Encounter Data System - CSSC Operations

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consult the Encounter Data Companion Guide. If there are options expressed in the WPC/TR3 or theCEM edits spreadsheet that are broader then the options identified in the Encounter Data CompanionGuide, the rules identified in the Encounter Data Companion Guide must be used.LegendSHADED rows represent segments in the X12N Implementation GuideNON-SHADED rows represent data elements in the X12N Implementation GuideISATABLE 1 – ISA-IEA INTERCHANGE ELEMENTSLoop ID Reference Name Codes Notes/CommentsISA01ISA02ISA03ISA04ISA05ISA06ISA07ISA08ISA11InterchangeControl HeaderAuthorizationInformationQualifierAuthorizationInformationSecurityInformationQualifierSecurityInformationInterchange IDQualifierInterchange SenderIDInterchange IDQualifierInterchangeReceiver IDRepetitionSeparator00 No authorizationinformation presentUse 10 blank spaces00 No securityinformation presentZZZZ80881^Use 10 blank spacesCMS expects to seea value of “ZZ” todesignate that thecode is mutuallydefinedEN followed byContract ID NumberCMS expects to seea value of “ZZ” todesignate that thecode is mutuallydefined837 Institutional Companion Guide Version 8.0/June 201210
ISATABLE 1 – ISA-IEA INTERCHANGE ELEMENTS (CONTINUED)Loop ID Reference Name Codes Notes/CommentsISA13InterchangeControl HeaderInterchangeControl NumberMust be fixed lengthwith nine (9)characters andmatch IEA02IEAISA14AcknowledgementRequestedISA15 Usage Indicator TPInterchangeControl TrailerIEA02InterchangeControl NumberUsed to identify filelevel duplicatecollectively withGS06, ST02, andBHT031 A TA1 will be sent ifthe file issyntacticallyincorrect, otherwiseonly a ‘999’ will besentTestProductionMust match thevalue in ISA134.2 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 EDS functionalgroup (GS-GE) specific elements.Note: Only those elements that require explanation are presented in the table.837 Institutional Companion Guide Version 8.0/June 201211
Page 1 and 2: ___________________________________
Page 3 and 4: Table of Contents1.0 Introduction1.
Page 5 and 6: 1.0 Introduction1.1 ScopeThe CMS En
Page 7 and 8: 1.4 ReferencesMAOs and other entiti
Page 9: other entities should refrain from
Page 13 and 14: TABLE 3 - ST-SE TRANSACTION SET HEA
Page 15 and 16: TABLE 4 - 837 INSTITUTIONAL HEALTH
Page 21 and 22: The 277CA is used to acknowledge th
Page 23 and 24: TABLE 6 - TESTING FILE NAME COMPONE
Page 25 and 26: The report format example is as fol
Page 27 and 28: TABLE 10 - 837 INSTITUTIONAL PERMAN
Page 29 and 30: 9.0 837 Institutional Business Case
Page 31 and 32: SBR*P*18*XYZ1234567******16~AMT*D*2
Page 33 and 34: HI*BG:01~NM1*71*1*JONES*AMANDA*AL**
Page 35 and 36: HI*BR:3121:D8:20120330~HI*BH:41:D8:
Page 37 and 38: HI*BE:30:::20~HI*BG:01~NM1*71*1*JON
Page 39 and 40: HI*BE:30:::20~HI*BG:01~NM1*71*1*JOH
Page 41 and 42: N3*705 E HUGH ST~N4*NORFOLK*VA*2350
Page 43 and 44: SV2*0300*HC:D0999*50.00*UN*1~DTP*47
Page 45 and 46: N4*NORFOLK*VA*235049999~REF*T4*Y~LX
Page 47 and 48: N4*NORFOLK*VA*235099999~NM1*PR*2*HA
Page 49 and 50: SBR*P*18*XYZ1234567******16~AMT*D*9
Page 51 and 52: TABLE 11 - ENCOUNTER DATA INSTITUTI
Page 53 and 54: TABLE 11 - ENCOUNTER DATA INSTITUTI

Encounter Data System - CSSC Operations

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