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Back  RFI # 1630: STSE envelope relative to file

Formal vs. Informal Help Informal Formal

Submitter

David Pagliari

Description

Should a 5010 837 professional claim submitted in its own ST-SE envelope with other ST-SE envelope claims be treated as a discrete claim for editing purposes?For example: sending an 5010 837 professional file with 3 claims such as:
ISA
GS
ST
DETAIL SEGMENTS CLAIM 1
SE
ST
DETAIL SEGMENTS CLAIM 2
SE
ST
DETAIL SEGMENTS CLAIM 3
SE
GE
IEA
If there is an issue with one of the claims in its own ST-SE envelope, should entire file be rejected or only the ST-SE envelope in error?

Submitter Assigned Keywords

SE-ST envelope File edits

Response

There is no concept of a physical file within the ASC X12 standards.Therefore, the response will focus on an ASC X12 interchange ISA/IEA.

Ultimately, any decision to reject a single transaction set (ST/SE) or a functional group (GS/GE) is up to the receiver of the interchange ISA/IEA. The ASC X12 005010X231A1 (Implementation Acknowledgment for Health Care Insurance (999)) is designed to communicate acceptance or rejection of either an entire functional group (GS/GE) or acceptance or rejection of an individual transaction within the functional group. If a TR3 error is found within one transaction set (ST/SE) that contains a single claim, the related 999 can communicate rejection of only that transaction set (ST/SE) (single claim) and communicate acceptance of all other transaction sets (ST/SE) within the same functional group, or communicate rejection of the entire functional group.

This response does NOT address failing edits for business rules outside of the scope of the TR3.
Submission 7/19/2012
Status Date 4/30/2013
Status F - Final
Primary References
Document 005010X222
Section2.4
Set ID837