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Back  RFI # 58: Transaction Set 997 versus 999

Formal vs. Informal Help Informal Formal

Submitter

Todd Cochrane

Description

It is unclear at this time what X12 requires for the 5010 HIPAA implementation. There are conflicting statements found within the implementation guides. For example, in the front matter of the guides 005010X222(837), in sections 1.6, 1.6.1 and 1.6.2 it appears there is no recommendation.

Response

For a healthcare TR3 implementation, the 999 transaction must be used.

Recommendation

The official response to a formal RFI is a letter from the current ASC X12 chair. This website often displays a summary of the RFI. Click here to view a PDF of the letter for this RFI.

Further guidance as to which transaction is to be used can be found in section 1.3.2 of TR3 05010X230 (997). This TR3 specifically states: This 997 implementation guide can NOT be used for responding to any implementation guideline (TR3). The front matter for the 5010 Healthcare TR3s was written prior to the development of the 5010 X12C TR3s for the acknowledgments. While the X12C TR3s were in development, the decision was made to reference their development. Per section 1.6, readers are informed as to the purpose of both the 997 and 999 transaction sets. The documents further states the implementation guides (TR3) were in development and intended to be used in conjunction with the TR3 containing section 1.6. Later guide authors such as guide 005010X279, gave specific guidance regarding which acknowledgment transaction to be implemented. The specific instructions are in alignment with 005010X230 (997) and 005010X231 (999) implementation guides (TR3). For further guidance concerning the implementation of acknowledgments can be found in the Technical Report Type 2 document named X12 Acknowledgement Reference Model (ARM). The ARM contains examples specific to healthcare acknowledgment implementations. During the Errata process for TR3 005010X231, now TR3 005010X231A1, the following statements were added the document, further clarifying the position of the 997 and 999 for healthcare implementation. When acknowledging a healthcare implementation guide (TR3) based transaction, only a single transaction set 999 can be used. When acknowledging a healthcare implementation guide (TR3) based transaction, the transaction set 997 must not be used.
Submission 1/1/2010
Status Date 1/1/2010
Status F - Final
Primary References
Document 5010