Configuring Program Options

1. To configure the program options, select Setup arrow Options in the main menu.

The "Options" menu

Alternatively, you can click on the "Setup" button located on the main toolbar.

The "Setup" button
2. The following screen will appear.

The "Setup" window

You can configure the options:
Processed Files
Print Additional Pages
Document Color
Outbox Directory Path

Detailed descriptions to follow.

3. Once you have finished editing the options, click "Save."

Processed Files

In order to prevent the duplicate processing of files, the HIPAA Claim Master can move or delete files after they have been processed. Since the HIPAA Claim Master program can be launched by the Window's scheduler (see Running the Application via Scheduler), it is important to either move or delete processed files, so that they will not be picked up again. You have the choice to either do nothing, move the processed files to a specific folder or delete the files:

Leave in Place — Select this option to do nothing with processed files.

Tip: This option is not recommended.

Move — Select this option to move the processed files to a specified folder.
Delete — Select this option to delete the processed files.


Keep a log of every file processed — Determines whether the log entry should be created for each file processed. By default, the log is only active in command line use (without human interaction.) If you want a log entry created for each manual processing, except viewing on screen, place a check mark here. See also: Accessing Daily File Log.


Never Check for Update — To check the HIPAA Claim Master version update, uncheck the "Never Check for Update" check box. If the check box is unchecked, the application will automatically look for the new version available and a pop up window displayed. On selecting the new version, the application will get updated to the current version available. The lower right corner of the application window displays information including alerts on version updates.

The message on the bottom bar

Print Additional Pages

There may be additional pages with data that have no representation on the standard forms.

This option determines whether the additional pages with either COB information or segments with additional information that have no representation on the standard forms should be printed on either paper or image files. This option helps you save paper. If you only need the main claim form, there is no need to print 2 extra sheets.

If you only need the main claim form, there is no need to print these two (2) extra sheets, in this case, leave the following options unckecked to save your paper.

Additional Info — There may be additional pages with segments containing additional information that have no representation on the standard forms. If this option is checked, then these additional pages will be printed on paper and image files.
COB Info — There may be additional pages containing COB information that have no representation on the standard forms. If this option is checked, then the additional pages will be printed on paper and image files.

Document Color

This section of the setup window is concerned with the output colors. You have the choice to render the form in red or in black. The form background can be set to red to make the form visually more appealing and to allow the use of a color filter for OCR software. The color can be selected for the following media:

Note: The data is always black.

On Screen — Choose a color for the form when displaying claims on screen.
On Paper — Choose a color for the form when printing claims.

Outbox Directory Path

Define the destination folder where the result files will be stored.

No questions yet.

Configuring Specific Options

You can set regional and other user-specific options that do not apply to all users. Follow the instructions below.

1. To configure the program options, select Setup arrow Specific Options in the main menu.

The "Specific Options" menu
2. The following screen will appear.

The "Specific Options" window
3. You can enable/disable the following options:
Do not use calculated Values in Claim Forms — The HIPAA Claim Master calculates the Open Amount from charges minus previous payments and patient paid amounts and some other values. If you prefer not to do this, check this option.
Export POA and ICD Version information with Diagnosis Codes, separated by a colon — You can opt out of writing POA and ICD version information to the database. The default is now to write this information to the database. This option changed. The default behavior is required to create valid claims.

Present on Admission (POA) information is now often required by insurers to exclude "hospital infections" from coverage. These are diseases that are acquired by the patient after admission to the hospital and often cause high costs and even death. In the SQL export the POA codes are colon separated from the diagnosis codes. If this causes problems, you can deselect this here. With the introduction of ICD-10 it is important to save the version of ICD codes that are in the claim to the database. Since it is intrinsically linked to the Diagnosis code we decided against creating another set of fields. It would mean creating another 80 or so fields for POA and ICD version. Instead we opted to concatenate the ICD version qualifier and the POA indicator with Diagnosis Code qualifier separated by a colon (:)

o Principal Diagnosis Code has POA and ICD version. Example:

Z77.22:Y:ABK with the diagnosis code in first position, followed by the POA indicator 'Y' and the ICD-10 qualifier

o Other Diagnosis Code has POA and ICD version. same as above

Example: J151::ABF Here the POA code is committed

o E-Codes also have both POA and ICD version, same as above

Example E8600:Y:ABN

o Admit Diagnosis Code has no POA info. By definition is the diagnosis code under which a patient was admitted present at admission.

Example L01.03:ABJ Only the ICD version qualifier is added to the diagnosis code

o Reason for Visit codes have no POA info. Same as Admit diagnosis

This way of connecting diagnosis information with POA and ICD codes is bi-directional, meaning if you create 837 files from database, then the above example is the way to do it. Internally HIPAA Claim Master will parse out the information and assemble the respective HI segment within all applicable rules.

Display Drug Information with accordance with Medical NDC reporting requirements (CMS-1500: in box 24A, UB-04: in box 43) — The Medi-Cal NDC reporting requirement is concerned with the transmission of drug data that belongs to a specific procedure. In the 837, this information is in the LIN and CPT segments of the 2400 loop. Here the display of NDC in the CMS-1500:

The NDC code is in the upper half of field 24 A. The quantity in 24 D.

The format for the quantity is a full 10-digit number. The 10 digits consist of seven digits for the whole number, followed by the three-digit decimal portion of the number. In the example above line 1 indicates 20 milliliter, line 2 1000 units, line 3 250 milliliter and line 4 10 grams.

The NDC information in the UB04 form

In the UB04 the NDC information goes into the "Description" field 43 as one string with quantities in the same format as in the CMS-1500.
CMS-1500: Display procedure description in 24D — See Displaying the Revenue or Procedure Code Descriptions.
CMS-1500: Display line remarks (NTE*ADD) in 24D (overrides description)
CMS-1500: Do not display Pay-To Provider information in Box 33 - When a Pay-To provider is specified in loop 2010AB, the address information is usually displayed in box 33.
CMS-1500: Copy Billing Provider to Facility if not specified; box 33 to 32
CMS-1500: Populate line providers only if different from claim level - Display cleaned up in EDI files where the rendering provider is repeated on every line.
UB 04: Show description of Procedure Code (Revenue code is default)

Field locator 43 will be populated with the procedure code description in case such code is in SV2 segment

Use Facsimile Mode in UB 04 and CMS-1500 - For the purists, this mode strives to make the claim look like it has been filled with a Dot-Matrix printer. More here.
4. Once you have finished editing the options, click "Save."

No questions yet.

Configuring Claim Forms

The introduction of the National Provider ID (NPI) brought new claim forms. All three types of claims now have a form that contains the NPI. The HCFA-1500 became the CMS-1500, the UB92 was replaced with the UB04 and the ADA 2006 replaced the earlier versions.

You can choose which forms to use and it will give you the choice to either print the form and the data or to suppress the form, so that only the data appears. This is important if you want to print on pre-printed forms or use OCR to read the data.


1. To configure the program options, select Setup arrow Claim Forms in the main menu.

The "Claim Forms" menu
2. The following screen will appear.

The "Claim Forms" window
3. You can configure the following options:
Auto Form Selection
Dental Claims
Professional Claims
Institutional Claims

They are described further below.

4. Once you have finished editing the options, click "Save."


Auto Form Selection

Check this option to automatically select the forms. The system selects the forms based on the following logics. If NPI is present in Billing Provider's information, then choose new Forms with NPI, otherwise use forms pecified below.

Tip:We recommend to activate this setting. Older Pre-NPI claim files will then be displayed in the old forms while newer files with NPI will be rendered in the new forms.


Dental, Professional, Institutional Claims

Select the forms for the following claims:

Dental Claims
Professional Claims
Institutional Claims

Specify the following settings:

Scale — The UB04 form is bigger than the other claim forms. It is 12" x 9" instead of the customary 8 1/2" x 11" and it usually does not print in its entirety due to the print margins. For that reason it is possible to scale the form down to a printable size.
Don't print form, just data — Additionally, you have the choice to print just the data and suppress the form. 
Tip:This feature comes in handy when you want to print to pre-printed forms or if you have an OCR system that does not need the forms.

No questions yet.

Using the EDI Viewer and Editor

EDI files are often hard to read, especially if they have no carriage returns and line feeds to put each segment on a line of its own.

The EDI Editor available in the HIPAA Claim Master replaces all element separators with a star "*", all sub element separators with a colon ":" and all segment separators with a tilde "~" even if the original file uses different delimiters.

Tip: Changing EDI files can be a tricky undertaking. You should be experienced in the format of the 837 and understand that an 837 claim file could be a legal document that should not be altered without the consent of the originator.


To Open EDI Editor

To access the EDI Editor, select the "EDI Editor" option under "View" menu item. 

The "EDI Editor" menu

Alternatively, you can click on the "EDI" icon on the toolbar to invoke the EDI Editor.

This option is only enabled when you have opened an EDI file.

The "EDI Editor" button

The following screen will appear:

The EDI Editor window


To Cut, Copy, Paste

When you right-click anywhere in the text, a context menu will appear with typical test edit options such as cut, copy and paste.

Context menu


To Find and Replace

The "Find" and "Replace" utilities work as in a common text editor. To use them, right-click somewhere in the document and then from the displayed context menu select the "Find" or "Replace" command. Alternatively, you can press Ctrl F simultaneously on your keyboard to bring the text search utility.

The "Find" pop-up

Pressing Ctrl H simultaneously will bring up the Replace utility.

The "Replace" popup

To Save the Changes

As long as you don't save, there will be no changes to the file.

If you make changes to the file, the "Save" button becomes enabled and you can save any changes. The HIPAA Claim Master will further work with those changed files, so you don't have to open the file again.

Notice: Changing EDI files can be a tricky undertaking. You should be experienced in the format of the 835 and understand that an 835 claim file could be a legal document that should not be altered without the consent of the originator.

The "Save" button


No questions yet.

Selecting a Code Set

EDI relies on transaction code sets. These codes represent longer explanations and descriptions.

At the onset of EDI one of the main design ideas was to make the EDI files as short as possible and to allow different languages to use the same descriptions by reducing long verbose explanations to 2-3 byte long codes. Computer storage was incredibly expensive and making any file larger than it absolutely had to was considered wasteful.

The code sets are stored in the file codesets.xml in the Configuration subdirectory:

Windows XP: C:\Documents and Settings\All Users\Application Data\HIPAAsuite\HIPAA Claim Master\Configuration\
Windows 7, Vista: C:\ProgramData\HIPAAsuite\HIPAA Claim Master\Configuration\


The Configuration folder in Windows 7

Tip: The folder is hidden.


To view/edit transaction code sets in HIPAA Claim Master, follow the instructions below.

1. Go to the "Code Sets" item in the main menu. 

The "Code Sets" menu
2. From the sub-menu, select a code set name. The following menu items are available via the "Code Sets" menu:

A to E
Adjustment Reason
Adjustment Reason Group
Admission Source
Admission Type
Amount Qualifier Codes
Attachment Report Type
Certification Type
Communication Codes
DTP Codes
Delay Reason Codes

F to P

Facility Type
Filing Codes
Filing Indicator Codes
ID Codes
Info Release
Marital Status
Patient Location
Pattern Codes
Pricing Codes
Prognosis Codes
Provider Codes

Q to Z

REF Codes
Remark Codes
Signature Source
Subluxation Codes
Tooth Numbering
Unit Codes
Yes/No Codes


The following screen-shot illustrates how to select the "Patient Location" code set for display. 

The "Patient Location" sub-menu

3. The Code Set configuration window will be displayed. 

You can add, delete or edit codes. Read further how.

Below you can see this window for the Patient Location. 

The window provides the following information:
Number of records in codeset — The total number of codes. For example, for Payment Location it is equal to 14.
Codes and their corresponding descriptions. The codes are indicated in the source EDI files. The descriptions are  displayed instead of codes in the result easy-to-read files. For example, for Payment Location, there are the following codes and corresponding descriptions:
A — Acute Care Facility
B — Boarding Home
C — Hospice
D — Intermediate Care Facility

The "Patient Location" code set configuration window

4. Click on the "Save" button to save the changes.



Adding a New Row

To add, click on the last row. Now you can see the indicator in the first grey field.

The indicator

Click the field again to enter to the Edit mode. Now you can enter the text.

Note: Only after you leave this row, the changes will take place.


Deleting a Row

To delete, click the left margin. This action will highlight the whole row.

Highlighting a row by clicking the left margin

Now press the <DELETE> key on your keyboard.


Editing the Row

To edit, click two times the cell you want to change. Make your changes. Clicking or moving outside this cell overwrites the cell contents with the new value. To make these changes permanent, click the 'Save' button.

Notice: Don't forget to save the changes by pressing the 'Save' button.

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Accessing Daily File Log

The HIPAA Claim Master can keep a log entry for each file that gets processed. This feature is especially helpful when the HIPAA Claim Master is run through automated processes. The log is essential in tracking errors and documentation.


Enabling Logging

To enable logs, check the "Keep a log of every file proccessed" checkbox under Setup arrow Options  arrow Log.

The "Keep a log of every file processed" check-box


To record the errors only in the log, check the "Record errors only in log" box displayed in the "Log" section.

The "Record errors only in log" check-box


Accessing Logs

Follow the instructions below to access the log files for your HIPAA Claim Master.

Click Logs arrow Daily Logs in the main menu.

The "Log" menu

If there is a log file for the current day, it will be displayed. If not, the page will be blank. You can navigate to each date with the calendar control on top of the page.


Log files are simple text files, one for each day that are stored in date hashed folders. Alternatively, access the Logs folder in the following directory:

Windows XP: C:\Documents and Settings\All Users\Application Data\HIPAAsuite\HIPAA Claim Master\Logs
Windows 7, Vista: C:\ProgramData\HIPAAsuite\HIPAA Claim Master\Logs

The directory structure for the daily logs

Tip: The folder is hidden by default. But if you type in the address in the top bar of the Windows explorer, you will find that it exists. Or you can change the explorer settings to show hidden files and directories.


Tip: The ProgramData folder contains all your application data, like program settings, user data, etc, for all of the installed programs on the computer. The ProgramData folder holds the same files that were contained in the \Documents and Settings\All Usersand \Documents and Settings\All Users\Application Data folders in XP.


For each day that the HIPAA Claim Master is used (If logs are enabled), there will be a log file which carries the name in the filename.

Within the directory, find a folder for the year you are looking log for. Then find a sub-folder for the necessary month with files for each day. Double-click a file which has the name equal to the necessary date. The log will look like this:

The daily file log


This entry is for a problem free file. Out of this entry you will get:

Process start time
Trading partner ID
Claim type
Number of claims
Number of lines
Number of exports/image files/ prints
Processing time
Average time per claim


An entry with errors might look like the following:


The second entry shows a database export problem. The message contains details that allow tracking of the problem. In this case a carriage return was in the file between the 2 and the 4.

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Accessing Statistics

The HIPAA Claim Master stores the amount of claims processed per month. These usage statistics are needed for a per-claim licensing model.

Follow the instructions below to access the statistics in your HIPAA Claim Master.

Click Logs arrow Statistics in the main menu.

The "Statistics" menu

The following screen will display.

The "Claim Printer Usage Report" window

The screen shows the number of claims processed in total and by year and month. The data is stored as an encrypted key in the registry.

Clicking the "Send Usage Report for Billing Purposes" button creates an email that contains this report and sends it to HIPAAsuite. The per-claim licensing model depends on this report for billing purposes. If you have the unlimited Licensing Scheme, you do not need to worry about this function.

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Selecting a Printer

If you want to print to a printer other than the computer's defined default printer, you will need to select the desired printer.

Note: The HIPAA Claim Master Version 4.0 onwards does not need anymore third party software for the creation of image files. Older versions of the HIPAA Claim Master needed to have the Peernet Tiff Image Printer  or PDF Image Printer driver installed.


Follow the instructions below.

Go to File arrow Select Printer in the main menu.


The "Printer" window will appear. Select the necessary printer.

Selecting the Printer for output on paper

Though you do not have any documents in your print queue, click on "Print" to select this printer for future output.

No questions yet.

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