Batch And Real-Time Transactions Guidelines for HMSA EDI Partners
Batch And Real-Time Transactions should adhere to the guidelines given in the today’s post. HMSA will respond to a batch request within eight hours. If the request is for non-HMSA requests (ie, BlueCard or FEP) the transaction must be routed to another entity outside of HMSA and may not be available for up to 24 hours. HMSA may return multiple 27x response files that correspond to a single batch 27x request transmission file depending on the contents and processing requirements of the transactions contained within the original transmission.
Real Time 27x transactions should adhere to the following guidelines: Only one Real Time 27x transaction (ST/SE) should be submitted within each transmission file. For Real Time 27x request transactions, the HIPAA Implementation Guide limits the number of patient requests to one within a single transaction (ST/SE). Each patient is defined as either one subscriber loop, if the subscriber is the patient, or one dependent loop, if the dependent is the patient. Real Time 27x request transactions will be taken in by HMSA for processing as they are received. HMSA may return multiple 27x response files that correspond to a single Real Time 27x request transmission file depending on the processing requirements of the transaction contained within the original transmission. Refer to the following section on “Matching 27X Requests and Responses.” Real Time processing of 27x requests for BlueCard and FEP members may not be available at all or during certain hours depending on the processing capabilities of the other Blue Cross and Blue Shield plans or the FEP Operations Center. If the other Blue Cross and Blue Shield plan or FEP is not able to process a Real Time request, a 27x response transaction will be returned to the requester indicating that the system is unavailable. The requester has the option of resubmitting the 27x request in a batch mode or contacting the other Blue Cross and Blue Shield plan via telephone, fax, or e-mail.