997 Functional Acknowledgement And Claim Audit Report For BCHP Vendors
997 Functional Acknowledgement is returned for each batch transaction received. This file acknowledges the receipt of the file and reports any data compliance issues. BUCKEYE COMMUNITY HEALTH PLAN also expects to receive a 997 Functional Acknowledgement transaction when the trading partner receives any outbound batch transaction. BUCKEYE COMMUNITY HEALTH PLAN has created an Audit Report for any health care claim transaction (837I and 837P) received. This is not a HIPAA-mandated report; however it summarizes the number of claims received and any claims that were rejected due to invalid information.
997 Functional Acknowledgement
A functional acknowledgement is to report the acceptance or rejection of functional group, transaction set or segment. BUCKEYE COMMUNITY HEALTH PLAN will generate an outbound 997 to acknowledge all inbound transactions received. If any part of the transaction from the ISA to IEA does not pass Compliance, only the bad transaction sets will reject on the 997 and will need to be fixed by the sender and resent.
Claim Audit Report
BUCKEYE COMMUNITY HEALTH PLAN will continue to provide a Claim Audit report for each Inbound 837 Transaction received for both Institutional and Professional files. The format of the report has not changed and the error codes will remain the same. A sample of the report is available in Samples A & B. A listing of the error codes can be found in Sample C. Any claim that has been rejected and is acknowledge on this report, must be corrected and resent either electronically via an 837 or on paper. Those claims that have been rejected are based on front-end edits and do not pertain to our claims adjudication process.
Some transactions can be submitted interactively. BUCKEYE COMMUNITY HEALTH PLAN only creates a 997 – Acknowledgement for an interactive request transaction if it fails the compliance check. Otherwise, the appropriate response transaction serves as the acknowledgement of the receipt of the transaction.