PIE Transaction

PIE Transaction (Payer Initiated Eligibility/Benefit) Washington State Medicaid Testing Requirements

PIE Transaction should be submitted by the trading partner through the Washington State Medicaid ProviderOne Secure File Transfer Protocol (SFTP). The trading partner downloads acknowledgements for the test file from the ProviderOne SFTP HIPAA ACK folder. If the ProviderOne system generates a positive TA1 and positive 999 acknowledgements, the PIE Transaction file is successfully accepted. The trading partner is then approved to send PIE Transaction files in production.

If the test file generates a negative TA1 or negative 999 acknowledgments, then the submission is unsuccessful and the file is rejected. The trading partner needs to resolve all the errors reported on the negative TA1 or negative 999 and resubmit the file for test. Trading partners will continue to test in the testing environment until they receive a positive TA1 and positive 999. Completion of the testing process must occur prior to submitting electronic transactions in production to Washington State Medicaid.

Testing is conducted to ensure the following levels of HIPAA compliance:

  • Level 1 – Syntactical integrity: Testing of the EDI file for valid segments, segment order, element attributes, testing for numeric values in numeric data elements, validation of X12 or NCPDP syntax, and compliance with X12 and NCPDP rules.
  • 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 intrasegment situational data elements, testing for non-medical code sets.

Transmission sizes are limited based on two factors: Number of Segments/Records allowed by HCA HCA file size limitations HCA accepts PIE transaction files with single ISA/IEA and GS/GE envelopes. PIE transactions (with the limit of 5,000 repeats of Loop 2000C within an ST/SE envelop), can have multiple ST/SE envelops within the same GS/GE envelope. HCA limits a file size to 10 MB while uploading HIPAA files through SFTP.

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