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

Data FlowPEACH STATE HEALTH PLAN has secure options available for exchanging data electronically.All transactions will be submitted in a batch mode. Section 02: Method of Transmissionprovides information on data transmissions.For each batch transaction received, PEACH STATE HEALTH PLAN will return a 997 –Functional Acknowledgement. This file acknowledges the receipt of the file and reports anydata compliance issues. PEACH STATE HEALTH PLAN also expects to receive a 997 –Functional Acknowledgement transaction when the trading partner receives any outbound batchtransaction. For additional information about the use of the 997 transactions, refer to Section04: Acknowledgements and Reports, of this companion guide.PEACH STATE HEALTH PLAN has created an Audit Report for any health care claimtransaction (837I and 837P) received. This is not a HIPAA-mandated report; however itsummarizes the number of claims received and any claims that were rejected due to invalidinformation. Additional information is available in Section 04 – Acknowledgements andReports.A batch request or inquiry transaction, 270, 276, 278 results in the creation of the responsetransaction, 271, 277 or 278 respectively. PEACH STATE HEALTH PLAN will post theresponses in a reasonable amount of time for the requestor to retrieve. Section 02: Method ofTransmission provides communication specifications for data exchange.Finally, some transactions can be submitted interactively. PEACH STATE HEALTH PLAN onlycreates a 997 – Acknowledgement for an interactive request transaction if it fails the compliancecheck. Otherwise, the appropriate response transaction serves as the acknowledgement of thereceipt of the transaction.Processing AssumptionsSome transactions are created and generated by, or on behalf of, a provider. Others arecreated by PEACH STATE HEALTH PLAN either in response to a request received from aprovider or as a means to provide pertinent information to providers or contracted vendors. Thefollowing list identifies each transaction by PEACH STATE HEALTH PLAN’s definition asinbound and/or outbound:Table 1.2 – PEACH STATE HEALTH PLAN Transaction Definition6