Test EDI files Submission and Validation Guides
The process of submitting test EDI files varies based on the selected platform and the implementation method. During EDI implementation, you will log a ticket to the ON24/7 application that includes the following information:
- Tracking/Reference number
- Number of claims submitted
- Time and date of submission
- Submitter ID
- Line of Business
This ticket provides your Implementation Analyst with the information needed to process the test EDI files. Self-directed format conversion projects will require a similar ticket, but will not require an Emdeon personal response. In both scenarios, processing will complete within 24 hours.
After the file is submitted, you will receive a File Syntax Acknowledgement (997) or an Implementation Acknowledgement (999) within 24 hours. Use the received acknowledgement to verify that the file was received and the file structure can be processed. If the acknowledgement indicates failure, take the corrective steps necessary and resubmit.
A 997 or 999 file-level acknowledgement is not a guarantee that your claims were accepted.
Once the EDI file is acknowledged, Emdeon ensures that the required fields are present and readable. The results of this verification are provided in the Emdeon Batch Transaction Report, which is delivered to your client mailbox.
Certification for a new implementation requires the successful submission of 100 test EDI files (claims) with a 95% acceptance rate. Certification for a conversion begins by submitting the same number of test claims as an average day’s production volume in a minimum of three files. The rejection rate on the test claims in a conversion project cannot exceed the current production-level rejection rate. You will receive confirmation from your Implementation Analyst in the form of a certification letter. Once certified, you will receive the credentials and authorization necessary to submit in live production.
Emdeon Processing Hours
Claim files may be submitted at any time of the day or night except for Sunday from 1:00 a.m. to 7:00 a.m. CST, which may be used for planned systems maintenance. Claims are processed and delivered throughout the day beginning at 5:00 a.m. central time Monday through Saturday. Claim file delivery times and frequency are based on a pre-determined schedule that has been agreed upon by Emdeon and each Payer. Even though claims may be submitted at any time, daily processing Monday through Friday ceases at 8:30 p.m. CST. All data files completely received at cut-off will be formatted for batch production processing. Any file submitted after the cut-off times will be held and accumulated until processing resumes the following weekday.