X12 837 QUICKLINK PROFESSIONAL FRONT-END VALIDATION ...

Level 4 – IMPLEMENTATION GUIDE (IG) EDITSPASS: If a Provider (Provider HL03=20) PASSES IG edits:Processing will continue to Subscriber Level.Subscriber Hierarchical Level (HL03=22)IG edits applied to Loops 2000B, 2010BA, 2010BC & 2010BD will return the Subscriber HL and all claims anddependent claims for that subscriber.FAIL: If a Subscriber (HL03=22) FAILS IG edits:All claims for this Subscriber (HL03=22) will be rejected. Dependent claims for this subscriber willalso be rejected.IG edits will be performed on the remaining segments in the Subscriber (HL03=22). If a dependent orclaim does not have any IG errors, it will still be rejected if the subscriber has IG errors.The EMC Receipt Report will list all errors.The submitter must correct all errors within the Subscriber (HL03=22), including claim and dependentclaim errors. Resubmit the Subscriber (HL03=22), including claims and dependent claims.IG editing will continue with the next Subscriber (HL03=22), Provider (HL03=20) or Transaction Set(ST through SE), whichever follows next in the functional group.PASS: If a Subscriber (HL03=22) PASSES IG edits:Processing continues with either Claim Level if Subscriber has claims, or Dependent Level, whicheverfollows next in the interchange.Dependent Hierarchical Level (HL03=23)IG edits applied to Loops 2000C & 2010CA will return the Dependent HL and all claims for that dependent.FAIL: If a Dependent (HL03=23) FAILS IG edits:All claims for this Dependent (HL03=23) will be rejected.IG edits will be performed on the remaining segments in the Dependent (HL03=23). If a dependent’sclaim does not have any IG errors, it will still be rejected if the dependent has IG errors.The EMC Commercial Receipt Report will list all errors.The submitter must correct all errors within the Dependent (HL03=23), including claims. Resubmit theDependent (HL03=23) and claims.IG editing will continue with the next Dependent (HL03=23), Subscriber (HL03=22), Provider(HL03=20) or Transaction Set (ST through SE), whichever follows next in the interchange.PASS: If a Dependent (HL03=23) PASSES IG edits:Processing will continue to Claim Level.Claim LevelIG edits applied to Loops 2300 – 2430 will return the claim.FAIL: If a Claim FAILS IG edits:The specific Claim will be rejected.Level 5 - Commercial Business Edits will NOT be performed on the claim.The EMC Commercial Receipt Report will list all errors.The submitter must correct all errors within this Claim and resubmit it with its associated dependentand subscriber information.EMC Front End Validation – Quicklink Commercial Professional 4010A133