Trading Partner

WCMBP Trading Partner Testing Procedures (Office of Workers’ Compensation Programs)

Completion of the testing process is not mandatory prior to submitting electronic transactions to WCMBP. However, it is strongly recommended to ensure proper billing and prompt medical bill processing and payment. Testing is conducted to ensure the following HIPAA compliance levels:

  1. Level 1 Syntactical integrity: Testing of the EDI file for valid segments, segment order, element attributes, numeric values in numeric data elements, validation of X12 syntax, and compliance with X12 rules.
  2. Level 2 Syntactical requirements: Testing for HIPAA Implementation Guide specific syntax requirements, such as limits on repeat counts, used and not used qualifiers, codes, elements and segments. It will also include testing for HIPAA required or intra segment situational data elements, testing for non medical code sets as laid out in the Implementation Guide, and values and codes noted in the Implementation Guide via an X12 code list or table.
  3. Level 3 HIPAA Balance Testing: Validate that claim line items amounts are equal to the total claim amount.
  4. Level 7 WCMBP defined custom rules: Transactions are validated against WCMBP defined custom rules as specified in the Transaction Specification section.

Trading Partner Testing Procedures

  1. WCMBP companion guides available for download via the web.
  2. The trading partner submits all HIPAA test files through the WCMBP web portal or Secure File Transfer Protocol (SFTP).
  3. The trading partner downloads acknowledgements for the test file from the WCMBP Portal or SFTP.
  4. If WCMBP system generates a positive TA1 and positive 999 acknowledgement, the file is successfully accepted. The trading partner is then ready to send 837 HIPAA files in production.
  5. If the test file generates a negative TA1 or negative 999 acknowledgment, then the submission is unsuccessful and the file is rejected. The trading partner should resolve all the errors that are reported on the negative TA1 or negative 999 and resubmit the file for test. Trading partners can continue to test in the testing environment until they receive a positive T A1 and positive 999.

To learn more about EDI and become a CEDIAP® (Certified EDI Academy Professional), please visit our course schedule page.

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