X12 Interchange Acknowledgement (250: Claim Status Infrastructure Rule)

X12 Interchange Acknowledgement X12 Interchange Acknowledgement must be returned for real time X12 276 claim status inquiries if the functional group is rejected, or the X12 277 response, to be conformant with this rule. CAQH CORE Rules do not address usage of the X12 Interchange Acknowledgement TA1.  To send real time acknowledgments each health plan seeking CORE Certification will have to work with its clearinghouse and/or vendor to jointly complete CORE Certification in order for the health plan to be awarded the CORE Certification Seal. A clearinghouse or vendor would not be able to certify “generically” as a health plan and then transfer that CORE Certification to any health plan. The CAQH CORE Acknowledgements Rules do not address the use of the X12 Interchange Acknowledgement TA1.

Good business practices for electronic message exchange encourage all senders and receivers to appropriately acknowledge receipt and either acceptance/rejection and errors found in any message. That said, CAQH CORE 250: Claim Status Rule is focused on the conduct of the HIPAA-named X12 276/277 transaction sets, and the CAQH CORE Operating Rules are focused on the X12 as well. Thus, the CAQH CORE 250 Rule only addresses the use of the ASC X12 Implementation Acknowledgements (999) and when to use it when conducting the X12 276/277 transaction sets. Additionally, in order to meet CORE Certification requirements, an entity is required to attest to its compliance with HIPAA, which requires the use of the appropriate X12 TR3.

 CAQH CORE 250 Rule requires that the health plan or information receiver must always return an ASC X12 Implementation Acknowledgement (999) for all functional groups, whether or not the group is rejected. This requirement allows the provider to know within a reasonable timeframe if the submitted batch of inquiries was accepted by the health plan and will be processed. Likewise, the rule also requires that the provider must always return an ASC X12 Implementation Acknowledgement (999) for all functional groups whether or not the group is rejected, thereby allowing timely resolution of any issues.

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