EDI Translator Reports and Edits (New Jersey Medicaid Transaction Submission)
New Jersey Medicaid validation of HIPAA interchanges will be done at four different levels of processing. The type of notification to the submitter will depend on where in the process the editing is completed.
The first level of editing will be at the point of receipt. A TA1 Interchange Acknowledgement will be sent to the EDI Submitter upon completion of uploading (dropping-off) their interchanges. If the submitter disconnects immediately after uploading and does not receive the TA1 then one is created for the submitter to retrieve from the Website indicating the initial validation of the interchange. Conveyed in this acknowledgement will be whether the transmitted interchange was accepted for further processing. A rejection at this level will indicate the interchange needs immediate correction before additional processing can commence. Please refer to the TR3s for details.
Interchanges will reject at this level for the following conditions:
- Duplicate Interchange Control Number received for same Submitter (duplicate file received)
- Interchanges containing Carriage Return/Line Feed characters following the Segment Terminator
- Invalid Segment Terminator
- Invalid Subsequent Separator
- Invalid Interchange Content
- Submitter ID is not the same in ISA and GS records
- Receiver ID is not the same in the ISA or GS Records
- Invalid Version (i.e., if it is 004010X96A1, 004010X97A1, 004010X98A1) the file will reject.
- Invalid 5010 Version (i.e., if it is not 005010X222A1, 005010X223A2, 005010X224A2)
The second level of editing will be performed as part of the WebSphere (Mercator) translator processing and will result in the creation of a 999 Implementation Acknowledgement for the EDI Submitter to retrieve from the Website indicating additional validation of the interchange. Validation is done on a one-to-one correspondence between the functional group, transactions sets or segments within the interchange. Data elements in error will be identified in this acknowledgement and will indicate whether the transmitted interchange is accepted or rejected and if correction and resubmission is required before additional processing is commenced. Please refer to the TR3 for details.
The third level of editing will be performed in the NJMMIS preprocessing after the WebSphere (Mercator) translator processing and will be related to the EDI Submitter/Provider relationship information. Errors found in this level of editing will be identified on the HIPAA Claims Rejected Report. The HIPAA Claims Rejected Report in a semi-colon delimited file is sent to the Website for the EDI Submitter to retrieve and import to a spreadsheet application.
The fourth level of editing will be performed in the NJMMIS Claims Adjudication Cycle, which is performed over the weekend. Errors found at this level of editing will be conveyed as Adjustment Reason and Remark Codes in the 835 Health Care Claim Payment/Advice for paid or denied claims or as Claim Status or Entity Codes in the 277P Health Care Claims Pending Status Information interchange for claims pending final adjudication or as NJMMIS Edit Codes on the Website in a PDF image of the hard copy remittance advice or on the hard copy remittance advice.
To learn more about HIPAA EDI transactions and become a certified EDI Professional please visit our course schedule page.