IEHP EDI Functional Acknowledgement

IEHP EDI Functional Acknowledgement/Reports (837 Health Care Claim: Professional Transaction)

IEHP EDI Functional Acknowledgement/Reports – TA1 – Interchange Acknowledgement – enables the receiver to notify the sender when there are problems with the interchange control structure. As the interchange envelope enters the EDFES, the EDI translator performs TA1 validation of the control segments/envelope. The sender will only receive a TA1 if there are syntax errors in the submitted file. Errors found in this stage will cause the entire X12 interchange to reject with no further processing. IPA will receive a TA1 interchange report acknowledging the syntactical inaccuracy of an X12 interchange header ISA and trailer IEA and the envelope’s structure. Encompassed in the TA1 is the interchange control number, interchange date and time, interchange acknowledgement code and interchange note code.

999- Functional Acknowledgment

The 999 Acknowledgement may produce three (3) results:
1. Accepted (A)
2. Rejected (R)
3. Accepted with errors (E)

As a result, the 999 may acknowledge receipt of a transaction, such as a healthcare claim, but it does not necessarily mean that transaction will be processed. The 999 can also report on exactly what syntax issues caused the errors in the original transaction.

EVR- Encounter Validation Response (EVR) Extensible Markup Language (XML) files

The response files will provide details on whether a file was accepted or rejected and whether an encounter data record was accepted or denied. If errors were found in the encounter data files submitted, it will result in a rejected file and/or denied encounter data record.

IEHP EDI Functional Acknowledgement/Reports: CMS Acknowledgements 

A submitted encounter file will be either accepted or rejected by CMS. The following response reports are provided by CMS:

  1. TA1 – Interchange Acknowledgement. The TA1 report enables the receiver to notify the sender when there are problems with the interchange control structure. The sender will only receive a TA1 if there are syntax errors in the submitted file.
  2.  999 – Functional Group acknowledgement. The 999 acknowledgement report provides information on the validation of the GS\GE functional groups(s) and the consistency of the data.
  3. 277CA – Claim Acknowledgement. The 277CA is used to acknowledge the acceptance or rejection of encounters submitted using a hierarchical level (HL) structure. The first level of hierarchical editing is at the Information Source level. The next level is at the Information Receiver level. The third hierarchal level is at the Billing Provider of Service level; and the fourth and final level is done at the Patient level. Edits received at any hierarchical level will stop and no further editing will take place.
  4. MAO-001 – Encounter Data Duplicate Report. MAO-001 report will not be provided if there are no duplicate errors received on submitted encounters.
  5. MAO-002- Encounter Data Processing Status Report. The MAO-002 reflects two (2) statuses at the encounter and service line level: “accepted” and “rejected”. Lines that reflect a status of “accepted” yet contain an error message in the Edit Description column are considered “informational” edits.
  6. MAO-004- Encounter Data Diagnosis Eligible for Risk Adjustment Report. The CMS acknowledgement and/or reports in Section 6 of the 837I Encounter Data System Companion Guide will apply with the following exceptions: 1) Encounters designated as Medicaid will receive a 277CA report. 2) Encounters designated as Medicaid will not receive the MAO-001 or MAO-002 reports.

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