EDI Mapping Guides For WPS Health Solutions: Control Segments / Envelopes
EDI Mapping Guides require that Interchange Control (ISA/IEA), Function Group (GS/GE), and Transaction (ST/SE) envelopes must be used as described in the national implementation guides. Medicare’s expectations for inbound ISAs and a description of data on outbound ISAs are detailed in this EDI Mapping Guides post.
Medicare only accepts functional groups based upon one TR3 Implementation Guide per Interchange Envelope (ISA/IEA). If transactions based upon more than one TR3 Implementation Guide are being submitted, each must be contained within its own Interchange
Inbound Transactions As detailed in the HIPAA adopted implementation guides, delimiters are determined by the characters sent in specified, set positions of the ISA header. For transmissions to Medicare (inbound transmissions), these characters are determined by the submitter and can be any characters which are not contained within any data elements within the ISA/IEA Interchange Envelope.
Delimiters – Outbound Transactions
Medicare recommends the use of the following delimiters in all outbound transactions; trading partners/submitters should contact their local FI, RHHI, Carrier, A/B MAC or CEDI for any deviations. Note that these characters will not be used in data elements within an ISA/IEA Interchange Envelope.
Inbound Data Element Detail and Explanation
All data elements within the interchange envelop (ISA/IEA) must follow X12 syntax rules as defined within the adopted implementation guide.
GS-GE Functional group (GS-GE) codes are transaction specific. Therefore, information concerning the GS/GE Functional Group Envelope can be found in the transaction specific appendices of this companion guide. ST-SE Medicare has no requirements outside the HIPAA adopted transaction implementation guides.
This is an example of the electronic envelope for an Iowa B, 837 professional. Please note, individual submitter ID, contract code and transaction will affect values in elements. For additional examples, please refer to the applicable TR3.
ISA*00* *00* *ZZ*SUBID *ZZ*CONTR *110203*1226*^*00501*000000049*1*T*:~ GS*HC*SUBID*CONTR*20110203*12262822*49*X*145010X222~ ST*837*49001*005010X222~