HMSA EDI Center File Name Standard Descriptions

HMSA EDI Center File Name Standard Descriptions are given in the blog for providers that submit claims electriically via EDI to HMSA EDI Center. It is strongly recommended that any provider submitting claims electronically, make the appropriate arrangements to ensure the security of the claims data being submitted to HMSA EDI Center. At a minimum, HMSA EDI Center recommends that a duplicate copy of each submission be retained until the provider or their representative has been advised by HMSA that the data has been received and processed.

Format: CCmmddhhnnss%&.xxz (secure FTP and 271, 277 files) ((CC) specifies type of file)

aa Functional Acknowledgement (999)
ta Interchange Acknowledgment (TA-1)
ca Claims (837) – All
sa Claims Status Inquiry/Response (276/277)
la Eligibility Benefit Inquiry/Response (270/271)
ea Benefit Enrollments (834)
ma Premium Payments (820)
pa Service Review Request And Response(278)
rr Electronic Remittance Advice (835) – Private Business
rc Electronic Remittance Advice (835) – Senior Plans
rq Electronic Remittance Advice (835) – QUEST Integration
rf Electronic Remittance Advice (835) – FEP
rb Electronic Remittance Advice (835) – ITS
jx Claims Rejected to Provider Report (QNXT)
gx Report to Provider (QNXT)

  • (mm) specifies month file was created
  • mm = 01 through 12
  • (dd) specifies day file was created
  • dd = 01 through 31
  • (hh) specifies hour file was created
  • hh = 00 through 24
  • (nn) specifies minute file was created
  • nn = 00 through 59
  • (ss) specifies second file was created
  • ss = 00 through 59
  • (%) specifies if file is Inbound or Outbound
  • i – Inbound to EDI center
  • o – Outbound from EDI Center
  • (&) specifies if the file is a Production or Test file
  • p = Production
  • t = Test
  • (xx) specifies sequence of files submitted
  • 01 through 99
  • (z) specifies if the file is compressed

Example: la1129130516op.01z – An eligibility response file created on Nov 29 at 13:05:16 (1:05 pm 16 sec), outbound, production, sequence 01 and compressed.

The 999 Functional Acknowledgment has been designed to allow trading partners to establish an automated control function as a part of their business exchange process. This transaction is not mandated by HIPAA but can be used to identify the acceptance or rejection of functional groups and transaction sets based on a syntactical analysis of the submitted data. Currently, the 999 reports level 1 and level 2 errors based on the guidelines developed by the Strategic National Implementation Process (SNIP).

Leave a Reply

Your email address will not be published.

Post Navigation