EDI Acknowledgment – Emdeon Submitter Guidance
EDI Acknowledgment Emdeon implementation guidance is given below in today’s post for supporting claim acknowledgment transactions in response to a submitted 837 5010 claim file. Emdeon strongly recommends that submitters accept EDI Acknowledgment transaction responses.
837 5010 EDI Acknowledgment File received from Submitters
Emdeon generated EDI acknowledgment transactions in response to an 837 5010 claim file received from a submitting trading partner:
- Emdeon shall provide a 005010 TA1 Interchange Acknowledgement provided it is requested by the submitter (ISA14=1)
- Emdeon shall provide either a 999 Implementation Acknowledgement or a 997 Functional Acknowledgement based on submitter preference
- 005010X231A1 999 Implementation Acknowledgement for Healthcare Insurance
- 005010X230 997 Functional Acknowledgment for Healthcare Insurance
- Emdeon will offer both a human readable or standard X12 response for both the 999 and 997
Emdeon clearinghouse will advise the sending trading partner of syntax errors only when Emdeon clearinghouse cannot technically accept the file due to critical syntax errors. Emdeon clearinghouse will accept files / transactions whenever technically possible for downstream validation resulting in an Emdeon claim level rejection or clean claim to the payer.
- Emdeon clearinghouse will not report any implementation guide rule errors in 999 reporting.
- Emdeon shall provide claim level clearinghouse validation reporting of the acceptance or rejection status of the claim. The reporting options are:
- Emdeon Vision for Claim Management
- Emdeon Reporting – Human Readable, Portrait or Landscape
- Emdeon Reporting – Machine Readable
- 004040X167 277 Healthcare Claim Acknowledgment
- 005010X214 277 Healthcare Claim Acknowledgment (277CA)
- Both 277 versions will include support of claim level STC12 (free-form text). This will be utilized to support Emdeon structured Standardized Messaging
- 005010X221A1 835 Healthcare Claim Payment Advice
- Per the WEDI Acknowledgement Requirements White Paper, (www.wedi.org) the WEDI recommended responses to an 837 5010 claim file submission are as follows:
- 005010 TA1 Interchange Acknowledgement
- 005010X231A1 999 Implementation Acknowledgement for Healthcare Insurance
- 005010X214 277 Healthcare Claim Acknowledgment
- 005010X221A1 835 Claim Payment.
More about Emdeon EDI requirements for partners
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