Washington State Medicaid 835 Health Care Payment/Advice: Companion Guidelines
Washington State Medicaid 835 Health Care Payment/Advice transaction requirements are used in tandem with the v5010 ASC X12N Implementation Guides, are compliant with both ASC X12 syntax and those guides. When the trading partner request for 835 payment/advice by any one of the specified methods, request will be validated using EDI validator, translated and will be processed. The positive outcome will be 835 response.
Transmission methods
Trading partners can exchange Washington State Medicaid 835 Health Care Payment/Advice transaction one of the following methods:
- Provider One Web Portal
- Secure File Transfer Protocol (SFTP)
- Hypertext Transfer protocol (HTTP MIME + Multipart ) (batch)
- Simple Object Access Protocol (SOAP + WSDL) (batch).
HCA will validate all 835 transactions up to HIPAA validation levels 1 and 2. If a receiver rejects any part of the transmission, they must reject the entire transmission. Data on rejected 835 transmissions should not be used to update Trading Partner databases. HCA transmits 835 Transactions within single functional groups, and in single ST-SE Segments.
Washington State Medicaid requires every trading partner to have a valid login credentials to retrieve 835 transactions through all four submission methods available
Washington State Medicaid 835 transaction does not expect any custom values for ST- SE segment of 835 Request. In addition to this, refer to the ASC X12 835 technical report type 3 guide. HIPAA standards for the maximum file size of each transaction set are specified in the 835 Implementation Guide. The 835 Implementation Guide recommends a limit of 10,000 CLP Claim Payment Segments in 2100 Claim Payment Information Loop. ProviderOne may exceed the recommended limit of 10,000 CLP (Claim Payment Information) segments per ST-SE envelope in order to maintain the balancing requirement within 835. HCA has no size limitations for postings to its FTP Server.
Delimiters
The Provider will use the following delimiters on outbound transactions:
- Data element separator, Asterisk, ( * )
- Sub-element Separator, Vertical Bar, ( : )
- Segment Terminator, Tilde, ( ~ )
- Repetition Separator, Caret, (^)
HCA transmits 835 Transaction files with a single ISA/IEA and GS/GE envelope. 835 Transaction contains all the claims within one ST-SE segment within the same GS/GE envelope.
HCA will validate all 835 transactions up to HIPAA validation levels 1 and 2. If a receiver rejects any part of the transmission, they must reject the entire transmission. Data on rejected 835 transmissions should not be used to update Trading Partner databases. HCA transmits 835 Transactions within single functional groups, and in single ST-SE Segments.