X12 837 QUICKLINK PROFESSIONAL FRONT-END VALIDATION ...

More documents

Recommendations

Info

LEVEL 1 – ISA EditsISA0500001INTERCHANGE ID QUALIFIER FOR SENDER MUST = ‘ZZ’The Interchange ID Qualifier must be present in ISA05 and must equal ‘ZZ’, Mutually Defined.Empire requires the value of ‘ZZ’ from the list of Qualifiers present in the 837 ImplementationGuide. (004010X098A1)Example:ISA*00*----------*00*----------*ZZ*123456---------*ZZ*WP803----------*010210*1324*U*00401*800000041*0*P*:~ISA0600001SENDER ID (SUBMITTER ) MISSING OR NOT ON EMPIRE CONTROL FILEThe sender's submitter ID (ISA06) must be present and must match a submitter number on aninternal Empire control file. The ISA06 element is fixed length and must be left justified andspace filled to its fixed length.Example:ISA*00*----------*00*----------*ZZ*123456---------*ZZ*WP803----------*010210*1324*U*00401*800000041*0*P*:~ISA0600002SUBMITTER NOT AUTHORIZED FOR 837 CLAIM TYPEThe submitter (Sender ID in ISA06) must be authorized on an internal Empire control file tosubmit claims in the X12 837 format. The ISA06 element is fixed length and must be left justifiedand space filled to its fixed length.Example:ISA*00*----------*00*----------*ZZ*123456---------*27*WP803----------*010210*1324*U*00401*800000041*0*P*:~ISA0700001ISA07 MUST='27' (MEDB),'28' (MEDA), OR 'ZZ' (BCBS OR COMMERCIAL)The Interchange ID Qualifier must be present in ISA07 and must equal ‘27’, ‘28’, or ‘ZZ’. ForEmpire Blue Shield and Commercial claims, the value must equal ‘ZZ’.Example:ISA*00*----------*00*----------*ZZ*123456---------*ZZ*WP803----------*010210*1324*U*00401*800000041*0*P*:~ISA0700004ISA07='ZZ':ISA08 RECEIVER ID MUST='BS803', '00303', ‘WI303’ OR ‘WP803’Empire Blue Cross Blue Shield and Commercial only edit: If the Interchange IDQualifier in ISA07 is 'ZZ', then the Interchange Receiver ID in ISA08 must equal 'BS803'for Empire Blue Shield professional claims, '00303' for Empire Blue Cross institutional claims,‘WI303’ for Institutional Commercial claims or ‘WP803’ for Professional Commercialclaims.Example:ISA*00*----------*00*----------*ZZ*123456---------*ZZ*WP803----------*010210*1324*U*00401*800000041*0*P*:~EMC Front End Validation Edits – Quicklink Commercial Professional 4010A13
LEVEL 1 – ISA EditsISA08/GS08SENDER NOT AUTHORIZED FOR PROD OR GS08 VERSION IS INCORRECTThe submitter (Sender ID in ISA06) must be authorized on the Empire internal control to submitproduction claims for the line of business indicated by the Interchange Receiver ID in ISA08 andfor the 837 version entered in GS08 Version Identifier Code. For Empire ProfessionalCommercial claims, the ISA08 value must equal ‘WP803’. The ISA06 and ISA08 elements arefixed length and must be left justified and space filled to their fixed length.Example:ISA*00*----------*00*----------*ZZ*123456789------*ZZ*WP803 ----------*010210*1324*U*00401*800000042*0*P*:~GS*HC*123456*WP803*20010521*1615*800000041*X*004010X098A1~ISA0800004SUBMITTER NOT AUTHORIZED TO SEND TEST CLAIMS TO RECEIVERThe submitter (Sender ID in ISA06) must be authorized on the OMNIPRO control file tosubmit test claims for the line of business indicated by the Interchange Receiver ID inISA08. Receiver ID valid values: Medicare Part B = 00803; Medicare Part A = 00308;Empire Blue Shield = BS803; Empire Blue Cross = 00303; InstitutionalCommercial = WI303; Professional Commercial=WP803.Example:ISA*00*----------*00*----------*ZZ*123456---------*ZZ*WP803----------*010210*1324*U*00401*800000041*0*T*:~Example:ISA*00*----------*00*----------*ZZ*123456---------*ZZ*WP803----------*010210*1324*U*00401*800000041*0*P*:~ISA0800008FILE HAS MANY ISA’S: ALL ISA08’S IN FILE MUST = 1 ST ISA08 RECVWhen a file contains multiple ISA through IEA interchanges, the Interchange Receiver ID(ISA08) in the first Interchange Control Header (ISA) is determined to be the line of business forall ISA through IEA interchanges in the file. If a different receiver ID (ISA08) is encountered inany ISA08 following the first ISA08, that interchange (ISA through IEA) will be rejected.Example:ISA*00*----------*00*----------*ZZ*123456789------*ZZ*WP803----------*010210*1324*U*00401*800000041*0*P*:~ISA*00*----------*00*----------*ZZ*123456789------*ZZ*WP803----------*010210*1324*U*00401*800000042*0*P*:~ISA0800009ISA08 RECVR ID = ‘WP803’ (PROF COMM) : ISA07 QUAL ID MUST = ‘ZZ’Professional commercial only edit. If the Receiver ID in ISA08 is ‘WP803’ forProfessional commercial claims, then Interchange ID Qualifier in ISA07 must equal‘ZZ’.Example:ISA*00*----------*00*----------*ZZ*123456---------*ZZ*WP803----------*010210*1324*U*00401*800000041*0*P*:~EMC Front End Validation Edits – Quicklink Commercial Professional 4010A14
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 34 and 35: 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
Page 52 and 53:
LEVEL 5 - EMPIRE BUSINESS EDITSWP00
Page 54 and 55:
Page 56 and 57:
show all

X12 837 QUICKLINK PROFESSIONAL FRONT-END VALIDATION ...

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

Delete template?

Save as template?