Encounter Data System - CSSC Operations

More documents

Recommendations

Info

2.0 Contact Information2.1 The Customer Service and Support Center (CSSC)The Customer Service and Support Center (CSSC) personnel are available for questions from 8:00A.M. –7:00P.M. EST, Monday-Friday, with the exception of federal holidays and can be contacted at 1-877-534-CSSC (2772) or by email at csscoperations@palmettogba.2.2 Applicable websites/emailThe following websites provide information to assist in EDS submission:ResourceEncounter Data ParticipantGuidesEDS EmailANSI ASC X12 TR3Implementation GuidesWashington Publishing CompanyHealth Care Code SetsCMS Edits SpreadsheetWeb Addresswww.csscoperations.comeds@ardx.netwww.wpc-edi.comwww.wpc-edi.comhttp://www.cms.gov/MFFS5010D0/20_TechnicalDocumentation.asp3.0 File Submission3.1 File Size LimitationsDue to system limitations, the combination of all ST-SE transaction sets per file cannot exceed certainthresholds depending upon the connectivity method of the submitter. FTP and NDM users cannotexceed 85,000 encounters per file. Gentran users cannot exceed 5,000 encounters per file. For allconnectivity methods, the TR3 allows no more than 5000 CLMS per ST-SE segment. The followingdemonstrates the limits due to connectivity methods:ConnectivityMaximum Number ofEncountersFTP/NDM 85,000 5,000Gentran 5,000 5,000Maximum Number of ST-SENote: Due to system processing overhead associated with smaller numbers of encounters within theST-SE, it is highly recommended that larger numbers of encounters within the ST-SE be used.In an effort to support and provide the most efficient processing system, it is recommended that FTPsubmitters’ scripts should not upload more than one (1) file per five (5) minute interval to allowmaximum performance. Files that are zipped should contain one (1) file per transmission. MAOs and837 Institutional Companion Guide Version 8.0/June 20128
other entities should refrain from submitting multiple files within the same transmission. NDM andGentran users may submit a maximum of 255 files per day.3.2 File Structure – NDM/Connect Direct and Gentran Submitters Only80 byte fixed block is a common mainframe term. This means every line (record) in a file must beuploaded as 80 bytes/characters long. NDM/Connect Direct and Gentran submitters must use thisapproach.Files should be created in a manner where the segments are one continuous stream of information thatcontinues to the next line every 80 characters.Segments should be stacked in the files, using only 80 characters per line. At position 81, MAOs andother entities must create a new line. On the new line starting in position 1, continue for 80 characters,and repeat creating a new line in position 81 until the file is complete. If the last line in the file does notfill to 80 characters, it should be spaced out to position 80 and then save the file.NOTE:If MAOs and other entities are using a text editor to create the file, a new line can be created by pressingthe Enter key. If MAOs and other entities are using an automated system to create the file, create a newline by using a CRLF (Carriage Return Line Feed) or a LF (Line Feed).For example the ISA record is 106 characters long:The first line of the file will contain the first 80 characters of the ISA segment; the last 26 characters ofthe ISA segment will be continued on the second line. The next segment will start in the 27th positionand continue until column 80.ISA*00* *00* *ZZ* ENH9999*ZZ* 80881*120816*1144*^*00501*000000031*1*P*:~4.0 Control Segments/Envelopes4.1 ISA-IEAThe term interchange denotes the ISA-IEA envelope that is transmitted. Interchange control is achievedthrough several “control” components, as defined in Table 1. The interchange control number iscontained in data element ISA13 of the ISA segment. The identical control number must also occur indata element IEA02 of the IEA segment. All elements in the ISA-IEA interchange must be populated.There are several elements within the ISA-IEA interchange that must be populated specifically forencounter data purposes. Table 1 below provides EDS Interchange Control (ISA-IEA) specific elements.Note: Only those elements that provide specific details relevant to encounter data are presented inthe table. When developing the encounter data system, users should base their logic on the highestlevel of specificity. First, consult the WPC/TR3. Second, consult the CMS edits spreadsheets. Third,837 Institutional Companion Guide Version 8.0/June 20129
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: 1.4 ReferencesMAOs and other entiti
Page 11 and 12: ISATABLE 1 - ISA-IEA INTERCHANGE EL
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

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?