Encounter Data Companion Guide - CSSC Operations

The report format example is as follows:FILE NAME: XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXFILE CONTROL: XXXXXXXXXNUMBER OF CLAIMS: 99,999FILE WAS NOT SENT TO THE EDPS BACK-END PROCESS FOR THE FOLLOWING REASON(S)XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXTable 10 provides the complete list of testing and production EDFES notification messages.TABLE 10 – EDFES NOTIFICATIONSAPPLIES TO ENCOUNTER TYPE NOTIFICATION MESSAGEAll files submittedAll files submittedAll files submittedAll files submittedEnd-to-End Testing– File 1All files submittedProduction filessubmittedProduction filessubmittedAllAllAllAllAllAllAllAllFILE ID (XXXXXXXXX) IS ADUPLICATE OF A FILE IDSENT WITHIN THE LAST 12MONTHSSUBMITTER NOTAUTHORIZED TO SENDCLAIMS FOR PLAN(CONTRACT ID)PLAN ID CANNOT BE THESAME AS THE SUBMITTERIDAT LEAST ONEENCOUNTER IS MISSING ACONTRACT ID IN THE2010BB-REF02 SEGMENTSUBMITTER NOT FRONT-END CERTIFIEDTHE DATE ON ALL CLAIMSMUST START IN THE YEAR2012SUBMITTER NOTCERTIFIED FORPRODUCTIONTHE INTERCHANGE USAGEINDICATOR MUST EQUAL‘T’NOTIFICATION MESSAGEDESCRIPTIONThe file ID must beunique for a 12 monthperiodThe submitter is notauthorized to send forthis planThe Contract ID cannotbe the same as theSubmitter IDThe Contract ID is missingThe submitter must befront-end certified tosend encounters forvalidationEncounters must containdates in the year 2012The submitter must becertified to sendencounters forproductionThe Professional Tier 2file is being sent with a ‘P’in the ISA15 field837 Institutional Companion Guide Version 9.0/August 201225