB20113V01 are effective January 1, 2013 and implemented on January 7, 2013.) because dates do not coincide with quarterly updates. Detailed explanation documented in CG to instruct submitter how to access CEM Edits Spreadsheet.	No
2.0 Contact Information	2.0 Contact Information	Rev	Updated this section to include additional resources and new information regarding availability of resources	No
2.2 Applicable Websites/Email Resources	2.2 Applicable Websites/Email Resources	Rev	Updated Resource listing to identify new EDS inbox email address from [email protected] to [email protected]	No
	3.0 File Submission	New	Added section to desciribe requirements for EDS file size limitations and file structure	Yes (system change)
3.2 File Structure	3.2 File Structure – NDM/Connect:Direct and Gentran/TIBCO Submitters Only	New	Added Note to NDM/Connect:Direct Users: If a submitter has not established a sufficient number of Generated Data Groups (GDGs) to accommodate the number of files returned from the EDFES, not all of the EDFES Acknowledgement reports will be stored in the submitter’s system. To prevent this situation, NDM/Connect:Direct submitters should establish a limit of 255 GDGs in their internal processing systems.	Yes (system change)
4.0 Control Segments/Envelopes	4.0 Control Segments/Envelopes	Rev	Section 4.2, Table 2 – Provided additional guidance to ensure accurate formatting of encounter data files, including specific requirements for specific segments and transaction evenlopes. Note: The tables within this section are updated as needed.	Yes (system change)
	5.0 Transaction Specific Information	New	Separated information from section 4.0 to provide detailed guidance and specific data elements required for submission of 837-Institutional encounters Note: The tables within this section are updated as needed.	No
5.0 Acknowledgements and Reports	6.0 Acknowledgements and/or Reports	Rev	Updated guidance to more accurately reflect the purpose and logic for generation and distribution of EDFES reports	Yes (system/staffing change)
	6.4 MAO-001 Encounter Data Duplicates Report	New	Added section to describe requirements and guidance for EDPS MAO-001 Encounter Data Duplicates Report	Yes (system/staffing change)
	6.5 MAO-002 Encounter Data Processing Status Report	New	Added section to describe requirements and guidance for EDPS MAO-002 Encounter Data Processing Status	Yes(system/staffing change)
	6.6 Reports File Naming Conventions	New	Added section to identify EDFES and EDPS File Naming Conventions for Test and Production files	No
	6.6 Reports File Naming Conventions	Rev	Updated FTP Mailbox Naming Convention in Table 5 - Testing EDFES Reports File Naming Conventions and Table 8 - Production EDFES Reports File Naming Conventions	No
	6.7 EDFES Notifications	New	Added guidance and an associated table listing notifications submitted to MAOs and other entities that identify errors with encounter file submission	No
	6.7 EDFES Notifications	Rev	Updated Table 10 - EDFES Notifications to identify new and updated notifications for testing and production	No
	7.0 Front-End Edits	New	Added section to identify deactivated EDFES CEM edits (temporary and permanent deactivation) Note: The tables within this section are updated as needed	Yes(system/staffing change)
	7.1 Deactivated Front-End Edits	Rev	Updated Deactivated Front-End Edits table to include an additional CEM edit	No
	8.0 Duplicate Logic	New	Added section to provide purpose and editing logic for EDS duplicate logic validation	No
	9.0 Business Cases	New	Added ten (10) business case scenarios, including data strings for each, to provide comprehensvie submission guidance for commonly submitted encounter types	No
	10.0 Encounter Data Institutional Processing and Pricing System Edits	New	Added section to identify edits used by the EDPS to validate and process encounters. Subsections for section 10.0 include a table outlining the error codes, error descriptions/messages, and editing categories; EDIPPS Enhancements Implementation Dates; and Edits Prevention and Resolution Strategies Note: This section is updated as needed.	No
	10.0 Encounter Data Institutional Processing and Pricing System Edits	Rev	Updated EDIPPS Error Codes and Error Code Descriptions to remove deactivated edits and add new edits	No
	10.1 EDIPPS Edits Enhancements Implementation Dates	Rev	EDPS Edits Enhancements Implementation updates for new, revised, or deactivated edits.	No
	10.2 EDPS Edits Prevention and Resolution Strategies	Rev	Updated EDIPPS Edits Prevention and Resolution and Prevention Strategies to remove deactivated edits and add new or revised edits strategies	No
	11.0 Submission of Default Data in a Limited Set of Circumstances	New	Added section to provided guidance for MAOs and other entities' submission of default data . Subsection 11.1 added to list the actual default data descriptions and default data reason codes. Note: Default Data Reason Codes were previously identified as Proxy Data Reason Codes, but revised to better identify the purpose for the codes.	Yes (system)
	11.1 Default Data Reason Codes (DDRC)	Rev	Updated description title from “Proxy” Data to “Default” Data; and description of PDRC to DDRC to more accurately reflect purpose of coding	No
	12.0 Tier II Testing	New	Added section to provide guidance for MAOs and other entities to submit test data to the EDS for verfication of encounter accuracy prior to submission of producation data	No
	13.0 EDS Acronyms	New	Added section to identify acronyms frequently used in the EDS. Note: This section is updated as needed.	No
	Revision History	New	Added section to identify revisions history for monthly 837-I EDS Companion Guides (identifies version number, date of release, and description of revisions occurring for each release	No

---

Sheet 3: 837P-DME

June 2012 (old version)	May 2014 (new version)	Type of Change	Reason for Change	Burden Change
Preface	Preface	Rev	Email address to submit questions changed from [email protected] to [email protected].	No
Introduction	Introduction	Rev	Updated content through this section to more fully define the scope and overview of the 837-P DME EDS Companion Guide	No
	1.3 Major Updates	New	Added section to identify significant updates made to each new release of the monthly 837-P DME EDS Companion Guides	No
1.4 References	1.4 References	Rev	Removed sentence (For example, the edits contained in a spreadsheet version of EB20113V01 are effective January 1, 2013 and implemented on January 7, 2013.) because dates do not coincide with quarterly updates. Detailed explanation documented in CG to instruct submitter how to access CEM Edits Spreadsheet.	No
2.2 Applicable Websites/Email Resources	2.2 Applicable Websites/Email Resources	Rev	Updated Resource listing to identify new EDS inbox email address from [email protected] to [email protected]	No
3.0 File Submission	3.0 File Submission	Rev	Updated guidance in this section to include reference to TIBCO connectivity and provide more detailed requirements for EDS file size limitations and file structure	No
3.2 File Structure – NDM/Connect:Direct and Gentran/TIBCO Submitters Only	3.2 File Structure – NDM/Connect:Direct and Gentran/TIBCO Submitters Only	New	Added Note to NDM/Connect:Direct Users: If a submitter has not established a sufficient number of Generated Data Groups (GDGs) to accommodate the number of files returned from the EDFES, not all of the EDFES Acknowledgement reports will be stored in the submitter’s system. To prevent this situation, NDM/Connect:Direct submitters should establish a limit of 255 GDGs in their internal processing systems.	Yes (system change)
4.0 Control Segments/Envelopes	4.0 Control Segments/Envelopes	Rev	Updated tables in section 4.1 and 4.2 to include additional required data elements. Note: The tables within these sections are updated as needed.	Yes (system change)
5.0 837 Professional: Data Element Table	5.0 Transaction Specific Information	New	Updated information in this section to provide detailed guidance and specific data elements required for submission of 837-P DME encounters Note: The tables within this section are updated as needed.	No
	6.4 MAO-001 Encounter Data Duplicates Report	New	Added section to describe requirements and guidance for EDPS MAO-001 Encounter Data Duplicates Report	No
6.6 Reports File Naming Conventions	6.6 Reports File Naming Conventions	Rev	Updated FTP Mailbox Naming Convention in Table 5 - Testing EDFES Reports File Naming Conventions. Added Tables 8 and 9 to identify Production EDFES Reports File Naming Conventions	No
	6.7 EDFES Notifications	New	Added new section to separately address guidance for EDFES Notifications	No
	6.7 EDFES Notifications	Rev	Updated Table 10 - EDFES Notifications to identify new and updated notifications for testing and production	No
7.0 Front-End Edits	7.1 Deactivated Front-End Edits	Rev	Updated Deactivated Front-End Edits table to identify edits as "Deactivated edits" instead of "permanently" deactivated edits.	No
	7.2 Temporarily Deactivated Front-End edits	New	Added section to identify edits that are temporarily deactivated in the EDFES	Yes (system change)
9.0 DME Business Cases	9.0 DME Business Cases	Rev	Updated data strings in DME Business Case scenarios	No
10.0 Encounter Data DME Processing and Pricing System Edits	10.0 Encounter Data DME Processing and Pricing System Edits	Rev	Updated EDDPPS Error Codes and Error Code Descriptions to remove deactivated edits and add new edits	No
	10.1 EDDPPS Edits Enhancements Implementation Dates	New	Added this section to identify dates and reasons for new, revised, or deactivated edits.	No
	10.1 EDDPPS Edits Enhancements Implementation Dates	Rev	EDPS Edits Enhancements Implementation updates for new, revised, or deactivated edits.	No
	10.2 EDPS Edits Prevention and Resolution Strategies	Rev	Added overview information and a list of edits generated in the EDPS to provide EDPPPS Edits Prevention and Resolution and Prevention Strategies to assist MAOs and other entities with reconciliation of encounter submission.	No
	12.0 Submission of Default Data in a Limited Set of Circumstances	New	Added section to provided guidance for MAOs and other entities' submission of default data . Subsection 12.1 added to list the actual default data descriptions and default data reason codes. Note: Default Data Reason Codes were previously identified as Proxy Data Reason Codes, but revised to better identify the purpose for the codes.	Yes (system change)
	12.1 Default Data Reason Codes (DDRC)	Rev	Updated description title from “Proxy” Data to “Default” Data; and description of PDRC to DDRC to more accurately reflect purpose of coding	No
	13.0 Tier II Testing	New	Added section to provide guidance for MAOs and other entities to submit test data to the EDS for verfication of encounter accuracy prior to submission of producation data	No
	14.0 EDS Acronyms	New	Added section to identify acronyms frequently used in the EDS. Note: This section is updated as needed.	No