Change Request Detail
No.
1085
Date
8/31/2009
Submitter
Type of Request
Pertaining to more than one, or not sure
Status
DSMO Process Completed
Business Reason
ASC X12 N is requesting the DSMO to consider recommending to NCVHS that the following ASC X12 acknowledgement transactions be considered for adoption as HIPAA required transactions by HHS/CMS/OESS, using version 005010.

    ASC X12 999 Acknowledgement transaction using Technical Report type 3 (document number: 005010X231) for implementation specifications.
    ASC X12 277 Claim Acknowledgement (277CA) transaction using Technical Report type 3 (document number: 005010X214) for implementation specifications.
    ASC X12 TA1 Acknowledgement Segment (document number: 005010X231 Appendix C.1)

These transactions will help the healthcare industry to better reconcile the status of transmitted EDI transactions, especially when sending claims and remittance transactions. But, the sender of ASC X12 transactions mandated by HIPAA will benefit from knowing that the receiving party has successfully received the transactions or has encountered errors that need to be reconciled.
Suggestion
These Acknowledgements must be used with ASC X12 HIPAA transactions sent in batch or real-time mode as instructed by the TR3 document for each transaction. Please note that real-time as used in this request does not refer to real-time adjudication, rather the real-time transmission of files.

The TA1 segment must be sent when requested by the submitter OR as described in X12.5 section 3.2.2, OR as instructed by the TR3 document for each transaction. If these conditions are not met, do not send the TA1 segment. The TA1 is not recommended for use in a real-time environment, and for any usage of the TA1 in real-time, mutual trading partner agreement is required.

The 277CA acknowledgement must be used in batch and real-time to acknowledge 837 claims submission at the pre-processing stage for application level validation errors. The business use requires reporting both accepted and non-accepted claims for adjudication, not including real-time adjudication.

The 999 is used to acknowledge syntactical and relational analysis of a functional group as specified by the TR3 or to acknowledge receipt of an error-free functional group that fully complies with an implementation guideline. The 999 can acknowledge standard syntax errors as well as implementation guide (IG) errors. The 999 cannot be used for any application level validation errors.
DSMO Category
I
Recommendation
Approve. DSMO approves this request for ASC X12 transactions. However, the DSMO recommends further public comment be accepted about the 835 and 820 acknowledgments as there are business cases where acknowledgements may not be the most appropriate. We recommend that the acknowledgement files for the 835 and 820 transactions be based upon trading partner agreements.
Appeal Recommendation