Important Changes for X12 Version 5010 HIPAA Transactions

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 ID Group codes version 004010/ industry identifier version 005010/ industry identifier
270 HS 004010X092A1 005010X279
271 HB 004010X092A1 005010X279
276 HR 004010X093A1 005010X212
277 HN 004010X093A1 005010X212
278 HI 004010X094A1 005010X217
820 RA 004010X061A1 005010X218
834 BE 004010X095A1 005010X220
835 HP 004010X091A1 005010X221
837Prof HC 004010X098A1 005010X222
837Inst HC 004010X096A1 005010X223A1
837Dent HC 004010X097A1 005010X224A1

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

From the Blog

Blockchain + EDI = Faster, Bigger Ecosystems

Published September 20, 2018

Read the Blog
Upcoming Events

Cleo Connect 2018

Scheduled October 16, 2018

See All Events
Careers

Entry-Level Sales Representative

Cleo is looking for passionate, motivated self-starters who aspire to be successful business leaders to join our Sales Development team.

See All Openings