1. ASC X12 Acknowledgments EDI - Session 1 Spring Conference April 16, 2010 Gary Beatty President EC Integrity Senior Manager Deloitte. Vice Chair ASC X12 gary@ecintegrity.com gbeatty@deloitte.com

2. Session Objectives o Discuss purpose of acknowledgments o Discuss structure and contents o Discuss usage o Discuss purpose of acknowledgments TA1 / TA3 Interchange Acknowledgements 997 / 999 Functional Group Acknowledgements 824 / 277 Business Acknowledgements

3. Acknowledgment Flow SubmitterReceiver X12 Transaction X12 Syntax / Compliance Business Compliance TA1 / TA3 997 / 999 824/277 271 / 277 / 278 / 835 / etc. Business Processing Technical Resources Business Resources

4. 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 AND NOTIFICATION (TR3 - 005010X231)

5. INTERCHANGE ACKNOWLEDGMENT Interchange control number Date and time Accept or reject or Accept w/Errors Note (not error) code Sent within interchange envelope

6. TA1 * TA101 I12 Inter Ctrl Number M 1 N0 9/9 * 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 * TA105 I18 Interchange Note Code M 1 ID 3/3 INTERCHANGE ACKNOWLEDGMENT ~ Data Element I18 000No error008Invalid Interchange Receiver ID 001The Interchange Control Number in the Header and Trailer Do Not Match. The Value From the Header is Used in the Acknowledgment. 009Unknown Interchange Receiver ID 002This Standard as Noted in the Control Standards Identifier is Not Supported. 010Invalid Authorization Information Qualifier Value 003This Version of the Controls is Not Supported011Invalid Authorization Information Value 004The Segment Terminator is Invalid012Invalid Security Information Qualifier Value 005Invalid Interchange ID Qualifier for Sender013Invalid Security Information Value 006Invalid Interchange Sender ID014Invalid Interchange Date Value 007Invalid Interchange ID Qualifier for Receiver015Invalid Interchange Time Value

7. TA1 * TA101 I12 Inter Ctrl Number M 1 N0 9/9 * 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 * TA105 I18 Interchange Note Code M 1 ID 3/3 INTERCHANGE ACKNOWLEDGMENT ~ Data Element I18 016Invalid Interchange Standards Identifier Value024Invalid Interchange Content (e.g., Invalid GS Segment) 017Invalid Interchange Version ID Value025Duplicate Interchange Control Number 018Invalid Interchange Control Number Value026Invalid Data Element Separator 019Invalid Acknowledgment Requested Value027Invalid Component Element Separator 020Invalid Test Indicator Value028Invalid Delivery Date in Deferred Delivery Request 021Invalid Number of Included Groups Value029Invalid Delivery Time in Deferred Delivery Request 022Invalid Control Structure030Invalid Delivery Time Code in Deferred Delivery Request 023Improper (Premature) End-of-File (Transmission)031Invalid Grade of Service Code

8. 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 090721>1700>^>00501>900000001>1>P>+ GS>HC>SSSSSS>01001>20090721>1700>700000001>X>005010X222 ST>837>000000001>005010X222 :: SE>32>000000001 GE>1>700000001 IEA>1>900000001 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 >28>SSSSSS >090721>1701>^>00501>000000001>1>P>+ TA1>900000001>090721>1705>R>006 IEA>0>900000001 Interchange Acknowledgement Example (TA1)

9. The primary purpose of a Implementation Acknowledgment is to acknowledge the receipt of ONE Functional Group. 999 – Implementation Acknowledgement (TR3 – 005010X231)

10. 999 Implementation Acknowledgments 3 Levels of acknowledgment Functional Group Transaction Sets Error Details Describes actions at all Levels

11. FUNCTIONAL GROUP RESPONSE  Functional Group Control Number  Implementation Guide ID  Level of acceptance  Transaction set counts  Functional Group syntax errors GS GE

12. TRANSACTION SET RESPONSE o Transaction set control number o Implementation Guide ID o Level of acceptance o Syntax error codes ST SE

13. ERROR DETAIL Segment and loop information Segment syntax error codes Element information Element syntax error codes Copy of bad data

14. 0400IK3Error IdentificationS1 0500CTXSegment Context S9 0500CTXBusiness Context S1 999 Implementation Acknowledgment Functional Group ID: FA Table 1 – Header POS# SEQ ID NAME REQ. DES MAX USE LOOP REPEAT 0100STTransaction Set HeaderR1 0200AK1Functional Group Response HeaderR1 LOOP ID – 2000 - AK2 TRANSACTION SET RESPONSE HEADER >1 0300AK2Transaction Set Response HeaderS1 LOOP ID – 2100 - AK2/IK3 ERROR IDENTIFICATION >1 0900AK9Functional Group Response TrailerR1 1000SETransaction Set TrailerR1 0800IK5Implementation Transaction Set Response TrailerR1 LOOP ID – 2110 – AK2/IK3/IK4 IMPLEMENTATION DATA ELEMENT NOTE >1 0600IK4Implementation Data Element NoteS1 0700CTXElement Context S10

15. 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.

16. 999 Example (continued)

17. 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.comwww.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”) 824 – Application Reporting for Insurance (TR3 - 005010X186) Business level acknowledge for non-health care claim(s) – 837 validity and acceptability of the business transactions

18. 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

19. 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

20. 277CA Example Table 1

21. 277CA Example (Table 2 – Loop 2000A - Information Source Detail)

22. 277CA Example(Table 2 – Loop 2000B - Information Receiver Detail)

23. 277CA Example (Table 2 – Loop 2000C – Billing Provider of Service Detail)

24. 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.

25. PROCESSING EDI management software should handle acknowledgment issues. Trading partners must decide on the level of error detail to Support.

26. AGREE ON What to send Conditions to detail Expected reply time Response to non-receipt Error condition procedures

27. 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