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Administrative Transaction Acknowledgements v3.1

UHIN STANDARDS COMMITTEE

 

Approved

 

 

UHIN STANDARDS COMMITTEE

Administrative Transaction Acknowledgements

STANDARD

Version 3.1

 

 

UHIN Administrative Transaction Acknowledgements Standard is compatible with all HIPAA 5010 requirements.

 

Purpose: The purpose of this Standard is to create a process for acknowledging all electronic transactions between trading partners based on the communication, syntax, semantic and business process specifications.

 

Applicability: This Standard applies to all administrative transactions in the state of Utah, including those utilizing the Utah Health Information Network Gateway or any direct connection.

 

Basic Concepts: There are multiple transactions that are used within the healthcare industry as acknowledgments. This standard follows the national recommendation for transaction acknowledgements.

 

Detail: The following transactions are used for the acknowledgement of transactions.

  1. XML message communication message
  2. TA1 transaction interchange validation
  3. 999 Acknowledgement Response
  4. 271 Eligibility Response
  5. 277CA Claim Acknowledgement
  6. 277 Claim Response
  7. 277 Pend
  8. 277 U (Unsolicited)
  9. 835 Remittance Advice

 

Response Transactions

 

There are multiple levels of transaction acknowledgment reporting. The following are the levels that are addressed when acknowledging a file of transactions based on two distinct methods Batch and Real Time.

 

Batch Method

 

  1. Communication Acknowledgement: At this level the sender knows whether or not the data was successfully sent to the intended receiver. This happens while the connection is in session; for UHIN systems this is an XML message.

 

  1. Transaction Interchange Validation: This validation lets the sender know if there are any problems with the ISA/IEA for the interchange. This is where a receiver would identify a duplicate transaction file. This acknowledgement is sent after the connection has closed; for UHIN systems this is a TA1.

 

  1. Syntax and TR3 Acknowledgement: This acknowledgement level tells the sender if the transaction within the ISA/IEA is acceptable. This happens after the connection has closed; for systems this is a 999. This acknowledgement is used for acknowledging each functional group.

 

  1. Claims Acknowledgment: The sender determines if the individual transactions will be accepted for processing by the receiver. This happens after the connection has closed; for UHIN systems this would be a 277CA.

 

  1. X12 Response: The receiver sends the appropriate X12 response transaction.

 

For specific detail of the appropriate acknowledgment/responses to a submission see Table 1.

 

Real Time

 

For this type of processing there are only two acknowledgements.

 

  1. Communication or Other Error: The first acknowledgement would only be sent to the sender in the event of an error with communication or syntax. This happens once the real-time is in session has closed; for UHIN systems this is a 999 or TA1 sent in a batch connection.

 

  1. X12 Response: The second acknowledgement would be the final X12 transaction or response transaction.

 

For specific detail of the appropriate acknowledgment/responses to a submission see Table 2.

 

TABLE 1

Batch Method

Router Client Sends

 

UHIN Response

 

Route Server Response

270

 

XML communication Message

1

XML communication Message

 

 

 

2

TA1 Transaction Interchange Validation

 

 

 

3

999 Response

 

 

 

4

271 X12 Response

 

 

 

 

 

276

 

XML communication Message

1

XML communication Message

 

 

 

2

TA1 Transaction Interchange Validation

 

 

 

3

999 Response

 

 

 

5

277 X12 Response

 

 

 

 

 

837

 

XML communication Message

1

XML communication Message

 

 

 

2

TA1 Transaction Interchange Validation

 

 

 

3

999 Response

 

 

 

5

277CA Claim Acknowledgment

 

 

 

6

835 X12 Response

 

 

 

 

 

Route Server Sends

 

UHIN Response

 

Router Client Response

835

 

XML communication Message

3

999 Response

 

 

TABLE 2

 

Real Time Method

Router Client Sends

 

UHIN Response

 

Route Server Response

270

 

XML communication Message

2/3

TA1 or 999 for error

 

 

TA1 for no Route Server response

4

271 X12 Response

 

 

 

 

 

276

 

XML communication Message

2/3

TA1 or 999 for error

 

 

TA1 for no Route Server response

5

277 X12 Response

 

 

 

Implementation Issues:

 

  1. Communication messages are required to be sent before any front end editing occurs.
  2. All XML communication messages can be found in the UTRANSEND Technical Reference Manual.

 

 

Implementation Date:

 

History: (MM/DD/YY)

 

Original

V3

A 1

A 2

ORIGINATION DATE

6/13/05

10/06/10

7/7/2014

 

APPROVAL DATE

 

05/18/2011

9/10/2014

 

EFFECTIVE DATE

 

06/18/2011

11/5/2014

 

* A = Amendment

 

 

 

 

 

 

 

 

 

 

1

 

 

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