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Back  RFI # 259: 997 AK901 R vs P

Formal vs. Informal Help Informal Formal

Submitter

bill knox

Description

I received the following AK9 segment in a 997 file from a payer: AK9*R*6*6*5~. The payer accepted 5 transaction sets and rejected 1 transaction set. The payer rejects on a transaction set level as opposed to file level. I interpreted the AK9*R that was returned as being a file rejection, and resent the entire file after making the correction in the one transaction set that was truly rejected. The payer processed the claims as duplicates from all the accepted transaction sets. My question is, if the payer is rejecting only one transaction set in a file shouldn't the AK9 segment have been returned with a P instead of an R: AK9*P*6*6*5~ Doesn't an AK9*R mean the whole file has rejected and no claims will be processed?

Is the payer incorrect in reporting an AK9*R when they are actually processing some claims?

Response

997 Functional Acknowledgements are in response to a Functional Group which may contain one or more transaction sets. This issue is explicitly addressed in all guides on pages B.27 and B.28. The AK9 segment is the Functional Group Response Trailer. In AK901, code P is defined as "Partially Accepted, At Least One Transaction Set Was Rejected". Code R is defined as "Rejected". Use of code R indicates rejection of the entire functional group (including all transaction set within that specific functional group). In order for the Payer to indicate that only one transaction set was rejected, code P should have been used in AK901.

Recommendation

When code P is used in AK901, the originator usually only retransmits the rejected transaction sets that are identified in the AK2 segment as rejected transaction sets.
Submission 6/2/2005
Status Date 7/13/2005
Status F - Final
Primary References
Document 004010X096
SectionB.2
Page561
Set ID997
Segment IDAK9
Element Position01