Important Changes for X12 Version 5010 HIPAA Transactions

When it comes to adopting the recent changes for X12 Version 5010 for HIPAA transactions, there are key differences to learn.

Please note: This post originally appeared on Extol.com (EXTOL has been acquired by Cleo).

In a recent blog, we discussed the final rule adopting X12 Version 5010 for HIPAA transactions.  There are key differences that should be noted besides the many changes to segments and elements.  Three of the important changes for version 005010 are Version/industry group ID (GS08), ST03 element, and the 999 Implementation Acknowledgment.  The three sections to follow will address each of these areas.

1. Version/industry group ID GS08 changes

Message IDGroup codes version 004010/ industry identifierversion 005010/ industry identifier

270HS004010X092A1005010X279

271HB004010X092A1005010X279

276HR004010X093A1005010X212

277HN004010X093A1005010X212

278HI004010X094A1005010X217

820RA004010X061A1005010X218

834BE004010X095A1005010X220

835HP004010X091A1005010X221

837ProfHC004010X098A1005010X222

837InstHC004010X096A1005010X223A1

837DentHC004010X097A1005010X224A1

2. ST03 added 

The ST03 element was added to all of the above transactions.  This element contains the same value as GS08.  Some EDI translation products omit the ISA and GS segments (envelopes) prior to application (ST-SE) processing.  By providing the information from GS08 at this level, it will ensure that the appropriate application mapping is used at translation time.

3. 999 Implementation Acknowledgment

The 999 Implementation Acknowledgment transaction is an EDI response message to confirm a file was received and could be properly read by the translator. The 999 can also report on exactly what syntax-related issue caused the errors on the original document.  It can notify the sender whether the document was accepted or rejected.  While the 999 will acknowledge receipt of the sent document, it does not guarantee that the transaction will be put in use by the business process.  For example, just because an acknowledgment is sent does not guarantee a “Claim” will be processed through the adjudication system.

999 Acknowledgment result types:

A – Accepted
R – Rejected
E – Accepted with errors

999 Acknowledgment sample data:

ST*999*0001*005010X231~
AK1*HC*6454*005010X231~
AK2*837*0001*005010X231~
IK3*CLM*120**8~
IK4*2*782*I12*92.511~
IK5*E~
AK9*A*1*1*1~
SE*8*0001~

AK1: This segment refers to the (GS) group level of the original document

AK101 is equal to GS01 from the original document.  For example, for a Claim, AK101= ‘HC’; for an Eligibility Inquiry, AK101 = ‘HS’
AK102 is equal to GS06 from the original document (Group Control Number)
AK103 is equal to GS08 from the original document (EDI Implementation Version)

AK2: This segment refers to the (ST) Transaction Set level of the document

AK201 is equal to ST01 from the original document.  For example, for a Claim, AK201= ‘837’; for an Eligibility Inquiry, AK201 = ‘270’
AK202 is equal to ST02 from the original document (Transaction Set Control Number)
AK203 is equal to ST03 from the original document (EDI Implementation Version)

IK3: This segment reports errors in a data segment and identifies the location of the data segment

IK301 contains the segment name that has the error.  For example, the segment name is ‘CLM’
IK302 contains the numerical count position of this data segment from the start of the transaction set.  For example, the erroneous ‘CLM’ segment is in the 120th position
IK303 contains the loop ID where the error occurred.
IK304 contains the error code and it states the specific error.  For example, the code ‘8’ states “Segment Has Data Element Errors”

IK4: This segment reports errors in a data element and identifies the location of the data element

IK401 contains the data element position in the segment that is in error.  For example, the error is in position 2; CLM-02
IK402 contains the data element reference number, CLM-02 = ‘782’
IK403 contains the error code and states the specific error.  For the example, the code ‘I12’ states “Implementation Pattern Match Failure”; IK404 contains a copy of the bad data element data.

IK5: This segment reports errors in a transaction set

IK501 indicates states whether the whole document is ‘A’ (Accepted), ‘R’ (Rejected) or ‘E’ (Accepted with errors).  Other codes such as ‘M’, ‘W’ or ‘X’ are available but are rarely used (for security decryption purposes).  For example, IK501 = ‘E’ that means the claim was accepted with errors
IK502 is not used in the example above
IK506 is to report an error code for the full transaction.  IK502 sample error codes include:
1-Transaction Set Not Supported
2-Transaction Set Trailer Missing
3-Transaction Set Control Number in Header and Trailer Do Not Match

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