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Back  RFI # 2099: 999 confirming claim receipt

Formal vs. Informal Help Informal Formal

Submitter

Gary Stankowski

Description

When a carrier or their clearinghouse transmits (to provider and/or the provider’s clearinghouse) a 999 Functional Acknowledgement response to a transmission of claim(s) with a response code “A” (in Segment; IK5 – Element ID IK501 and/or Segment; AK9 – Element IK901); this “A”-coded 999 response from the carrier or the carrier clearinghouse confirms two things:
1) The date the carrier received the electronic claim transmission? True or false
2) The claim data was "accepted" by the carrier and the transmission contained no format errors and was transmitted using the requisite Institutional 837 (ASC X12N 837) compliant format? True or false

Submitter Assigned Keywords

ASC X12N 837 format compliance

Response

This response is based upon guide 005010X231 and any associated errata - Implementation Acknowledgment for Health Care Insurance.

1) The 999 does not necessarily indicate the date that the carrier received the claim transaction (837). First, there is no date within the 999 itself. Any date would need to be obtained from the related GS04. Second, if the payer is supplying the 999 themselves, then the date in GS04 may be the date that the carrier received the 837, but it may also be later than the date when the 837 was received. Third, if the payer’s clearinghouse is supplying the 999, then the date in GS04 may be the date that the carrier received the 837, but it may also be later than the date when the 837 was received. There is no indication from the 999 or the rest of the related interchange as to when the clearinghouse may have delivered the 837/claims to the payer. The actual receipt date would be obtained from a business transaction like the Health Care Claim Acknowledgment (277CA), which supplies the receipt date in loop 2200A using a DTP segment (Information Source Receipt Date), when the Information Source is the payer.


2) Two questions are being asked:
Is the claims data “accepted” by the carrier? This is not indicated by the 999.
Did the transmission not contain format errors as indicated in the ASC X12 837 TR3? True, “A” indicates accepted with no format errors from a syntactic viewpoint. Accepting the data from a business standpoint would be identified through a business transaction like the 277CA.

Recommendation

The correct healthcare acknowledgment model is defined in the ASC X12 Acknowledgment Reference Model (ARM).
Submission 9/29/2015
Status Date 4/28/2016
Status F - Final
Primary References
Document 005010X231
Section1.1
Segment IDIK5