837P Companion Guide - Peach State Health Plan Peach State ...

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SECTION 03: INTERCHANGE CONTROL STRUCTUREOverviewAppendix A, Section A.1.1 of each X12N HIPAA IG provides detail about the rules for ensuringintegrity and maintaining the efficiency of data exchange. Data files are transmitted in anelectronic envelope. The communication envelope consists of an interchange envelope andfunctional groups. The interchange control structure is used for inbound and outbound files. Aninbound interchange control structure is the envelope that wraps all transaction data (ST-SE)sent to PEACH STATE HEALTH PLAN for processing. Examples include 837, 270 and 276transactions. An outbound interchange control structure wraps transactions that are created byPEACH STATE HEALTH PLAN and returned to the requesting provider or contracted vendor.Examples of outbound transactions include 835, 271 and 277 transactions. The followingtables define the use of this control structure as it relates to communication with PEACH STATEHEALTH PLAN.Inbound TransactionsSegmentNameSegment IDLoop IDUsageSegmentNotesInterchange Control HeaderISAN/ARequiredAll positions within each data element in the ISA segment must be filled.Delimiters are specified in the interchange header segment.The character immediately following the segment ID, ISA, defines the dataelements separator. The last character in the segment defines the componentelement separator, and the segment terminator is the byte that immediatelyfollows the component element separator. Examples of the separators are asfollows:Character Name Delimiter* Asterisk Data Element Separator: Colon Sub-element Separator~ Tilde Segment TerminatorWhile it is not required that submitters use these specific delimiters it is recommended, sincethey are the ones that the PEACH STATE HEALTH PLAN uses for all outbound transactions.12
Element Usage <strong>Guide</strong> Description/Valid Values CommentsIDISA01 R Authorization Information Qualifier00 – No AuthorizationInformation PresentISA02 R Authorization Information Always blank. Insert 10 blankspaces.ISA03 R Security Information Qualifier00 – No Security InformationPresentISA04 R Security Information Always blank. Insert 10 blankspaces.ISA05 R Interchange ID QualifierZZ – Mutually DefinedISA06 R Interchange Sender ID For batch transactions, this is thesender ID assigned by the TradingPartner.. This field has a requiredlength of 15 bytes; therefore, thefield must be blank filled to the right.ISA07 R Interchange ID QualifierZZ – Mutually DefinedISA08 R Interchange Receiver ID This field has a required length of 15bytes; therefore, the field must beblank filled to the right.ISA09 R Interchange Date The date format is YYMMDD.ISA10 R Interchange Time The time format is HHMM.ISA11 R Interchange Control StandardsIdentifierU – U.S. EDI Community of ASCX12, TDCC, and UCSISA12 R Interchange Control VersionNumber00401 – Draft Standards forTrial Use Approved forPublication by ASC X12Procedures Review Boardthrough October 199713
Page 1 and 2: 837P InboundCompanion GuideProfessi
Page 3 and 4: DocumentVersion NumberREVISION HIST
Page 5 and 6: (004010X096A1)Explanation ofASC X12
Page 7 and 8: InboundOutboundNCPDP (Provider)NCPD
Page 9 and 10: Provider Selection Criteria Informa
Page 11: • CoreFTP, CuteFtp, WSFTP ProIf y
Page 15 and 16: ElementIDUsage Guide Description/Va
Page 17 and 18: Outbound TransactionsSegmentNameSeg
Page 19 and 20: ElementIDUsage Guide Description/Va
Page 21 and 22: SECTION 04: PROFESSIONAL CLAIM SUBM
Page 23 and 24: SegmentIDTable 3.1 - Segment Usage
Page 35 and 36: Segment and Data Element Descriptio
Page 37 and 38: IDDescription/ValidValuesREF01 R Re
Page 39 and 40: PER08 S CommunicationNumberPER09 N/
Page 41 and 42: PRV02 R ReferenceIdentification Qua
Page 43 and 44: U.S.N405 N/A Location Qualifier Not
Page 45 and 46: REF segment, in this loop.24: Emplo
Page 47 and 48: Segment NotesElement UsageIDGuideDe
Page 49 and 50: IDDescription/ValidValuesNM101 R En
Page 51 and 52: Segment NameSegment IDLoop IDUsageS
Page 53 and 54: Segment IDLoop IDUsageSegment Notes
Page 55 and 56: CLM05 R Health Care ServiceLocation
Page 57 and 58: Segment Name Date - Onset of the cu
Page 59 and 60: DTP02 R Date Time PeriodFormat Qual
Page 61 and 62: Format QualifierDTP03 R RelatedHosp
Page 63 and 64:
Loop ID 2300UsageSituationalSegment
Page 65 and 66:
CR204 S Subluxation LevelCodeCR205
Page 67 and 68:
Segment Name VisionSegment IDCRCLoo
Page 69 and 70:
HI04-03 R Date Time PeriodFormat Qu
Page 71 and 72:
First NameNM105 S Referring Provide
Page 73 and 74:
last or OrganizationNameNM104 S Ren
Page 75 and 76:
Segment NameSegment IDLoop IDUsageS
Page 77 and 78:
SBR04 S Other Insured GroupNameSBR0
Page 79 and 80:
NM103 R Other Insured LastNameNM104
Page 81 and 82:
NM111 N/A Entity Identifier Code No
Page 83 and 84:
SV118 N/A Postal Code Not UsedSV119
Page 85 and 86:
CRC02 R Certification ConditionIndi
Page 87 and 88:
ValuesREF01 R Reference6R: Provider
Page 89 and 90:
PRV03 R ReferenceIdentificationProv
Page 91 and 92:
Identification QualifierREF02 R Sup
Page 93 and 94:
N402 R Ordering ProviderState CodeN
Page 95 and 96:
SECTION 05: ACKNOWLEDGEMENTS AND RE
Page 97 and 98:
Segment NameSegment IDLoopUsageSegm
Page 99 and 100:
AK504 S Transaction Set SyntaxError
Page 101 and 102:
Claim Audit ReportPEACH STATE HEALT
Page 103 and 104:
SECTION 07: TESTINGSummaryThere are
Page 105 and 106:
B: Sample Audit ReportProcess Date
Page 107:
58 Invalid Mbr DOB; Invalid Prv; In
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837P Companion Guide - Peach State Health Plan Peach State ...

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