837 Institutional Healthcare Claim

837 Institutional Healthcare Claim Testing: Set-up, Directory and File Naming

837 Institutional Healthcare Claim Testing should be followed by requesting information on establishing connections through the SFTP server. Upon completion of 837 Institutional Healthcare Claim set-up, providers will receive additional instructions on SFTP usage.

SFTP Directory Naming Convention

There would be two categories of folders under Trading Partner’s SFPT folders: 1

  1. TEST – Trading Partners should submit and receive their test files under this root folder
  2. PROD – Trading Partners should submit and receive their production files under this root folder.

Following folder will be available under TEST/PROD folder within SFTP root of the Trading Partner:

  • ‘HIPAA_Inbound’ – This folder should be used to drop the Inbound files that needs to be submitted to HCA
  • ‘HIPAA_Ack’ – Trading partner should look for acknowledgements to the files submitted in this folder. TA1, 999 and custom error report will be available for all the files submitted by the Trading Partner
  • ‘HIPAA_Outbound’ – X12 outbound transactions generated by HCA will be available in this folder
  • ‘HIPAA_Error’ – Any inbound file that is not HIPAA compliant or is not recognized by ProviderOne will be moved to this folder ‘HIPAA Working’ – There is no functional use for this folder at this time.

The HIPAA Subsystem Package is responsible for assisting ProviderOne activities related to Electronic Transfer and processing of Health Care and Health Encounter Data, with a few exceptions or limitations. HIPAA files are named: For Inbound transactions: HIPAA…. Example of file name: HIPAA.101721500.122620072100_P_1.dat

  • is the Trading Partner Id
  • is the Date timestamp
  • is the original file name which is submitted by the trading partner.
  • All HIPAA submitted files MUST BE .dat files or they will not be processed.

Acknowledgement Procedures

Once the file is submitted by the trading partner and is successfully received by the ProviderOne system, a response in the form of TA1 and 999 acknowledgment transactions will be placed in appropriate folder (on the FTP server) of the trading partner. The ProviderOne system generates positive TA1 and positive 999 acknowledgements, if the submitted HIPAA file meets HIPAA standards related to syntax and data integrity. For files, which do not meet the HIPAA standards a negative TA1 and/or negative 999 are generated and sent to the trading partner.

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