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Back  RFI # 1759: Std to Reject on TP Enrollment

Formal vs. Informal Help Informal Formal

Submitter

Kenneth Greenspan

Description

I would like to know if there is an industry standard or best practice for rejecting a transaction (such as an 837 or 835) on enrollment/registration. For example, say a trading partner submits an 837I claim batch to a clearinghouse, however the submitting partner is not enrolled/registered to submit to said clearinghouse. I’m wondering whether it makes sense to add an error code to AK905 or possibly via the CTX segment within the 999 to represent an enrollment error like this. I believe the 999 is not supposed to acknowledge business errors, so is the 824 transaction a possibility?

Submitter Assigned Keywords

enrollment registration CTX 999 824 AK905

Response

The 824 Application Advice is not the correct transaction set to use in the scenario as presented.

For Healthcare transactions the recommended acknowledgment model are the TA1 - Interchange Acknowledgment and the 999 - Implementation Acknowledgment. The recommended acknowledgment model for Healthcare is documented in the Acknowledgment Reference Guide.

Regarding your specific data examples:

The error with the ISA06 containing an invalid trading partner ID, respond with a TA105 response of Invalid Sender (006).
The error with the GS02 containing an invalid application sender's code respond with a AK905 of Functional Group not Supported (1). This code is referencing the implementation Guide 005010X231A1 - Implementation Acknowledgement for Healthcare.
The error with the GS03 containing an invalid application receiver's code respond with a AK905 of Functional Group not Supported (1). This code is referencing the implementation Guide 005010X231A1 - Implementation Acknowledgement for Healthcare.

In a later version of the standard ( 5012) the following codes were added to data element 716 (AK905).

7 Invalid Application Sender's Code
8 Invalid Application Receiver's Code
9 Invalid Responsible Agency Code

30 Invalid Group Date
31 Invalid Group Time
Submission 3/3/2013
Status Date 9/23/2013
Status F - Final
Primary References
Document 005010X231
Section2.4
Page32