X12 837 QUICKLINK PROFESSIONAL FRONT-END VALIDATION ...

More documents

Recommendations

Info

Level 4 – IMPLEMENTATION GUIDE (IG) EDITSLevel 4 - OverviewThe IG edits will be performed if the functional group passes prior levels of editing.IG edits are applied to all segments beginning with and including the ST segment; ending with and including theSE segment.All segments, elements and composite elements will be edited for usage, qualifiers and situational notes asdefined in the ASC X12N 837 (004010X098A1) implementation guide dated October 2002.The IG edits are performed at several levels within the ST through SE.The error levels within Level 4 - IG Edits are:TransactionProviderSubscriberPatientClaimWhen an error occurs at one level within the ST through SE, all claims below that level are rejected. IG editingcontinues throughout the lower levels to identify any additional errors.Critical IG EditsSome IG edits are considered ‘critical’ because failing one of these edits means the entire ST through SE isreturned.Example:IG Error CodeIG0002IG Error NarrativeCRITICAL ERROR, HL01 MUST INCREMENT BY 1 WITHIN ST THROUGH SEGeneric IG EditsSome IG edits are generic and have been used repeatedly throughout the 837. These generic edits begin with‘AK’.Example:IG Error CodeAK4037IG Error NarrativeINVALID CODE VALUEFor example:Loop 1000A, NM102, valid values are ‘1’ or ‘2’Loop 2010BA, REF01, valid value is ‘Y4”If either element NM102 or REF02 has an invalid value, it will receive the AK4037 error code. If bothelements have invalid values, then each element will receive the AK4037 error code.EMC Front End Validation – Quicklink Commercial Professional 4010A131
Level 4 – IMPLEMENTATION GUIDE (IG) EDITSLoop / Segment / Element Specific IG EditsThe remaining IG edits are specific to a loop, segment or element, or a relationship between multiple elementsor segments.Example:IG Error CodeIG0029IG0048IG Error NarrativeLOOP 2010BD N3 MISSING, REQUIRED WHEN LOOP 2010BD NM1 PRESENTLOOP 2300 PWK02=BM/EL/EM/FX, PWK06 MISSINGA EMC Commercial Receipt Report EMCD6102-04 (for production transmissions), EMCDA6102-14 (for ‘NewBiller’ transmissions), EMCD6102-03 (for unknown line of business production transmissions) and EMCD6102-13 (for unknown line of business ‘New Biller’ transmissions) have been developed for ASC X12N 837 4010A1Commercial transmissions. The reports identify:The loop, segment, and element that is in error; and the qualifier, if applicable.The error level.The data in error (input data).Transaction LevelIG edits applied to ST, BHT and REF segments and Loops 1000A & 1000B will return the entire transaction.FAIL: If a Transaction Set (ST through SE) FAILS IG edits:All claims for this transaction set (ST through SE) will be rejected.IG edits will be performed on the remaining segments in the ST through SE.The EMC Commercial Receipt Report will list all errors.The submitter must correct all errors within the ST through SE and resubmit the ST through SE thatwas in error.NOTE: Several IG edits are considered ‘critical’ errors. These critical edits are applied to HL segments. Failingany of these critical edits will cause the entire transaction set (ST through SE) to be rejected.PASS: If a Transaction Set (ST through SE) PASSES IG edits:Processing will continue to the Provider Level.Billing / Pay-To Provider Hierarchical Level (HL03=20)IG edits applied to Loops 2000A, 2010AA & 2010AB will return the Provider HL and all subscriber anddependent claims for that provider.FAIL: If a Provider (HL03=20) FAILS IG edits:All claims for this Provider (HL03=20) will be rejected. Claims for every subscriber and everydependent for this provider will be rejected.IG edits will be performed on the remaining segments in the Provider (HL03=20). Even if asubscriber, dependent or claim does not have any IG errors, it will still be rejected because the billingprovider has IG errors.The EMC Commercial Receipt Report will list all errors.The submitter must correct all errors within the Provider (HL03=20) and resubmit the Provider(HL03=20) that was in error.IG editing will continue with the next Provider (HL03=20) or Transaction Set (ST through SE),whichever follows next in the functional group.EMC Front End Validation – Quicklink Commercial Professional 4010A132
Page 6 and 7: LEVEL 1 - ISA EditsISA0500001INTERC
Page 8 and 9: LEVEL 1 - ISA EditsISA0900001INTERC
Page 10 and 11: LEVEL 1 - ISA EditsISA0000IEACHARAC
Page 12 and 13: 997 SegmentsA 997 is created for ea
Page 14 and 15: 997 Segments1. Determine which func
Page 16 and 17: 997 SegmentsExample 1This is an exa
Page 18 and 19: 997 SegmentsExample 2This 997 is fo
Page 26 and 27: 997 SegmentsExample 6These two 997
Page 28 and 29: 997 SegmentsGE*1*1229~This is the f
Page 30 and 31: 997 SegmentsIEA*1*000000001~This is
Page 32 and 33: Level 3 - GS EDITSGS Error Codes an
Page 36 and 37: Level 4 - IMPLEMENTATION GUIDE (IG)
Page 46 and 47: Level 5 - EMPIRE BUSINESS EDITSFAIL
Page 48 and 49: Level 5 - EMPIRE BUSINESS EDITSWP00
Page 50 and 51: LEVEL 5 - EMPIRE BUSINESS EDITSWP00

X12 837 QUICKLINK PROFESSIONAL FRONT-END VALIDATION ...

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

Delete template?

Save as template?