EDI Acknowledgment – Emdeon Receiver Guidance
This blog post represents EDI Acknowledgment Emdeon implementation guidance for supporting claim acknowledgment transactions in response to a received 837 5010 claim file. Emdeon strongly recommends that payers return EDI Acknowledgment, claim status, and ERA transaction responses.
837 5010 Claim EDI Acknowledgment file received from Emdeon
Payer generated claim acknowledgement and status transactions in response to an 837 5010 claim file sent from Emdeon:
- Emdeon shall accept a 005010 TA1 Interchange EDI Acknowledgment in response to an 837 5010 claim file sent from Emdeon
- Emdeon shall accept either a 999 Implementation Acknowledgement or 997 Functional Acknowledgement based on payer preference
- 005010X231A1 999 Implementation Acknowledgement for Healthcare Insurance
- 005010X230 997 Functional Acknowledgment for Healthcare Insurance
- Emdeon shall accept the following claim level status responses to an 837 5010 claim file:
- 005010X214 277 Healthcare Claim Acknowledgment (Includes support of claim level STC12 free-form text.)
- 005010X213 277: Health Care Claim Request For Additional Information
- 005010X228 277: Health Care Claim Pending Status Information
- Emdeon shall also continue to support the following:
- Emdeon Claim Status Overlay (CSO) Format
- Payer Proprietary Claim Status Reporting
- All existing X12 acknowledgement transaction versions
- Emdeon will accept the following claim payment remittance advice:
- 005010X221A1 835 Claim Payment/Advice
- Emdeon will also continue to support the following:
- All existing X12 Claim Payment Remittance Advice versions
- Payer Proprietary Remittance Advice
Per the WEDI Acknowledgement Requirements White Paper, (www.wedi.org) the recommended four responses to an 837 5010 claim file are as follows:
- 005010 TA1 Interchange Acknowledgement
- 005010X231A1 999 Implementation Acknowledgement for Healthcare Insurance
- 005010X214 277 Healthcare Claim Acknowledgment
- 005010X221A1 835 Claim Payment/Advice.
Offering dedicated resources and on-going communication and support, Emdeon’s team of highly trained professionals helps business partners experience accurate and timely implementation for claim and ERA transaction capability. As an implementing partner, you will receive:
• A single business contact throughout the implementation process
• Continuous communication & status updates
• Detailed implementation project plans
• Reliable, flexible, secure systems and state-of-the-art technology
• Post-production monitoring.
All issues or concerns while in Emdeon Clearinghouse EDI production or self-directed implementation should be logged to ON24/7. For customers following a guided implementation, any concerns should be discussed with your primary contact in Account Management or Implementation before contacting customer or technical support.