Transcript Introduction to Electronic Data Interchange

Spring Conference
EDI - Session 1
April 16, 2010
ASC X12
Acknowledgments
Gary Beatty
•President EC Integrity
•Senior Manager Deloitte.
•Vice Chair ASC X12
[email protected]
[email protected]
Session Objectives
o Discuss purpose of acknowledgments
• TA1 / TA3 Interchange Acknowledgements
o Discuss
structure
and
contents
• 997 / 999 Functional
Group
Acknowledgements
• 824 / 277 Business Acknowledgements
o Discuss
usage
Acknowledgment Flow
Submitter
X12 Transaction
Receiver
X12 Syntax /
Compliance
Business
Compliance
Business
Processing
TA1 / TA3
997 / 999
Technical Resources
Business Resources
824/277
271 / 277 / 278 / 835 / etc.
INTERCHANGE
ACKNOWLEDGMENT AND
NOTIFICATION
(TR3 - 005010X231)
TA1 Segment used to report status of
processing for an interchange or
non-delivery
TA3 Segment used to provide a notice
from the service request handler for
delivery and to report services
performed.
INTERCHANGE
ACKNOWLEDGMENT
Interchange control number
Date and time
Accept or reject or Accept w/Errors
Note (not error) code
Sent within interchange envelope
INTERCHANGE ACKNOWLEDGMENT
TA1 *
TA101 I12
Inter Ctrl
Number
M 1 N0 9/9
*
TA105 I18
Interchange
Note Code
M 1 ID 3/3
*
TA102 I08
Interchange
Date
M 1 DT 6/6
*
TA103 I09
Interchange
Time
M 1 TM 4/4
*
TA104 I17
Interchange
Ack Code
M 1 ID 1/1
~
Data Element I18
000
No error
008
Invalid Interchange Receiver ID
001
The Interchange Control Number in the Header
and Trailer Do Not Match. The Value From the
Header is Used in the Acknowledgment.
009
Unknown Interchange Receiver ID
002
This Standard as Noted in the Control Standards
Identifier is Not Supported.
010
Invalid Authorization Information Qualifier Value
003
This Version of the Controls is Not Supported
011
Invalid Authorization Information Value
004
The Segment Terminator is Invalid
012
Invalid Security Information Qualifier Value
005
Invalid Interchange ID Qualifier for Sender
013
Invalid Security Information Value
006
Invalid Interchange Sender ID
014
Invalid Interchange Date Value
007
Invalid Interchange ID Qualifier for Receiver
015
Invalid Interchange Time Value
INTERCHANGE ACKNOWLEDGMENT
TA1 *
TA101 I12
Inter Ctrl
Number
M 1 N0 9/9
*
TA105 I18
Interchange
Note Code
M 1 ID 3/3
*
TA102 I08
Interchange
Date
M 1 DT 6/6
*
TA103 I09
Interchange
Time
M 1 TM 4/4
*
TA104 I17
Interchange
Ack Code
M 1 ID 1/1
~
Data Element I18
016
Invalid Interchange Standards Identifier Value
024
Invalid Interchange Content (e.g., Invalid GS Segment)
017
Invalid Interchange Version ID Value
025
Duplicate Interchange Control Number
018
Invalid Interchange Control Number Value
026
Invalid Data Element Separator
019
Invalid Acknowledgment Requested Value
027
Invalid Component Element Separator
020
Invalid Test Indicator Value
028
Invalid Delivery Date in Deferred Delivery Request
021
Invalid Number of Included Groups Value
029
Invalid Delivery Time in Deferred Delivery Request
022
Invalid Control Structure
030
Invalid Delivery Time Code in Deferred Delivery Request
023
Improper (Premature) End-of-File (Transmission)
031
Invalid Grade of Service Code
Interchange Acknowledgement Example (TA1)
Scenario:
When the Interchange Envelop was processed by the receiver’s translator their trading partner’s Interchange
Sender Identifier (SSSSSSs) was entered incorrectly with an extra “s” and was not found.
Submitted Envelopes:
ISA>00>1234567890>00>1234567890>28>SSSSSSs
>28>PPPPP
GS>HC>SSSSSS>01001>20090721>1700>700000001>X>005010X222
ST>837>000000001>005010X222
::
::
SE>32>000000001
GE>1>700000001
IEA>1>900000001
090721>1700>^>00501>900000001>1>P>+
Resulting Interchange Acknowledgement - TA1.
This resulted in a TA1 Interchange Acknowledgement to be sent back with an Interchange Note Code of 006
“Invalid Interchange Sender ID”.
ISA>00>1234567890>00>1234567890>28>PPPPP
TA1>900000001>090721>1705>R>006
IEA>0>900000001
>28>SSSSSS
>090721>1701>^>00501>000000001>1>P>+
999 – Implementation Acknowledgement
(TR3 – 005010X231)
The primary purpose of a
Implementation Acknowledgment
is to acknowledge the receipt of
ONE
Functional Group.
999 Implementation Acknowledgments
3 Levels of acknowledgment
Functional Group
Transaction Sets
Error Details
Describes actions at all Levels
FUNCTIONAL GROUP RESPONSE
GS
 Functional Group Control Number
GE
Implementation Guide ID
 Level of acceptance
 Transaction set counts
 Functional Group syntax errors
TRANSACTION SET
RESPONSE
oTransaction set control number
oImplementation Guide ID
ST
oLevel of acceptance
oSyntax error codes
SE
ERROR DETAIL
Segment and loop information
Segment syntax error codes
Element information
Element syntax error codes
Copy of bad data
999 Implementation Acknowledgment
Table 1 – Header
POS# SEQ ID NAME
0100 ST
Transaction Set Header
0200 AK1 Functional Group Response Header
Functional Group ID: FA
REQ. DES MAX USE LOOP REPEAT
R
1
R
1
LOOP ID – 2000 - AK2 TRANSACTION SET RESPONSE HEADER
0300 AK2
Transaction Set Response Header
S
>1
1
LOOP ID – 2100 - AK2/IK3 ERROR IDENTIFICATION
>1
0400 IK3
Error Identification
S
1
0500 CTX Segment Context
S
9
0500 CTX Business Context
S
1
LOOP ID – 2110 – AK2/IK3/IK4 IMPLEMENTATION DATA ELEMENT NOTE
0600 IK4
0700 CTX
Implementation Data Element Note
Element Context
S
S
1
10
0800 IK5
Implementation Transaction Set Response Trailer
R
1
0900 AK9
1000 SE
Functional Group Response Trailer
Transaction Set Trailer
R
R
1
1
>1
999 Example
999 accepting an 837 Health Care Claim Functional Group which had 2 non-fatal errors and was
accepted for further processing. Each error is identified in the IK4 Segments.
999 Example (continued)
824 – Application Reporting for Insurance (TR3 - 005010X186)
•Business level acknowledge for non-health care claim(s) – 837
•validity and acceptability of the business transactions
277 - Health Care Claim Acknowledgment (TR3 - 005010X214)
•Business level acknowledgement for health care claim(s) – 837
•validity and acceptability of the claims at the pre-processing stage
External Claim Status Codes
Washington Publishing Company – www.wpc-edi.com
•Claim Status Category Codes
•Supplemental
•Acknowledgements
•Pending
•Finalized
•Requests for additional information
•General
•Error
•Searches
•Claim Status Code
•Entity Identifier Code (used when Claim Status Code description include “entity”)
277CA Example
Submitter: Best Billing Services
Receiver: First Clearinghouse
Provider: Smith Clinic
Claim Submission Date: February 5, 2006
Claim Processing Date: February 5, 2006
Number of Claim: 3
Total Charges: $1000.00
File was Rejected due to an invalid characters (extended characters – lower
case without prior agreement to use the extended character set) contained
within the Billing Provider’s Name.
NM1*85*2* Smith Clinic*****FI*123456789~
277CA Example
ST*277*0001*005010X214~
BHT*0085*08*277X2140001*20060205*1635*TH~
HL*1**20*1~
NM1*AY*2*FIRST CLEARINGHOUSE*****46*CLHR00~
TRN*1*200102051635S00001ABCDEF~
DTP*050*D8*20060205~
DTP*009*D8*20060205~
HL*2*1*21*1~
NM1*41*2*BEST BILLING SERVICE*****46*S00001~
TRN*2*2002020542857~
STC*A7:23*20060205*U*1000~
QTY*AA*3~
AMT*YY*1000.00~
HL*3*2*19*0~
NM1*85*2*SMITH CLINIC*****FI*123456789~
TRN*1*SMITH789~
STC*A7:511:85**U*1000.00*****A7:504~
QTY*QC*3~
AMT*YY*1000.00~
SE*22*0001~
277CA Example
Table 1
277CA Example
(Table 2 – Loop 2000A - Information Source Detail)
277CA Example(Table 2 – Loop 2000B - Information Receiver Detail)
277CA Example (Table 2 – Loop 2000C – Billing Provider of Service Detail)
Review the Purpose of the
TA1, 999 and 277CA
• When a TA1 is received, you will need to correct and resubmit the entire ISA –
IEA Interchange;
• When a 999 is received, you may:
• Recognize that syntax errors occurred and begin a correct/resubmit action,
• Recognize that all transactions were accepted.
• When a 277CA is received, you may:
• Recognize that business rule errors occurred and begin a correct/resubmit action on
specific claims,
• Recognize that all transactions were accepted,
• Use returned claim numbers for future claim status inquiries.
PROCESSING
EDI management software should
handle acknowledgment issues.
Trading partners must decide
on the level of error detail to
Support.
AGREE ON
What to send
Conditions to detail
Expected reply time
Response to non-receipt
Error condition procedures
Session Summary
Certifies delivery and format
Varying information available
Automate processing
Agree with trading partner
The Data Interchange Standards Association (DISA) holds a copyright on the TR3 documents:
Copyright © 2009, Data Interchange Standards Association on behalf of ASC X12, Format © 2009, http://store.x12.org