Standard Companion Guide - Magellan provider website

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MAGELLAN BEHAVIORAL HEALTH COMPANION GUIDESegPosLoopIDSegIDElmPosElmIDNameMaxUseUserReqBaseReqElemTypeMinLengthMinLengthLevel1Note20 GS Functional Group Header 1 S M20 GS 1 479 Functional Identifier Code 1 R M ID 2 2 (Populate with values fromTransaction-Specific Functional GroupSettings Table in the HIPAATransaction Standard CompanionGuide)20 GS 2 142 Application Sender's Code 1 R M AN 2 15 MBH NAIC # (01260) for transactionsfrom MBHTrading partner TIN for transactionsfrom them20 GS 3 124 Application Receiver's Code 1 R M AN 2 15 MBH NAIC # (01260) for transactionsto MBHTrading partner TIN for transactions tothem20 GS 4 373 Date 1 R M DT 8 8 Date in CCYYMMDD format (Thisformat to be used for 277Unsolicited3070 version)20 GS 5 337 Time 1 R M TM 4 8 Time in HHMM format20 GS 6 28 Group Control Number 1 R M N0 1 9 -Numeric 1 to 9 digits-Must be unique within an interchange(ISA/IEA)-Initialize the control number within anISA/IEA to the value in ISA13, andincrease for each Functional Groupwithin the interchange. SubsequentInterchanges (ISA/IEA) should haveISA13 higher than all prior GS06(GS/GE) control numbers.20 GS 7 455 Responsible Agency Code 1 R M ID 1 2 Set to "X"20 GS 8 480 Version / Release / Industry IdentifierCode1 R M AN 1 12 (Populate with values fromTransaction-Specific Functional GroupSettings Table in the HIPAATransaction Standard CompanionGuide)30 GE Functional Group Trailer 1 S M30 GE 1 97 Number of Transaction Sets Included 1 R M N0 1 6 Count of number of Transaction Sets(ST/SE) within the Functional Group(GS/GE)30 GE 2 28 Group Control Number 1 R M N0 1 9 Must match Control Number GS6 onFunctional Group Header (GS)* Red font denotes differences between transactionsLast Update: 3/24/03Revised: April 21, 2004 HIPAA X12 (004010 + Addenda) Version 1.16 Page 15 of 30
MAGELLAN BEHAVIORAL HEALTH COMPANION GUIDE2.5.4 Transaction Set Header/Trailer (ST-SE)Control numbers used on the ST/SE segments should reset and increment within the Interchange(ISA/IEA). The control number elements are ST02 and SE02. The Control Number value has thefollowing requirements:• Numeric• 4 to 9 digits• Start at 0001 within each Interchange (ISA/IEA)• Increment for each additional transaction set (ST/SE) within the Interchange.• Continue to increment this control number across all Functional Groups (GS/GE) withinthe Interchange. This number is unique within the Interchange.A “detail record” is defined as a “business document” such as a single claim (837), singleeligibility request (270), single claim status request (276) or single member (834).The following table will present the ST and SE segment layouts:LoopIDSegIDElmPosElmIDNameMaxUseUserReqBaseReqElemTypeMinLengthMinLengthLevel1NoteST Transaction Set Header 1 R MST 1 143 Transaction Set Identifier Code 1 R M ID 3 3 Set to transaction ID:270, 271, 276, 277, 278, 820, 834,835, 837, 997, TA1ST 2 329 Transaction Set Control Number 1 R M AN 4 9 · Starting at 0001 within eachInterchange (ISA/IEA)· Increment for each additionaltransaction set (ST/SE) within theInterchange.· Continue to increment across allFunctional Groups (GS/GE) within theInterchange. This number is uniquewithin the Interchange.SE Transaction Set Trailer 1 R MSE 1 96 Number of Included Segments 1 R M N0 1 10 Number of segments within theTransaction Set including the ST &SE segmentsSE 2 329 Transaction Set Control Number 1 R M AN 4 9 Must match the corresponding STsegment Transaction Set ControlNumber ST02Last Update: 3/24/03Revised: April 21, 2004 HIPAA X12 (004010 + Addenda) Version 1.16 Page 16 of 30
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