UHA Claim Submission (Trading Partner Guidelines)
UHA Claim Submission specific instructions are required for electronic transfer of the claims data via Electronic Data Interchange processing systems.
997 Functional Acknowledgement
UHA is required to create a 997 Functional Acknowledgement to report the results of the standard X12 syntax editing. The 997 will normally be available by the next business day. The 997 will detail error information down to the claim service line level. The 997 Set Specifications are located in the National Implementation Guide. The 997 will report standard X12 Syntax errors. The Trading Partner is responsible for retrieving and translating the 997. Transactions with errors must be corrected and resubmitted.
Decimals are only accepted in Dollar Field amounts. Two decimals will be accepted for charges. Example: 1000 will be interpreted as $1000.00 (not $10.00). Claims that contain amounts submitted with more than 2 decimals will be rejected.
All codes should be left justified. Codes should be submitted as stated in the code manuals. ICD-9-CM is composed of codes of either 3, 4, or 5 digits. A code is invalid if it has not been coded to the full number of digits required for that code. A preceding zero must be used if present in the ICD-9 manual.
ICD-9 Diagnosis Codes have a maximum size of five (5). UHA does not accept decimal points in Diagnosis Codes and Procedure Codes. First and Subsequent Codes are not allowed on 837 transactions. UHA will not accept Z9020 or Z9024 on 837 transactions regardless of service date.
835 Electronic Remittance
UHA will convert all lower case characters submitted on the inbound 837 file to upper case when sending to the UHA processing system. Information returned on the 835 ERA will be in upper case.
UHA may reject an interchange (transmission) with more then 5,000 CLM segments (claims) submitted per transaction. Do not use Credit/Debit card information in the 837 when submitting to UHA.
To learn more about HIPAA EDI Integration and become a certified EDI Professional please visit our course schedule page.