Companion Guide: Electronic Data Interchangeprovider.indianamedicaid.com/media/62096/5010cg edi... · Library Reference Number: CLEL10050 Document Management System Reference: Companion

H P S Y S T E M S U N I T

I N D I A N A H E A L T H C O V E R A G E P R O G R A M S

Companion Guide: Electronic Data Interchange

999 Acknowledgement and Submission Summary Report

L I B R A R Y R E F E R E N C E N U M B E R : C L E L 1 0 0 5 0 R E V I S I O N D A T E : N O V E M B E R 2 0 1 1 V E R S I O N 1 . 0

Library Reference Number: CLEL10050

Document Management System Reference: Companion Guide – 999 Acknowledgement and Submission Summary Report

Address any comments concerning the contents of this manual to:

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Indianapolis, IN 46204 Fax: (317) 488-5169

© 2011 Hewlett-Packard Development Company, LP.

ECMAP™ is a trademark of Sybase, Inc. Sybase and the Sybase logo are trademarks of Sybase, Inc. All other trademarks are property of their respective owners. ® indicates registration in the United States. Specifications are

subject to change without notice. All rights reserved.

Companion Guide – 999 Acknowledgement and Submission Summary Report

Library Number: CLEL10050 iii Revision Date: November 2011 Version: 1.0

Revision History Document

Version Number

CO Revision Date

Revision Page

Number(s)

Reason for Revisions

Revisions Completed By

Version 1.0 November 2011

All New document. HIPAA 5010 version

Systems/ Publications


Library Number: CLEL10050 iv Revision Date: November 2011 Version: 1.0

Table of Contents Section 1: Introduction .................................................................................. 1-1

Overview ..................................................................................................... 1-1 999 Functional Acknowledgement .............................................................. 1-1 Submission Summary Report ...................................................................... 1-1

Section 2: Acknowledgements ...................................................................... 2-1 999 Functional Acknowledgement – Outbound .......................................... 2-1

Section 3: EDI Submission Summary Report ............................................. 3-1 Purpose of Report ........................................................................................ 3-1 Format of Report ......................................................................................... 3-1 Detailed Field Descriptions ......................................................................... 3-2 Submission Summary Report Layout .......................................................... 3-4 Error Codes ................................................................................................. 3-5

Index ............................................................................................................... I-8


Library Number: CLEL10050 1-1 Revision Date: November 2011 Version: 1.0

Section 1: Introduction

Overview

The 5010 Companion Guide - Electronic Data Interchange 999 Acknowledgement and Submission Summary Report contains information specific to the 999 Functional Acknowledgement, and the EDI Submission Summary Report (SSR). These reports must be downloaded and reviewed to verify acceptance or rejection of electronic data interchange (EDI) data.

999 Functional Acknowledgement

The 999 Functional Acknowledgement is an X12 transaction that acknowledges the receipt of the batch transaction and reports the acceptance or rejection of a functional group, transaction set, or segment. The IHCP returns the 999 within two hours of the batch submission.

Submission Summary Report

The Submission Summary Report (SSR) is created to report the results of pre-adjudication edit checking to verify two levels of compliance, Health Insurance Portability and Accountability Act (HIPAA) compliance and Indiana Health Coverage Programs (IHCP)-specific compliance of 837D, 837I, and 837P transactions. SSRs are produced for each file received from a trading partner that contains an 837 transaction. The IHCP returns the SSR within two hours of the batch submission.



Section 2: Acknowledgements

999 Functional Acknowledgement – Outbound

The Indiana Health Coverage Programs (IHCP) generates an outbound 999 to acknowledge all inbound transactions received in batch mode. Interactive transactions do not report the acceptance of an interactive inbound transaction and generate an outbound 999 only when the interactive inbound transaction rejects for compliance errors.

The following tables define the data elements of the 999 Functional Acknowledgement.

Table 2.1 – Transaction Set Header

Segment Name Transaction Set Header Segment ID ST Loop N/A Usage Required Segment Notes Example ST*999*54321*005010X231~

Table 2.2 – Element ID (ST01-ST02)

Element ID Usage Guide Description/Valid Values Comments ST01 R Transaction Set Identifier Code

999 – Implementation Acknowledgement

ST02 R Transaction Set Control Number This number is assigned locally and matches the value in the corresponding SE segment.

ST03 R Implementation Convention Reference This field contains the same value as data element GS08.

Section 2: Acknowledgements Companion Guide – 999 Acknowledgement and Submission Summary Report

2-2 Library Number: CLEL10050 Revision Date: November 2011 Version: 1.0

Table 2.3 – Functional Group Response Header

Segment Name Functional Group Response Header Segment ID AK1 Loop N/A Usage Required Segment Notes This segment responds to the functional group information in the interchange envelope. Example AK1*HC*8215*005010X222A1~

Table 2.4 – Element ID (AK101-AK102)

Element ID Usage Guide Description/Valid Values Comments AK101 R Functional Identifier Code

HC – Health Care Claim (837) HS – Eligibility, Coverage or Benefit Inquiry (270) HR – Health Care Claim Status Request (276) HI – Health Care Services Review Information (278)

This is only a list of identifier codes used for 999s generated by the IHCP in response to inbound transactions.

AK102 R Group Control Number This data element contains the value from the GS06 data element from the GS segment of the original file being acknowledged.

AK103 R Version/Release/Industry Identifier Code This is the value in GS08 from the functional group to which this 999 transaction set is responding.

Table 2.5 – Transaction Set Response Header

Segment Name Transaction Set Response Header Segment ID AK2 Loop AK2 Usage Situational Segment Notes This segment starts the acknowledgment of a transaction set. If there are no errors at the

transaction set level, this segment is not returned. Example AK2*837*252525*005010X222A1*~

Companion Guide – 999 Acknowledgement and Section 2: Acknowledgements Submission Summary Report

Library Reference Number: CLEL10050 2-3 Revision Date: November 2011 Version: 1.0


Element ID Usage Guide Description/Valid Values Comments AK201 R Transaction Set Identifier Code

837 – Health Care Claim 270 – Eligibility, Coverage or Benefit Inquiry) 276 – Health Care Claim Status Request 278 – Health Care Services Review Information

This is only a list of identifier codes used for 999s generated by the IHCP in response to inbound transactions.

AK202 R Transaction Set Control Number

This data element contains the value from the ST02 data element from the ST segment of the original file being acknowledged.

AK203 S Implementation Convention Reference This is the value in ST03 from the transaction set to which this 999 transaction set is responding.

Table 2.7 – Error Identification

Segment Name Error Identification Segment ID IK3 Loop AK2/IK3 Usage Situational Segment Notes This segment reports segment and looping errors in the submitted transaction. Example IK3*NM1*16*2010BA*8~


Element ID Usage Guide Description/Valid Values Comments IK301 R Segment ID Code This data element lists the two or

three byte segment ID that contains the error, such as ST, SBR.

IK302 R Segment Position in Transaction Set This data element contains the sequential position of the segment ID identified in IK301. This count begins with 1 for the ST segment and increments by 1 from that point.

IK303 S Loop Identifier Code This data element identifies the loop where the erroneous segment resides.



Element ID Usage Guide Description/Valid Values Comments IK304 R Segment Syntax Error Code

1 Unrecognized segment ID 2 Unexpected segment 3 Required segment missing 4 Loop occurs over maximum times 5 Segment exceeds maximum use 6 Segment not in defined transaction set 7 Segment not in proper sequence 8 Segment has data element errors I4 Implementation “Not Used” segment present I6 Implementation dependent segment missing I7 Implementation loop occurs under minimum times I8 Implementation segment below minimum use I9 Implementation dependent “Not Used” segment present

This data element describes the type of error encountered.

Table 2.9 – Segment Context

Segment Name Segment Context Segment ID CTX Loop 2100 - AK2/IK3 Usage Situational Segment Notes This segment is used to identify the data that triggered the situational requirement. Example CTX*SITUATIONAL TRIGGER*SV2*45**1*234~

Table 2.10 – Element ID (CTX01-CTX06)

Element ID Usage Guide Description/Valid Values Comments CTX01 R Context Identification CTX01-1 R Context Name Always contains the value

“SITUATIONAL TRIGGER” CTX01-2 N/A Context Reference Not Used CTX02 S Segment ID Code Code defining the segment ID of

the data segment in error. CTX03 R Segment Position in Transaction Set The numerical count position of

this data segment from the start of the transaction set.



Element ID Usage Guide Description/Valid Values Comments CTX04 S Loop Identifier Code The loop ID number for this data

element in segments LS and LE CTX05 S Position in Segment Code indicating the relative

position of the data element or composite data structure in error

CTX05-1 R Element Position in Segment CTX05-2 S Component Data Element Position in

Composite To identify the component data element position within the composite in error

CTX05-3 S Repeating Data Element Position To identify the specific repetition of a data element in error

CTX06 S Reference in Segment To hold the reference number of a data element and optionally a component data element within a composite

CTX06-1 R Data Element Reference Number This element holds the reference number of the simple or composite element at segment level.

CTX06-2 S Data Element Reference Number This element holds the reference number of the simple element within acomposite.

Table 2.11 – Business Unit Identifier

Segment Name Business Unit Identifier Segment ID CTX Loop 2100 - AK2/IK3 Usage Situational Segment Notes This segment is used to identify the data that triggered the situational requirement. Example CTX*CLM01:123456789~


Element ID Usage Guide Description/Valid Values Comments CTX01 R Context Identification CTX01-1 R Context Name Refer to the IG for valid values CTX01-2 N/A Context Reference CTX02 N/A Segment ID Code Not Used CTX03 N/A Segment Position in Transaction Set Not Used

CTX04 N/A Loop Identifier Code Not Used CTX05 N/A Position in Segment Not Used CTX06 N/A Reference in Segment Not Used



Table 2.13 – Implementation Data Element Note

Segment Name Implementation Data Element Note Segment ID IK4 Loop AK2/IK3/IK4 Usage Situational Segment Notes This segment reports data element and composite errors in the submitted transaction. Example IK4*9**67*1~


Element ID Usage Guide Description/Valid Values Comments IK401 R Position in Segment This is a composite data

element. IK401-1 R Element Position in Segment This data element contains the

sequential position of the simple data element or composite data structure. This count begins with 1 for the initial element and increments by 1 from that point.

IK401-2 S Component Data Element Position in Composite

This data element identifies within the composite structure where the error occurs.

IK401-3 S Repeating Data Element Position This data element identifies the specific repetition of a data element that is in error

IK402 S Data Element Reference Number Reference number used to locate the data element in the Data Element Dictionary



Element ID Usage Guide Description/Valid Values Comments IK403 R Implementation Data Element Syntax Error

Code 1 Required data element missing 2 Conditional required data element missing 3 Too many data elements 4 Data element too short 5 Data element too long 6 Invalid character in data element 7 Invalid code value 8 Invalid date 9 Invalid time 10 Exclusion condition violated 12 Too many repetitions 13 Too many components I6 Code value not used in Implementation I9 Implementation dependent data element missing I10 Implementation “Not Used” data element present I11 Implementation too few repetitions I12 Implementation pattern match failure I13 Implementation dependent “Not Used” data element present

This data element describes the type of error encountered.

IK404 S Copy of Bad Data Element This is a copy of the data element in error

Table 2.15 – Element Context

Segment Name Element Context Segment ID CTX Loop 2100 - AK2/IK3/IK4 Usage Situational Segment Notes This segment is used to identify the data that triggered the situational requirement. Example CTX*SITUATIONAL TRIGGER*CLM*43**5:3*C023:1325~


Element ID Usage Guide Description/Valid Values Comments CTX01 R Context Identification CTX01-1 R Context Name Always contains the value

“SITUATIONAL TRIGGER”



Element ID Usage Guide Description/Valid Values Comments CTX01-2 N/A Context Reference Not Used CTX02 R Segment ID Code Code defining the segment ID of

the data segment in error. CTX03 R Segment Position in Transaction Set The numerical count position of

this data segment from the start of the transaction set.

CTX04 S Loop Identifier Code The loop ID number for this data element in segments LS and LE

CTX05 S Position in Segment Code indicating the relative position of the data element or composite data structure in error

CTX05-1 R Element Position in Segment CTX05-2 S Component Data Element Position in

Composite

CTX05-3 S Repeating Data Element Position To identify the specific repetition of a data element in error

CTX06 S Reference in Segment CTX06-1 R Data Element Reference Number CTX06-2 S Data Element Reference Number

Table 2.17 – Transaction Set Response Trailer

Segment Name Transaction Set Response Trailer Segment ID IK5 Loop 2000 - AK2 Usage Required Segment Notes This segment acknowledges the acceptance or rejection of a transaction and report errors. Example IK5*R*5~


Element ID Usage Guide Description/Valid Values Comments IK501 R Transaction Set Acknowledgment Code

A – Accepted E – Accepted, but errors were noted R – Rejected



Element ID Usage Guide Description/Valid Values Comments IK502 S Transaction Set Syntax Error Code

1 Transaction set not supported 2 Transaction set trailer missing 3 Transaction set control number in header and trailer do not match 4 Number of included segments does not match actual count 5 One or more segments in error 6 Missing or invalid transaction set identifier 7 Missing or invalid transaction set control number 18 Transaction set not in functional group 19 Invalid transaction set implementation convention reference I6 Implementation convention not supported

Code indicating implementation error found based on the syntax editing of a transaction set

IK503 S Transaction Set Syntax Error Code








Table 2.19 – Functional Group Response Trailer

Segment Name Functional Group Response Trailer Segment ID AK9 Loop N/A Usage Required Segment Notes This segment acknowledges the acceptance or rejection of a functional group and report the

number of transaction sets originally included, received, and accepted. Example AK9*R*1*1*0~




Element ID Usage Guide Description/Valid Values Comments AK901 R Functional Group Acknowledgment Code

A – Accepted E – Accepted, but errors were noted P – Partially Accepted, at least one transaction set was rejected R – Rejected

AK902 R Number of Transaction Sets Included This data element contains the value from the GE01 data element from the GE segment of the original file being acknowledged.

AK903 R Number of Received Transaction Sets AK904 R Number of Accepted Transaction Sets AK905 S Functional Group Syntax Error Code

1 Functional group not supported 2 Functional group version not supported 3 Functional group trailer missing 4 Group control number in the functional group header and trailer do not agree 5 Number of included transaction sets does not match actual count 6 Group control number violates syntax 19 Functional group control number not unique with interchange

Code indicating error found based on the syntax editing of the functional group header and/or trailer

AK906 S Functional Group Syntax Error Code










Table 2.21 – Transaction Set Trailer

Segment Name Transaction Set Trailer Segment ID SE Loop N/A Usage Required Segment Notes Example SE*123*54321~

Table 2.22 – Element ID (SE01-SE02)

Element ID Usage Guide Description/Valid Values Comments SE01 R Number of Included Segments This is the total number of

segments included in this acknowledgment. This value includes the ST and SE segments.

SE02 R Transaction Set Control Number This number is assigned locally and matches the value in the preceding ST segment.



Section 3: EDI Submission Summary Report

Purpose of Report

The Submission Summary Report (SSR) is created to report the results of pre-adjudication edit checking to verify two levels of compliance, Health Insurance Portability and Accountability Act (HIPAA) compliance and Indiana Health Coverage Programs (IHCP)-specific compliance of 837D, 837I, and 837P transactions.

The SSR is produced for each file received from a trading partner that contains an 837 transaction. The IHCP returns the SSR within two hours of the batch submission.

Trading partners should download and view the SSR, as claims that are rejected are not processed and will not appear on the provider’s remittance advice. Trading partners can correct errors immediately, and resubmit the claim or claims.

Format of Report

The SSR contains the following sections:

Sender Summary • Total Claims Received • Total Claims Rejected • Total Claims Accepted • Total Billed Amount • Total Accepted Billed Amount

Error Severity Summary • Rejecting Errors – total number of occurrences within the file • Non-Rejecting Warnings – total number of occurrences within the file • Total Errors - total number of rejecting and non-rejecting errors • Error Threshold – maximum number of errors displayed within the file • Errors Displayed - total number of errors displayed within the file

Claim Information – only displays if the claim receives a rejecting or non-rejecting warning error • Billing Provider information • Patient Account Number, Other Payer ICN, Billed Amount, Member ID and Name

Error Information • Error ID, SNIP Level, Severity and Error Message • Error Severity of Normal = Rejection • Error Severity of Warning = Accepted, but should be noticed and attempts made to fix the error on

future submissions

Rejected claims are due to Health Information Portability and Accountability Act (HIPAA) compliance errors and Indiana Health Coverage Programs (IHCP)-specific pre-adjudication editing.

Rejected claims contain errors that prevent them from continuing through the claim processing cycle. For claims with multiple details, the entire claim is rejected, even though only one service line is in error. The fact that a claim is accepted does not guarantee payment of the claim. It only means that it contained the basic information needed for processing.

Section 3: EDI Submission Summary Report Companion Guide – 999 Acknowledgement and Submission Summary Report


Claims receiving a non-rejecting warning edit are accepted, but should be noticed and attempts made to fix the error on future submissions.

Detailed Field Descriptions

Table 3.1 EDI Submission Summary Report, Field Descriptions

Field Description Report Name IHCP EDI Submission Summary Report Executed Date Time HH:MM and MM/DD/YY from the translated file Trading Partner Name Name of submitting trading partner Sender ID Interchange trading partner ID from the ISA envelope Version X12 version number from the ISA envelope Transaction Type Type of claim submitted electronically ISA Control Number Interchange control number from the ISA envelope GS Control Number Group control number from the ISA envelope Total Claims Received Number of claims received Total Claims Rejected Number of claims rejected for errors that prevent further processing.

Claims receiving error Severity of Normal Total Claims Accepted Number of claims accepted for further processing Total Billed Amount Sum of all claim billed amounts in the batch file Total Accepted Billed Amount Sum of all claim billed amounts accepted for further processing Rejecting Errors Number of occurrences of rejecting errors in the batch file Non-Rejecting Warnings Number of occurrences of non-rejecting warning errors in the batch file Total Errors Total number of occurrences of rejecting and non-rejecting warning

errors in the batch file Error Threshold Maximum number of errors displayed in the report. Any errors over the

threshold will not be displayed. Errors Displayed Number of errors displayed in the report THE FIELDS BELOW WILL ONLY BE DISPLAYED IF A CLAIM RECEIVES AN ERROR

Transaction Control Number Submitted Transaction Control Number Billing Provider Primary ID Submitted Billing Provider Primary ID Taxonomy Submitted Billing Provider Taxonomy Patient Account No. Submitted Patient Account number Other Payer ICN Submitted Other Payer ICN Billed Amount Submitted claim billed amount RID Submitted Member Identification number Member Submitted Subscriber last and first name Error ID Rejecting or non-rejecting warning error ID SNIP Level SNIP level of rejecting or non-rejecting warning error

Companion Guide – 999 Acknowledgement and Section 3: EDI Submission Summary Report Submission Summary Report


Field Description Severity Error severity – Normal = Rejecting error

Warning = Non-rejecting warning error Error Message Technical error message Business Message Business error message



Submission Summary Report Layout



Error Codes

The following table lists the possible error codes and descriptions received on the SSR.

Table 3.1- Submission Summary Report, Error Codes and Descriptions

Error Code Error Description X01 Encounter claim submitted by a non-MCO entity. 240 ESP member not eligible for High Risk insurer for dates of service.

Rid=999999999999 From DOS: mm/dd/yyyy To Dos: mm/dd/yyyy 241 Duplicate original HIP ESP claim 9999999999999 242 HIP ESP void/replacement claim with different mom/daughter ICN.

Mom ICN= 9999999999999 daughter ICN=9999999999999 243 HIP ESP void claim submitted, original not found. ICN: 9999999999999 243 Mom claim not found for ESP void. ICN: 9999999999999 244 HIP ESP void/replacement submitted, original claim was previously voided.

ICN 9999999999999 244 ESP void/replacement of claim already voided. ICN 9999999999999 245 HIP ESP replacement claim submitted, original claim was not found.

ICN 9999999999999 245 Mom claim not found for ESP replacement. ICN 9999999999999 246 HIP ESP replacement with all duplicate detail numbers. ICN: 9999999999999 250 HIP claim submitted for member not enrolled in Medicaid. RID: 999999999999 251 HIP member not eligible for dates of service.

Rid=999999999999 From DOS: mm/dd/yyyy To Dos: mm/dd/yyyy 258 Crosswalk did not give 1 to 1 match for NPI 9999999999. Number of rows returned

was 999. 259 Crosswalk did not give 1 to 1 match for NPI 9999999999. Number of rows returned

was 0 260 Billing NPI must be submitted for health care claims. 262 First Steps claim submitted past end of First Steps program. 265 MCE Denied claim submitted as a replacement. 271 Void and Replacement claims for COBA are not accepted. 272 Invalid Type of Bill. Value: XXX 274 Invalid MCE Payer ID in NM109 on 2330B: XXXXX 274 MCE submitted claim without a valid Payer ID. 275 Only claims with this following Status can be voided: Paid, Suspended, Resubmit, CCF,

Queue. 276 This Claim Type cannot be Voided (P, Q). 278 Claims with this Status cannot be replaced (J). 279 This Claim Type cannot be replaced (P, Q).



Error Code Error Description 280 Crossover A claims must contain crossover amounts (Medicare paid, deductible,

coinsurance and blood deductible amounts) at the header level. Header value is: 999.99 Dtl value is: 999.99 type: X TOB: XXX

281 Provider Attachment Control Numbers are NOT unique for SAK provider. CAN=999999

283 MCO void/replacement request past filing limit. 284 Provider ID on original claim could not be determined. 284 Provider ID on submitted claim (999999999) does not match provider ID on original

claim. 284 Service Location on submitted claim (X) does not match service location on original

claim. 284 Member ID on submitted claim (999999999999) does not match the Member ID on the

original claim. 284 MCE ID on submitted claim (999999999) does not match MCE ID on original claim. 284 MCE Region on submitted claim (X) does not match MCE Region on original claim. 285 Replacement request past filing limit. Please resubmit as a manual request. 286 Provider ID on original claim could not be determined. 286 Provider ID on submitted claim (999999999) does not match provider ID on original

claim. 286 Service Location on submitted claim (X) does not match service location on original

claim. 286 Member ID on submitted claim (999999999999) does not match the Member ID on the

original claim. 287 Voids may only be submitted for non-denied original claims. 288 Mismatch in claim type submitted vs claim type for the given ICN.

V/R ClmType: X OrigClmType: X 289 A void/replacement was already submitted for this claim. Please submit a

void/replacement for the most current claim. 290 Provider submitted a replacement or void for a claim that was not found. Please identify

claim to be voided or replaced and initiate another void or replacement if necessary. 290 Provider submitted a void and did not supply an ICN to identify the original claim.

Please identify the claim to be voided and initiate another void if necessary. 290 Provider submitted a void for a claim that was not found. Please identify the claim to

be voided and initiate another void if necessary. Value: 999999999 290 Provider submitted a replacement and did not supply an ICN to identify the original

claim. Please identify the claim to be replaced and initiate another replacement if necessary.

290 Provider submitted a replacement for a claim that was not found. Please identify the claim to be replaced and initiate another replacement if necessary. Value: 999999999

291 A replacement was submitted for a claim that was previously voided. Please submit as an original claim.

292 MCE has denied this encounter. 293 CAS – Invalid Adjustment Reason Code: xxx



Error Code Error Description 295 Invalid data submitted for crossover/COB claim. 296 The patient must be the same as the subscriber.

Patient ID: 999999999999 Subscriber ID: 999999999999 300 Series Scale is invalid for submitted value 99999.99. Field: “value of fieldname goes here”.

Valid scale for this field is 9 300 Series Field Value -99999 is negative. Field: “value of fieldname goes here”

400 Series Field Value 99x.xx is not numeric. Field: “value of fieldname goes here” 297 Diagnosis codes must be consecutive 1 - 8 contain no blanks. 298 Found Attachment Control Numbers are not unique. Duplicate on Detail: 99 ACN:

999999 298 Found Attachment Control Numbers are not unique. ACN: 999999 299 Claim contained more than the Maximum Detail records allowed for this claim type 804 INFORMATIONAL EDIT ONLY: Default provider table used for crosswalk:

NPI 9999999999 crosswalked to LPI 999999999 A 900 Missing billing provider number 902 Invalid billing provider number: ProviderID_ 903 Invalid provider service location: Provider ID/Service Location 903 Missing provider service location 911 Missing MCE/region Code for shadow claim 911 Missing region Code for shadow claim 999 Contact the EDI Solutions Helpdesk at 317-488-5061 or 1-877-877-5182


Library Number: CLEL10021 I-8 Revision Date: December 2009 Version: 5.0

Index

9 997 Functional Acknowledgement ...................... 1-1

Outbound ........................................................ 2-1

A Acknowledgements ............................................. 2-1

B Biller Summary Report ................................ 1-1, 3-1

Error codes ..................................................... 3-6 Error descriptions ........................................... 3-6 Field descriptions ............................................ 3-2 Field descriptions ............................................ 3-2 Format ............................................................ 3-1 General error codes ......................................... 3-6 Purpose ........................................................... 3-1

BSR, See Biller Summary Report ........................ 1-1

D Data segment

Note ................................... 2-3, 2-4, 2-5, 2-6, 2-7

E ECMAP™

HIPAA toolkit ................................................ 2-1 ECMAP™ ........................................................... 2-1 Error codes

General ........................................................... 3-6

F Field descriptions ................................................ 3-2 Functional group response

Header ............................................................. 2-2 Trailer ............................................................. 2-9

I Index .................................................................... I-9 Introduction

Overview......................................................... 1-1

R Revision History .................................................... iii

S Sybase, Inc. ......................................................... 2-1

ECMAP™ ....................................................... 2-1 HIPAA toolkit ................................................. 2-1

T Table of Contents .................................................. iv Transaction set

Header ............................................................. 2-1 Trailer ........................................................... 2-11

Transaction set response Header ............................................................. 2-2 Trailer ............................................................. 2-8

Documents

Companion Guide: Electronic Data Interchangeprovider.indianamedicaid.com/media/62096/5010cg edi... · Library Reference Number: CLEL10050 Document Management System Reference: Companion