837 Health Care Claim

837 Health Care Claim Reports And Considerations Notes (Beacon Health Options)

837 Health Care Claim Reports And Considerations Notes for Beacon Health Options company partners are given below as mandated by the administrative simplification provisions of HIPAA. All 837 Health Care Claim reports will be available to providers/trading partners via the EDI Gateway in the respective mailboxes. To access your mailbox, log in to the EDI Gateway and click on the download files link. Providers/trading partners are responsible for downloading these reports when available.

997 Functional Acknowledgement

  • Purpose: This is a X12 file response report
  • Source: Folder/Mailbox
  • Turnaround from time of submission: Day of Submission

Result – Result File

  • Purpose: To report claim level rejections and to report on total claims accepted along with their total claim amount
  • Source: Folder/Mailbox
  • Turnaround from time of submission

File level summary indicating accepted and rejected transaction sets within a file. Please refer the Implementation Guide for Health Care Claims. When a file is uploaded from the EDI Gateway, the submitter is provided with a reference ID for the submission. The file name of the Results Report file will be <reference ID>_results.txt. All files that are rejected at file level will not have a results file.

Transactions Supported (inbound)

Currently Beacon will support and accept the following HIPAA 5010 inbound transactions:

  • 837 Professional Health Care Claim – ASC X12N 837 (005010X222A1
  • 837 Institutional Health Care Claim – ASC X12N 837 (005010X223A2

Delimiters Supported

A delimiter is a character used to separate two data elements or sub elements, or to terminate a segment. Delimiters are specified in the interchange header segment, ISA. The ISA segment is a 105 byte fixed length record. The data element separator is byte number 4; the component element separator is byte number 105; and the segment terminator is the byte that immediately follows the component element separator. Once specified in the interchange header, delimiters are not to be used in a data element value elsewhere in the transaction. Beacon recommends utilizing the following default delimiters:

  • Data element separator – * (Asterisk)
  • Sub-element separator – : (Colon)
  • Segment terminator – ~ (Tilde)

If the data contains any of the above delimiters, different delimiters can be utilized and specified in the ISA segment.

Claims files submitted in production mode cannot exceed 5000 claims (CLM segments) in any one file.

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