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Back  RFI # 2086: AK102 Response to 837

Formal vs. Informal Help Informal Formal

Submitter

Andrew Lee

Description

A health plan is responding to our 837 with one ISA/IEA loop, one GS/GE loop, one ST/SE loop and many HL loops with man 999's. They are taking or original file, and splitting each claim out into their own file. In their processing they then respond to each claim with its own 999 and 277. In the 999, the still have our original control number in the AK102 for which the 837 has many claims. Essentially, the have a one to many 837 to 999 ratio.

I would like to get a ruling on the validity of the 999 having to respond to the original, single, 837 based on control numbers in the 999 segment AK102

Response

In response to your question, the correct acknowledgment response to an 837 within a single functional group (GS/GE) must be a single 999 Implementation Acknowledgment. One and only one 999 can be returned for a single functional group. The practice as depicted by the submitter of this RFI, is incorrect. The correct healthcare acknowledgment model is defined in the ASC X12 Acknowledgment Reference Model (ARM).

Further information concerning the usage and guidance on the 999 is given in RFI #58.

http://rfi.x12.org/Request/Details/58
Submission 8/26/2015
Status Date 2/8/2016
Status F - Final
Primary References
Document 005010X231A1
Section2.4
Page23
Segment IDAK1
Element Position02