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1 Copyright 2017, UCare, All Rights Reserved. UCare® is a registered service mark of UCare Minnesota and UCare Health, Inc.
HIPAA Transaction Standard Companion Guide 835 (ERA) Electronic Remittance Advice
Health Care Claim Payment/Advice
VERSION: 1 DATE: 01/01/2019
UCare Minnesota v5010 ASC X12N (ASC X12N 005010X221A1) 835 Companion Guide
2 Copyright 2017, UCare, All Rights Reserved. UCare® is a registered service mark of UCare Minnesota and UCare Health, Inc.
Disclosure Statement This document is intended to be a companion guide for use in conjunction with the ASCX12N National Electronic Data Interchange Transaction Set Implementation and Addenda Guides. This document contains clarifications as permitted by the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Standard for Electronic Transactions. This document is not intended to convey information that exceeds the requirements or usages of data expressed in the ASCX12N National Electronic Data Interchange Transaction Set Implementation and Addenda Guides defined by HIPAA. UCare is committed to maintaining the integrity and security of health care data in accordance with applicable laws and regulations. This material contains confidential, propriety information. Unauthorized use or disclosure of the information is strictly prohibited. The information in the document is furnished for UCare and Trading Partner use only. Changes are periodically made to the information in this document, these changes in the product and/or program described in the publication at any time. Disclosure of beneficiary data is restricted under the provisions of the Privacy Act of 1974 and the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The Provider Beneficiary transaction is to be used for conducting UCare business only. Please note: Payment of benefits remains subject to all health benefit plan terms, limits, conditions, exclusions and the member’s eligibility at the time services are rendered.
UCare Minnesota v5010 ASC X12N (ASC X12N 005010X221A1) 835 Companion Guide
3 Copyright 2017, UCare, All Rights Reserved. UCare® is a registered service mark of UCare Minnesota and UCare Health, Inc.
Table of Contents
Disclosure Statement 2
Table of Contents 3
Introduction
Scope 4
References 4
Additional References 4
Getting Started
Working with UCare 5
835 Electronic Remittances Advice Specifications
Information about the Health Care Claim Payment Advice (835) Transaction 6
Data Content and Specifications 7-11
General Notes 12
Contact Information 12
Trading Partner Agreements 12
Appendices 13
UCare Minnesota v5010 ASC X12N (ASC X12N 005010X221A1) 835 Companion Guide
4 Copyright 2017, UCare, All Rights Reserved. UCare® is a registered service mark of UCare Minnesota and UCare Health, Inc.
Introduction This Companion Guide to the v5010 ASC X12N Implementation Guides and associated errata adopted under HIPAA clarifies
and specifies the data content when exchanging electronically with UCare. Transmissions based on this companion guide,
used in conjunction with the v5010 ASC X12N Implementation Guides and the Minnesota Uniform Companion Guides, are
compliant with both ASC X12 syntax and those guides. This Companion Guide is intended to convey information that is
within the framework of the ASC X12N Implementation Guides and Minnesota Uniform Companion Guides adopted for use
under HIPAA. The Companion Guide is not intended to convey information that in any way exceeds the requirements or
usages of data expressed in the Implementation Guides.
Scope This Companion Guide is intended to describe to UCare trading partners the content for the ASC/X12N 835 5010 transaction with UCare. This Companion guide is designed to assist those who receive Electronic Remittance Advice (ERA) and/or payments in the 835 format from UCare. This guide is intended to supplement information from the ASC X12 Technical Reports Type 3 (TR3s).
References ASC X12 publishes implementation guides, known as Technical Reports Type 3 (TR3s), which define the data contents and
compliance requirements for the health care implementation of the ASC X12N/005010 transaction sets. Following are the
Interchange Technical Report Type 3 (TR3s) referenced in this guide:
ASC X12N/005010X221A1 Health Care Payment/Advice (835) and
Associated errata, hereinafter 005010X221A1 TR3s.
You are expected to comply with the requirements set forth in the TR3s. You can purchase these guides from the ASC X12
store at http://store.x12.org/ or from Washington Publishing Company (http://www.wpc-edi.com).
Entities subject to Minnesota Statutes, section 62J.536 and related rules must follow the data content and other transaction-
specific information of the Minnesota Uniform Companion Guide for the Implementation of the ASC X12/005010X221A1
Health Care Payment/Advice (835). A copy of the Minnesota Uniform Companion Guide is available at no charge from the
Minnesota Department of Health at: http://www.health.state.mn.us/asa/rules.html
Additional Information This transaction supports Electronic Remittance Advice (ERA) and/or payments in the 835 format for UCare. This Companion
Guide assumes that you, the reader, are a representative of the Trading Partner or Provider, and that as such, you
understand basic X12 structure, looping, and standard data requirements as set forth in the TR3 for each transaction set you
wish to exchange.
This Companion Guide also assumes that:
You have an EDI interface that supports the transaction sets the Trading Partner wishes to exchange.
You have resources to develop a connection between your interface and choice of trading partner.
UCare Minnesota v5010 ASC X12N (ASC X12N 005010X221A1) 835 Companion Guide
5 Copyright 2017, UCare, All Rights Reserved. UCare® is a registered service mark of UCare Minnesota and UCare Health, Inc.
Getting Started
Trading Partner Registration Before receiving an 835 transaction NOTE: You must register with a clearinghouse to receive 835s before UCare can send 835s to your clearinghouse and before you complete and submit the form below.
UCare’s payer ID: 52629 and 55413 Below is the EFT and ERA Authorization Agreement form link: https://www.ucare.org/providers/Claims-Billing/Pages/EFTERAElectionForm.aspx Please allow a minimum of 30 days for processing. You will be notified in advance of the date when the electronic RAs and/or EFT process will begin.
CONTACT INFO:
For additional application questions:
Phone: 1-612-884-2030
Email: [email protected]
Days/Times: Monday - Friday, 8:00 a.m. – 5:00 p.m. CST
Clearing House Registration UCare Agreement
UCare Minnesota v5010 ASC X12N (ASC X12N 005010X221A1) 835 Companion Guide
6 Copyright 2017, UCare, All Rights Reserved. UCare® is a registered service mark of UCare Minnesota and UCare Health, Inc.
Information about the Health Care Claim Payment Advice (835) Transaction
Adjustment As defined in the 005010X221A1 TR3, “the term adjustment refers to changes to the amount paid on a claim, service or remittance advice versus the original submitted charge/bill. Adjustment does not refer to changing or correcting a previous adjudication of a claim.” CARC and RARC Updates/Changes National organizations are responsible for maintenance of CARC and RARC and periodically add, delete, or make other changes to these codes. This Guide and Appendix incorporate by reference any changes adopted by national organizations with responsibilities for these codes. CARC are updated (additions, deletions, changes) three times/year by the Joint Claim Adjustment Reason/Health Care Claim Status Reason Code Maintenance Committee. These updates are published by Washington Publishing Company at www.wpc-edi.com. RARC are maintained by the federal Centers for Medicare & Medicaid Services (CMS). Updates to the Remark Codes (additions, changes, deletions) are published by Washington Publishing Company at www.wpc-edi.com. Relationship and Importance of Accurate Balanced 835 Transaction for 837 Coordination of Benefits COB It is necessary that the 835 transactions balance, contain accurate information, and utilize active CARC, RARC or NCPDP reject codes. After the receipt and posting of the 835 payment and/or adjustment data, this data must be used in 837 Coordination of Benefits (COB) situations. When submitting COB claims to secondary/tertiary payers, the provider needs to populate the appropriate 837 segments with the prior payer’s payment and/or adjustment data. If this data is inaccurate, or does not balance, then the subsequent 835 payment and remittance advice from the secondary/tertiary payer may be delayed, or inaccurate.
UCare Minnesota v5010 ASC X12N (ASC X12N 005010X221A1) 835 Companion Guide
7 Copyright 2017, UCare, All Rights Reserved. UCare® is a registered service mark of UCare Minnesota and UCare Health, Inc.
Loop Segm
en
t/
Elem
ent
Description
Elem
ent
Len
gth
Mapping Comments
Interchange Control Header Required
ISA Interchange Control Header To start and identify an interchange of zero or more functional groups and interchange-related control segments
ISA01 Authorization Information Qualifier 2/2 Code identifying the type of information in the Authorization Information
ISA02 Authorization Information 10/10 Information used for additional identification/authorization of the interchange sender or the data in the interchange.
ISA03 Security Information Qualifier 2/2 Code identifying the type of information in the Security Information
ISA04 Security Information 10/10 Security Information about the interchange sender or the data in the interchange.
ISA05 Interchange Sender ID Qualifier 2/2 Code indicating the system/method of code structure used to designate the sender or reliever ID element being qualified
ISA06 Interchange Sender ID 15/15
Identification code published by the sender for other parties to use as the receiver ID to route data to them; the sender always codes this value in the sender ID element
ISA07 Interchange Receiver ID Qualifier 2/2 Code indicating the system/method of code structure used to designate the sender or reliever ID element being qualified
ISA08 Interchange Receiver ID 15/15 Identification code published by the receiver of the data; When sending, it is used by the sender as their sending ID, thus other parties sending to them will use this as a receiving ID to route data to them
ISA09 Interchange Date 6/6 Date Expressed in YYMMDD format
ISA10 Interchange Time 4/4 Time in HHMM format
ISA11 Repetition Separator 1/1 The repetition separator is a delimiter and not a data element: the field provides the delimiter used to separate repeated occurrences of a simple data element or a composite data structure
ISA12 Interchange Control Version Number 5/5 “00501” Standards Approved for Publication by ASC X12 Procedures Review board
ISA13 Interchange Control Number 9/9 A control number assigned by the interchange sender The Interchange Control Number, ISA13, must be identical to the associated Interchange Trailer IEA02.
ISA14 Acknowledgement Request 1/1 Code indicating sender’s request for an interchange acknowledgement.
ISA15 Usage Indicator 1/1 Code indicating whether data enclosed by this interchange envelope is a test, production or information.
ISA16 Component Element Separator 1/1 Type is not applicable; the component element separator is a delimiter and not a data element; this field provides the delimiter used to separate component data elements within a composite data structure; this value must be different than the data element separator and the segment terminator
Functional Group Header Required
GS Functional Group Header To indicate the beginning of a functional group and to provide control information
GS01 Functional Identifier Code 2/2 “HP” Health Care Claim Payment/Advice code (835)
GS02 Application Sender’s Code 2/15 Code identifying party sending transmission; codes agreed to by trading partners
GS03 Application Receiver’s ID 2/15 Code identifying party receiving transmission; codes agreed to by trading partners
GS04 Date 8/8 Date Expressed in CCYYMMDD format
UCare Minnesota v5010 ASC X12N (ASC X12N 005010X221A1) 835 Companion Guide
8 Copyright 2017, UCare, All Rights Reserved. UCare® is a registered service mark of UCare Minnesota and UCare Health, Inc.
GS05 Time 4/8 Time Expressed in HHMMSS format
GS06 Group Control Number 1/9 Assigned number originated and maintained by the sender. The data interchange control number GS06 in this header must be identical to the same data element in the associated functional group trailer, GE02
GS07 Responsible Agency Code 1/2 Code identifying the issuer of the standard
GS08 Version/Release/Industry Identifier 1/12 “005010X221A1” Standards Approved for Publication by ASC X12 Procedures Review Board
Transaction Set Header Required
ST Transaction Set Header To indicate the start of a transaction set and to assign a control number
ST01 Transaction Set Identifier Code 3/3 “835” Health Care Claim Payment/Advice
ST02 Transaction Set Control Number 4/9 Identifying control number that must be unique within the transaction set functional group assigned by the originator for a transaction set. Transaction Set Control Number- Must equal SE02
BPR Financial Information Required
BPR01 Transaction Handling Code 1/2 Code designating the action to be taken by all parties. Example: “I” Remittance Information Only (The remittance detail is moving separately from the payment)
BPR02 Monetary Amount 1/18 Total Actual Provider Payment Amount
BPR03 Credit/Debit Flag Code 1/1 Example: “C” Credit “D” Debit
BPR04 Payment Method Code 3/3 Example: “CHK” Check “ACH” Electronic EFT Payment
BPR05 Payment Format Code 1/10 Example: “CCP” Cash Concentration/Distribution plus addenda (CCCD+)-(ACH)
BPR06 (DFI) ID Number Qualifier 2/2 Code identifying the type of identification number of Depository Financial Institution (DFI) Example: “01” ABA Transit Routing Number
BPR07 (DFI) Identification Number 3/12 Sender DFI Identifier
BPR08 Account Number Qualifier 1/3 Code indicating the type of account. Example: “DA” Demand Deposit
BPR09 Account Number 1/35 Sender Bank Account Number
BPR010 Originating Company Identifier 10/10 Payer Identifier
BPR11 Originating Company Supplement Code 9/9 Originating Company Supplement Code
BPR12 (DFI) ID Number Qualifier 2/2 Code identifying the type of identification number of Depository Financial Institution (DFI) Example: “01” ABA Transit Routing Number
BPR013 (DFI) ID Number 3/12 Receiver or Provider Bank ID Number
BPR014 Account Number Qualifier 1/3 Code indicating the type of account. Example: “DA” Demand Deposit
BPR015 Account Number 1/35 Receiver or Provider Account Number
BPR016 Date 8/8 Date Expressed in CCYYMMDD format. Check or EFT Effective Date
TRN Reassociation Trace Number Required
TRN01 Trace Type Code 1/2 Code identifying which transaction is being referenced. Example: “1” Current Transaction Trace Numbers
TRN02 Reference Identification 1/50 Check or EFT Trace Number
TRN03 Originating Company Identifier 10/10 Payer Identifier
TRN04 Reference Identification 1/50 Originating Company Supplemental Code
DTM Production Date Situational
DTM01 Date Time Qualifier 3/3 Code specifying type of date/time. Example: “405” Production
DTM02 Date 8/8 Date Expressed in CCYYMMDD format.
1000A Payer Identification Required
N1 Payer Identification To identify a party by type of organization, name, and code
N101 Payer Identifier Code 2/3 Code identifying an organizational entity, a physical location, property or an individual. Example: “PR” Payer
UCare Minnesota v5010 ASC X12N (ASC X12N 005010X221A1) 835 Companion Guide
9 Copyright 2017, UCare, All Rights Reserved. UCare® is a registered service mark of UCare Minnesota and UCare Health, Inc.
N102 Payer Name 1/60 Name of organizational entity, a physical location, property or an individual Example: “UCare”
N3 Payer Address Required
N301 Payer Address Line 1/55 Payer Address Information. Example: “P.O. Box 52”
N4 Payer City, State, Zip Code Required
N401 Payer City Name 2/30 Payer City Name. Example: “Minneapolis”
N402 Payer State Code 2/2 Payer State Code. Example: “MN”
N403 Payer Postal Zone or Zip Code 3/15 Payer Postal Zone/Zip Code. Example: “55440”
PER Payer Technical Contact Information Required
PER01 Contact Function Code 2/2 Code identifying the person/group named. Example: “BL” Technical Department
PER02 Payer Technical Contact Name 1/60 Payer Technical Contact Name. Example: “Provider Assistance Center”
PER03 Communication Number Qualifier 2/2 Code identifying the type of communication. Example: “TE” Telephone
PER04 Payer Contact Communication Number 1/256 Complete communication number. Example: “8885311493”
1000B Payee Identification Required
N1 Payee Identification To identify a party by type of organization, name, and code
N101 Payee/Entity Identifier Code 2/3 Code identifying an organizational, physical location, property or an individual. Example; “PE” Payee
N102 Payee Name 1/60 Payee Name
N103 Payee Identification Code Qualifier 1/2 Code designating the system/method of code structure for Identification Code. Example: “FI” Federal Taxpayer’s Identification Number
N104 Payee Identification Code 2/80 Code identifying a party or other code
N3 Payee Address Situational
N301 Payee Address Line 1/55 Payee Address Information
N302 Payee Address Line 1/55 Payee Address Information
N4 Payee City, State, Zip Code Situational
N401 Payee City Name 2/30 Payee City Name
N402 Payee State Code 2/2 Payee State Code
N403 Payee Postal Zone or Zip Code 3/15 Payee Postal Zone/Zip Code
REF Payee Additional Identification Situational
REF01 Additional Payee Identification Qualifier 2/3 Code qualifying the Reference Identification. Example; “PQ” Payee Identification “TJ” Federal Taxpayers Identification Number
REF02 Reference Identification Code 1/50 Additional Payee Identifier
2000 Header Number Situational (Required when claim or service level information follows)
LX Header Number To reference a line number in a transaction set
LX01 Assigned Number 1/6 Number assigned for differentiation within a transaction set
2100 Claim Payment Information Required
CLP Claim Payment Information To supply information common to all services of a claim
CLP01 Claim Submitter’s Identifier 1/38 Identifier used to track a claim from creation by the health care provider through payment. Patient Control Number
CLP02 Claim Status Code 1/2 Code identifying the status of the entire claim. Examples: 1-Processed as Primary 2-Processed as Secondary 3-Processed as Tertiary 4-Denied
CLP03 Monetary Amount 1/18 The amount of submitted charges this claim
CLP04 Monetary Amount 1/18 The amount paid this claim.
CLP05 Monetary Amount 1/18 The patient responsibility amount
CLP06 Claim Filing Indicator Code 1/2 Code identifying type of claim. Example: “HM” Health Maintenance Organization
CLP07 Reference Identification 1/50 Payer Claim Control Number
CLP11 Diagnosis Related Group (DRG) Code 1/4 Code indicating a patient's diagnosis group based on a patient's illness, diseases, and medical problems
CLP12 Quantity 1/15 Diagnosis-related group (DRG) weight
CLP13 Percent as Decimal 1/10 Discharge Fraction
UCare Minnesota v5010 ASC X12N (ASC X12N 005010X221A1) 835 Companion Guide
10 Copyright 2017, UCare, All Rights Reserved. UCare® is a registered service mark of UCare Minnesota and UCare Health, Inc.
CAS Claim Adjustment Information Situational (Required when dollar amounts and/or quantities are being adjusted at a claim level.)
CAS01 Claim Adjustment Group Code 1/2 “CO” Contractual Obligation “OA” Other Adjustment “PI” Payer Initiated Reductions “PR” Patient Responsibility
CAS02 Adjustment Reason Code 1/5 Claim Adjustment Reason Code
CAS03 Monetary Amount 1/18 Service Level Adjustment Amount; negative number increases amount, positive decreases
CAS04 Quantity 1/15 Numeric value of adjustment quantity
NM1 Patient Name Required
NM101 Patient Identifier Code 2/3 Code identifying an organizational entity, physical location, property or an individual. Example: “QC” Patient
NM102 Entity Type Qualifier 1/1 Code qualifying the type of entity. Example: “1” Person
NM103 Patient Last Name 1/60 Individual last name or organizational name
NM104 Patient First Name 1/35 Individual first name
NM105 Patient Middle Name 1/25 Individual middle name or initial
NM106 Name Prefix 1/10 Name Prefix
NM107 Name Suffix 1/10 Suffix to individual name
NM108 Identification Code Qualifier 1/2 Code designating the system/method of code structure for identification code. Example: “MI” Member Identification Number
NM109 Identification Code 2/80 Code identifying a party or other code.
REF Other Claim Related Identification Situational
REF01 Reference Identification Qualifier 2/3 Code qualifying the reference identification. Example: “1W” Member Identification Number
REF02 Reference Identification 1/50 Other Claim Related Identification
REF03 Other Claim Related Identification 1/80 Description
2110 Service Payment Information Situational
SVC Service Payment Information To supply payment and control information to a provider for a particular service
SVC01-1 Service Type Code 2/2 AD-American Dental Ass. Codes
ER-Jurisdiction Specific Procedure and Supply Codes
HC-Health Care Financing Administration Common Procedural Coding System (HCPC) Codes
HP-Health Insurance Prospective Payment System (HIPPS) Skilled Nursing Facility Rate Code
IV-Home Infusion EDI Coalition (HIEC) Product/Service Code
N4-National Drug Code in 5-4-2 Format
N6-National Health Related Item Code in 4-6 Format
NU-National Uniform Billing Committee (NUBC) UB92 Codes
UI-U.P.C. Consumer Package Code (1-5-5)
WK-Advanced Billing Concepts (ABC) Codes SVC01-2 Service Code 1/48 Identifying number for a product or service. Example:
Procedure Code
SVC01-3 Procedure Modifier 2/2 This identifies special circumstances related to the performance of the service, as defined by trading partners. Required when a procedure code modifier applies to this service, if not do not send.
SVC01-4 Procedure Modifier 2/2 This identifies special circumstances related to the performance of the service, as defined by trading partners. Required when a procedure code modifier applies to this service, if not do not send.
SVC01-5 Procedure Modifier 2/2 This identifies special circumstances related to the performance of the service, as defined by trading partners. Required when a procedure code modifier applies to this service, if not do not send.
SVC01-6 Procedure Modifier 2/2 This identifies special circumstances related to the performance of the service, as defined by trading partners. Required when a procedure code modifier applies to this service, if not do not send.
SVC01-7 Description 1/80 Procedure Code Description
SVC02 Monetary Amount 1/18 Line Item Charge Amount
UCare Minnesota v5010 ASC X12N (ASC X12N 005010X221A1) 835 Companion Guide
11 Copyright 2017, UCare, All Rights Reserved. UCare® is a registered service mark of UCare Minnesota and UCare Health, Inc.
SVC03 Monetary Amount 1/18 Line Item Provider Payment Amount
SVC04 Product/Service ID 1/48 National Uniform Billing Committee Revenue Code
SVC05 Quantity 1/15 Units of Service Paid Count
DTM Service Date Situational (if claim date is absent or different from service line date
DTM01 Date/Time Qualifier 3/3 “150” Service Period Start “151” Service Period End “472” Service
DTM02 Date 8/8 Date Expressed as CCYYMMDD Format
CAS Service Adjustment Situational (to account for difference in amount paid for this service)
CAS01 Claim Adjustment Group Code 1/2 “CO” Contractual Obligation “OA” Other Adjustment “PI” Payer Initiated Reductions “PR” Patient Responsibility
CAS02 Adjustment Reason Code 1/5 Claim Adjustment Reason Code
CAS03 Monetary Amount 1/18 Service Level Adjustment Amount; negative number increases amount, positive decreases
CAS04 Quantity 1/15 Numeric value of adjustment quantity
REF Service Identification Situational
REF01 Reference Identification Qualifier 2/3 Code qualifying the Reference Identification.
REF02 Reference Identifier 1/50 Provider Identifier
AMT Service Supplemental Information Situational
AMT01 Amount Qualifier Code 1/3 Code to qualify amount
AMT02 Monetary Amount 1/18 Service Supplement amount
LQ Health Care Remark Code Situational
LQ01 Code List Qualifier Code 1/3 Code List Qualifier Code. Example: “HE” Claim Payment Remark Codes
LQ02 Industry Code 1/30 Remark Code
PLB Provider Adjustment Situational
PLB01 Reference Identification 1/50 Provider Identifier
PLB02 Date 8/8 Date Expressed as CCYYMMDD. Fiscal Period End
PLB03 Adjustment Identifier To provide the category and identifying reference information for an adjustment
PLB03-1 Adjustment reason Code 2/2 Code indicating reason to invoice, debit/credit memo, or payment. Example: L6-Interest Owed FB-Forwarding Balance WO- Overpayment Recovery PI-Period Interim Payment
PLB03-2 Reference Identification 1/50 Reference information as defined for a particular transaction set to as a specific by the reference identification qualifier
PLB04 Monetary Amount 1/18 Provider Adjustment Amount
SE Transaction Set Trailer Required
SE01 Number of Included Segments 1/10 Transaction Segment Count
SE02 Transaction Set Control Number 4/9 Transaction Set Control Number. ST02 and SE02 must be identical
GE Functional Group Trailer Required
GE01 Number of Transaction Sets Included 1/6 Total number of transaction sets included in the functional group or interchange (transmission) group terminated by the trailer containing this data element.
GE02 Group Control Number 1/9 Assigned number originating and maintained by the sender. GE02 and GS06 must be identical
Interchange Control Trailer Required
IEA Interchange Control Trailer Required
IEA01 Number of the Included Functional Groups 1/5 A count of the number of functional groups included in an interchange
IEA02 Interchange Control Number 9/9 A control number assigned by the interchange sender
UCare Minnesota v5010 ASC X12N (ASC X12N 005010X221A1) 835 Companion Guide
12 Copyright 2017, UCare, All Rights Reserved. UCare® is a registered service mark of UCare Minnesota and UCare Health, Inc.
General Notes Data Contents and Specifications
This section describes the use of the Interchange Control segments (ISA, IEA). These segments mark the beginning and
ending of an interchange. This segment includes a description of the expected sender and receiver codes and delimiters. The
first element delimiter in the ISA segment is an Asterisk (*) which will be used as the delimiter throughout the transaction.
The final character in the ISA segment is a Tilde (~) which will be used as the delimiter for each segment in the transaction.
UCare, via Change Healthcare, has provided connectivity that complies with the Committee on Operating Rules for
Information Exchange (CORE) Safe Harbor principle (§5 Safe Harbor) according to the CORE Connectivity Phase II Rule 270.
Submitters may contact Change Healthcare for specification details.
Contact Information
Applicable Websites
www.ucare.org/providers
Providers can also contact UCare’s at:
Phone: 1-612-884-2030
Email: [email protected]
Days/Times: Monday - Friday, 8:00 a.m. – 5:00 p.m. CST
Trading Partner Agreements
Trading Partners
An EDI trading partner is defined as any UCare customer (provider, billing service, software vendor, employer group, financial
institution, etc.) that transmits electronic data to, or receives electronic data from UCare, or from a UCare contracted entity.
To ensure the integrity of the electronic transaction process, payers have EDI trading partner agreements that accompany the
standard implementation guide. The trading partner agreement is related to the electronic exchange of information, whether
the agreement is with an entity or part of a larger agreement. For example, a trading partner agreement may specify the
roles and responsibilities of each party to the agreement in conducting standard transactions.
As UCare will be directly exchanging 835 data with Change Healthcare, the existing trading partner agreement between
UCare and Change Healthcare will cover the data being passed and shared. It may be necessary for those originating these
transactions to complete trading partner agreements with Change Healthcare.
UCare Minnesota v5010 ASC X12N (ASC X12N 005010X221A1) 835 Companion Guide
13 Copyright 2017, UCare, All Rights Reserved. UCare® is a registered service mark of UCare Minnesota and UCare Health, Inc.
APPENDIX
Revision History
Revision Number
Date Section Notes
1.0 1/1/2019 Original document