Encounter Data Companion Guide - CSSC Operations

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TABLE 1 – ISA/IEA INTERCHANGE ELEMENTS (CONTINUED)LOOP ID REFERENCE NAME CODES NOTES/COMMENTSISAInterchangeControl HeaderISA07ISA08ISA11ISA13Interchange IDQualifierInterchangeReceiver IDRepetitionSeparatorInterchangeControl NumberZZ80881^CMS expects to seea value of “ZZ” todesignate that thecode is mutuallydefinedMust be fixed lengthwith nine (9)characters andmatch IEA02IEAISA14AcknowledgementRequestedISA15 Usage Indicator TPIEA02InterchangeControl TrailerInterchangeControl NumberUsed to identify filelevel duplicatecollectively withGS06, ST02, andBHT031 A TA1 will be sent ifthe file issyntacticallyincorrect, otherwiseonly a ‘999’ will besentTestProductionMust match thevalue in ISA13837 Institutional Companion Guide Version 9.0/August 201210
4.2 GS/GEThe functional group is outlined by the functional group header (GS segment) and the functional grouptrailer (GE segment). The functional group header starts and identifies one or more related transactionsets and provides a control number and application identification information. The functional grouptrailer defines the end of the functional group of related transaction sets and provides a count ofcontained transaction sets.All elements in the GS/GE functional group must be populated. There are several elements within theGS/GE that must be populated specifically for encounter data collection. Table 2 provides EDSfunctional group (GS/GE) specific elements.Note: Only those elements that require explanation are presented in the table.GSTABLE 2 - GS/GE FUNCTIONAL GROUP ELEMENTSLOOP ID REFERENCE NAME CODES NOTES/COMMENTSGS02GS03Functional Group HeaderApplication Sender’sCodeApplication Receiver’sCodeEN followed byContract ID Number80881 This value mustmatch the value inISA08GS06 Group Control Number This value mustmatch the value inGE02GEGS08Version/Release/IndustryIdentifier CodeFunctional Group Trailer005010X223A2Used to identify filelevel duplicatescollectively withISA13, ST02, andBHT03GE02 Group Control Number This value mustmatch the value inGS064.3 ST/SEThe transaction set (ST/SE) contains required, situational, and unused loops, segments, and dataelements. The transaction set is outlined by the transaction set header (ST segment) and thetransaction set trailer (SE segment). The transaction set header identifies the start and identifies thetransaction set. The transaction set trailer identifies the end of the transaction set and provides a countof the data segments, which includes the ST and SE segments. There are several elements that must be837 Institutional Companion Guide Version 9.0/August 201211
Page 6 and 7: 1.3 Major Updates1.3.1 EDIPPS Edits
Page 8 and 9: CONNECTIVITYMAXIMUM NUMBER OFENCOUN
Page 12 and 13: populated specifically for encounte
Page 14 and 15: TABLE 4 - 837 INSTITUTIONAL HEALTH
Page 21: The 277CA is used to acknowledge th
Page 25: The report format example is as fol
Page 28 and 29: 8.1 Header LevelWhen a file (ISA -
Page 30 and 31: 9.1 Standard Institutional Encounte
Page 32 and 33: 9.2 Capitated Institutional Encount
Page 34 and 35: 9.3 Chart Review Institutional Enco
Page 36 and 37: 9.4 Chart Review Institutional Enco
Page 38 and 39: 9.5 Complete Replacement Institutio
Page 40 and 41: 9. 6 Complete Deletion Institutiona
Page 42 and 43: 9. 7 Atypical Provider Institutiona
Page 44 and 45: 9.8 Paper Generated Institutional E
Page 46 and 47: 9.9 True Coordination of Benefits I
Page 48 and 49: 9.10 Bundled Institutional Encounte
Page 50: 10.0 Encounter Data Institutional P
Page 53 and 54: EDIPPSEDIT#TABLE 12 - ENCOUNTER DAT

Encounter Data Companion Guide - CSSC Operations

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