HIPAA training

Summa Care 835 Health Care Claim Payment Advice: Implementation Guides

In order to receive an 835 Health Care Claim Payment Advice, submitters of health care claims must complete the following:

  • Complete and submit a Trading Partner Agreement to SummaCare or enter into a contractual agreement with a SummaCare contracted Trading Partner.
  • Complete the SummaCare 835 Registration Form.
  • Complete testing requirements with SummaCare. New files may be available each business day by noon Eastern Standard Time.

The SummaCare 835 Transaction is for notification only and does not include Electronic Funds Transfer (EFT) to financial institutions.

Interchange Control Structure

835 transactions are generated one file per Trading Partner during each scheduled payables process. The envelope structure is as follows for each individual check processed within a file. If a Trading Partner receives more than one check payment within the 835 then there will be multiple iterations of the structure below within the file.

  • ISA – Interchange Control Header
  • GS – Functional Group header
  • ST – Transaction Set Header Detail Segments
  • SE – Transaction Set Trailer
  • GE – Functional Group Trailer
  • IEA – Interchange Control Trailer

Within the 835 transaction file the Interchange Control Structure(s) are ordered by check number in ascending order. The check number is located in the TRN02 segment. For each check within the 835 transaction the claims are ordered by claim number in ascending order. The claim number is located in the CLP07 segment.

To learn more about HIPAA EDI Implementation and become a certified EDI Professional please visit our course schedule page.

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