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Back  RFI # 258: Payers Bundling TIN's ERA File

Formal vs. Informal Help Informal Formal

Submitter

Sharon Sieve

Description

We have multi payers sending us separate 835 files by tin. United Health Care states the files are separate by tin but bundled into one file (ISA to IEA) for SSI (our billing Vendor) to pick up. This one file consists of pmts for 4 separate entities. (2 hosp, 1 phys billing, 1 Support Svcs) that need to be posted separately by entity into 3 dif computer systems. When we addressed w/UHC they state that they are not goverened by HIPAA to provide separate files. We sent to Ask Hipaa and they replied to send to X12 for the interpretation. They stated we should be able to work out w/trading partner but could file a complaint w/htct.hhs.gov/aset

Submitter Assigned Keywords

Bundling TIN in 855 era files

Response

This issue is explicitly addressed in guide 004010X091 in Appendix A, page A1 in figure A1. A single Interchange (ISA-IEA) can contain multiple Groups (GS-GE). Each Group can contain multiple transactions (ST-SE). The GE segment also specifies the number of included transactions in element 01.

It is valid to include multiple 835s within a single file (ISA -IEA).
Submission 5/25/2005
Status Date 7/19/2005
Status F - Final
Primary References
Document 004010x091a1
Section1.1.1
Page7
Set ID1.6