Testing X12 837P with Highmark
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Com1 Software
Aug 30, 2011, 4:25:55 PM8/30/11
to Command Line Translator
We started testing today with Highmark
Here are some useful links
https://www.highmark.com/edi/hipaa/index.shtml
EDI Reference Guides
https://www.highmark.com/edi/resources/guides/index.shtml
v5010 Provider Companion Guide
https://www.highmark.com/edi/pdfs/Companion_Guide_5010_0410.pdf
Current problem we are looking at:
Error number = 204 Severity = 1
Invalid ISA Element REPETITION SEP
Here are some useful links
https://www.highmark.com/edi/hipaa/index.shtml
EDI Reference Guides
https://www.highmark.com/edi/resources/guides/index.shtml
v5010 Provider Companion Guide
https://www.highmark.com/edi/pdfs/Companion_Guide_5010_0410.pdf
Current problem we are looking at:
Error number = 204 Severity = 1
Invalid ISA Element REPETITION SEP
Monkeyboy
Sep 7, 2011, 10:13:49 AM9/7/11
to Command Line Translator
I'm told the segment terminators are causing the problem... no idea
what that means though.
On Aug 30, 4:25 pm, Com1 Software <informat...@com1software.com>
wrote:
what that means though.
On Aug 30, 4:25 pm, Com1 Software <informat...@com1software.com>
wrote:
> We started testing today with Highmark
>
> Here are some useful linkshttps://www.highmark.com/edi/hipaa/index.shtml
> EDI Reference Guideshttps://www.highmark.com/edi/resources/guides/index.shtml
> v5010 Provider Companion Guidehttps://www.highmark.com/edi/pdfs/Companion_Guide_5010_0410.pdf
>
> Here are some useful linkshttps://www.highmark.com/edi/hipaa/index.shtml
> EDI Reference Guideshttps://www.highmark.com/edi/resources/guides/index.shtml
Com1 Software
Sep 7, 2011, 3:21:21 PM9/7/11
to Command Line Translator
Sorry for the delay in getting back
Regarding a problem with a segment terminator, my guess is a couple of
things.
The issue with T and P can be critical in some systems and if it is
wrong they can
tend to be giving back miss leading information.
The ISA segment is a fixed length segment you have to be a bit careful
with setting things in it.
If you can read your X12 837 file using the X12 File Viewer, then your
file is fine as far as that goes.
My thinking is getting the Test/Production issue out first and run
another test.
I have always found that in testing solve the first problem in the
file and do another test.
Many time the other problems will clear up when the first problem is
solved.
Setting "P" to a "T" indicating testing instead of production.
- This is done in the Insurance Contract Table
Main Menu, Files, Institution, Select Insurance Contract Table,
Select Insurance Carrier.
In the Insurance Contract Editor there are several small buttons on
the upper
left of the screen. Third one down is Claims Submission. If it says
NOT PRESENT to the
right of this, then use the Legacy Configuration Button.
In this portion of the Contract Editor you will see small button in
the middle left called
Control Mode. Click this button to set to TEST and save.
- Note: if the Claims Submission is PRESENT then select that button
and you will be able
to set the Control Mode there.
Regarding "NM1*87*2*" which was followed by MY company name - told
that needs to be Highmark Medicare.
My guess is that this is not a valid problem or we have the wrong
NM1 segment.
Note: may be related to Test/Prod switch.
Not sure if this is correct. If it is and that is what they want
then in then in the c1.cfg
you can hard code it in.
AD.NM1=ON
AD.NM101=ON
AD.NM102=ON
AD.NM103=ON,Your Company Name
AD.NM104=ON
AD.NM105=ON
AD.NM106=ON
AD.NM107=ON
AD.NM108=ON
AD.NM109=ON
Regarding a problem with a segment terminator, my guess is a couple of
things.
The issue with T and P can be critical in some systems and if it is
wrong they can
tend to be giving back miss leading information.
The ISA segment is a fixed length segment you have to be a bit careful
with setting things in it.
If you can read your X12 837 file using the X12 File Viewer, then your
file is fine as far as that goes.
My thinking is getting the Test/Production issue out first and run
another test.
I have always found that in testing solve the first problem in the
file and do another test.
Many time the other problems will clear up when the first problem is
solved.
Setting "P" to a "T" indicating testing instead of production.
- This is done in the Insurance Contract Table
Main Menu, Files, Institution, Select Insurance Contract Table,
Select Insurance Carrier.
In the Insurance Contract Editor there are several small buttons on
the upper
left of the screen. Third one down is Claims Submission. If it says
NOT PRESENT to the
right of this, then use the Legacy Configuration Button.
In this portion of the Contract Editor you will see small button in
the middle left called
Control Mode. Click this button to set to TEST and save.
- Note: if the Claims Submission is PRESENT then select that button
and you will be able
to set the Control Mode there.
Regarding "NM1*87*2*" which was followed by MY company name - told
that needs to be Highmark Medicare.
My guess is that this is not a valid problem or we have the wrong
NM1 segment.
Note: may be related to Test/Prod switch.
Not sure if this is correct. If it is and that is what they want
then in then in the c1.cfg
you can hard code it in.
AD.NM1=ON
AD.NM101=ON
AD.NM102=ON
AD.NM103=ON,Your Company Name
AD.NM104=ON
AD.NM105=ON
AD.NM106=ON
AD.NM107=ON
AD.NM108=ON
AD.NM109=ON
Com1 Software
Sep 15, 2011, 8:34:39 AM9/15/11
to Command Line Translator
Here is information regarding Invalid ISA Element REPETITION SEP
Interchange Control Structures
Typically, the term “interchange” connotes the ISA/IEA envelope that
is transmitted
between trading/business partners. Interchange control is achieved
through
several “control” components. The interchange control number is
contained in
data element ISA13 of the ISA segment. The identical control number
must also
occur in data element 02 of the IEA segment. Most commercial
translation software
products will verify that these two fields are identical. In most
translation
software products, if these fields are different the interchange will
be “suspended”
in error.
There are many other features of the ISA segment that are used for
control measures.
For instance, the ISA segment contains data elements such as
authorization
information, security information, sender identification, and receiver
identification
that can be used for control purposes. These data elements are agreed
upon
by the trading partners prior to transmission and are contained in the
written trading
partner agreement. The interchange date and time data elements as well
as
the interchange control number within the ISA segment are used for
debugging
purposes when there is a problem with the transmission or the
interchange.
Data Element ISA12, Interchange Control Version Number, indicates the
version
of the ISA/IEA envelope. The ISA12 does not indicate the version of
the transaction
set that is being transmitted but rather the envelope that
encapsulates the
transaction. An Interchange Acknowledgment can be denoted through data
element
ISA14. The acknowledgment that would be sent in reply to a “yes”
condition
in data element ISA14 would be the TA1 segment. Data element ISA15,
Test Indicator,
is used between trading partners to indicate that the transmission is
in a
“test” or “production” mode. This becomes significant when the
production phase
of the project is to commence. Data element ISA16, Subelement
Separator, is
used by the translator for interpretation of composite data elements.
The ending component of the interchange or ISA/IEA envelope is the IEA
segment.
Data element IEA01 indicates the number of functional groups that are
included
within the interchange. In most commercial translation software
products,
an aggregate count of functional groups is kept while interpreting the
interchange.
This count is then verified with data element IEA01. If there is a
discrepancy,
in most commercial products, the interchange is suspended. The other
data
element in the IEA segment is IEA02 which is referenced above.
Interchange Control Structures
Typically, the term “interchange” connotes the ISA/IEA envelope that
is transmitted
between trading/business partners. Interchange control is achieved
through
several “control” components. The interchange control number is
contained in
data element ISA13 of the ISA segment. The identical control number
must also
occur in data element 02 of the IEA segment. Most commercial
translation software
products will verify that these two fields are identical. In most
translation
software products, if these fields are different the interchange will
be “suspended”
in error.
There are many other features of the ISA segment that are used for
control measures.
For instance, the ISA segment contains data elements such as
authorization
information, security information, sender identification, and receiver
identification
that can be used for control purposes. These data elements are agreed
upon
by the trading partners prior to transmission and are contained in the
written trading
partner agreement. The interchange date and time data elements as well
as
the interchange control number within the ISA segment are used for
debugging
purposes when there is a problem with the transmission or the
interchange.
Data Element ISA12, Interchange Control Version Number, indicates the
version
of the ISA/IEA envelope. The ISA12 does not indicate the version of
the transaction
set that is being transmitted but rather the envelope that
encapsulates the
transaction. An Interchange Acknowledgment can be denoted through data
element
ISA14. The acknowledgment that would be sent in reply to a “yes”
condition
in data element ISA14 would be the TA1 segment. Data element ISA15,
Test Indicator,
is used between trading partners to indicate that the transmission is
in a
“test” or “production” mode. This becomes significant when the
production phase
of the project is to commence. Data element ISA16, Subelement
Separator, is
used by the translator for interpretation of composite data elements.
The ending component of the interchange or ISA/IEA envelope is the IEA
segment.
Data element IEA01 indicates the number of functional groups that are
included
within the interchange. In most commercial translation software
products,
an aggregate count of functional groups is kept while interpreting the
interchange.
This count is then verified with data element IEA01. If there is a
discrepancy,
in most commercial products, the interchange is suspended. The other
data
element in the IEA segment is IEA02 which is referenced above.
> We started testing today with Highmark
>
>
> Here are some useful linkshttps://www.highmark.com/edi/hipaa/index.shtml
> EDI Reference Guideshttps://www.highmark.com/edi/resources/guides/index.shtml
> v5010 Provider Companion Guidehttps://www.highmark.com/edi/pdfs/Companion_Guide_5010_0410.pdf
> EDI Reference Guideshttps://www.highmark.com/edi/resources/guides/index.shtml
Com1 Software
Sep 15, 2011, 9:08:19 AM9/15/11
to Command Line Translator
The TA1 is a single segment and is unique in the
sense that this single segment is transmitted without the GS/GE
envelope structures.
A TA1 can be included in an interchange with other functional groups
and
transactions.
Encompassed in the TA1 are the interchange control number, interchange
date
and time, interchange acknowledgment code, and the interchange note
code.
The interchange control number, interchange date and time are
identical to those
that were present in the transmitted interchange from the sending
trading partner.
This provides the capability to associate the TA1 with the transmitted
interchange.
TA104, Interchange Acknowledgment Code, indicates the status of the
interchange control structure. This data element stipulates whether
the transmitted
interchange was accepted with no errors, accepted with errors, or
rejected because
of errors. TA105, Interchange Note Code, is a numerical code that
indicates
the error found while processing the interchange control structure.
Values
for this data element indicate whether the error occurred at the
interchange or
functional group envelope.
The TA1 segment provides the capability for the receiving trading
partner to notify
the sending trading partner of problems that were encountered in the
interchange
control structure.
Due to the uniqueness of the TA1, implementation should be predicated
upon the
ability for the sending and receiving trading partners commercial
translators to accommodate
the uniqueness of the TA1. Unless named as mandatory in the Federal
Rules implementing HIPAA, use of the TA1, although urged by the
authors,
is not mandated
On Sep 15, 8:34 am, Com1 Software <informat...@com1software.com>
wrote:
sense that this single segment is transmitted without the GS/GE
envelope structures.
A TA1 can be included in an interchange with other functional groups
and
transactions.
Encompassed in the TA1 are the interchange control number, interchange
date
and time, interchange acknowledgment code, and the interchange note
code.
The interchange control number, interchange date and time are
identical to those
that were present in the transmitted interchange from the sending
trading partner.
This provides the capability to associate the TA1 with the transmitted
interchange.
TA104, Interchange Acknowledgment Code, indicates the status of the
interchange control structure. This data element stipulates whether
the transmitted
interchange was accepted with no errors, accepted with errors, or
rejected because
of errors. TA105, Interchange Note Code, is a numerical code that
indicates
the error found while processing the interchange control structure.
Values
for this data element indicate whether the error occurred at the
interchange or
functional group envelope.
The TA1 segment provides the capability for the receiving trading
partner to notify
the sending trading partner of problems that were encountered in the
interchange
control structure.
Due to the uniqueness of the TA1, implementation should be predicated
upon the
ability for the sending and receiving trading partners commercial
translators to accommodate
the uniqueness of the TA1. Unless named as mandatory in the Federal
Rules implementing HIPAA, use of the TA1, although urged by the
authors,
is not mandated
On Sep 15, 8:34 am, Com1 Software <informat...@com1software.com>
wrote:
Com1 Software
Sep 15, 2011, 9:16:44 AM9/15/11
to Command Line Translator
Here is a good link for X12 TA1 Acknowledgment Error Codes
http://jfs.ohio.gov/ohp/tradingpartners/pdfs/TA1_Interchange_Acknowledgment.pdf
On Sep 15, 9:08 am, Com1 Software <informat...@com1software.com>
Com1 Software
Sep 15, 2011, 10:45:39 AM9/15/11
to Command Line Translator
Missing an SBR03 section.
Reference Identification (SITUATIONAL)
INDUSTRY: Insured Group or Policy Number
ALIAS: Group or Policy Number
SEMANTIC: SBR03 is policy or group number
Required if the subscriber’s payer identification includes Group or
Plan Number. This data element is intended to carry the
subscriber’s Group Number, not the number that uniquely
identifies the subscriber
In the BCU mapping file INSGRP is the field that will need to be
populated.
To test to see if this is working after a conversion you can use the
patient account
screens or look in the command.log.
In the C1.CFG here is what we should have.
AE.SBR=ON
AE.SBR01=ON
AE.SBR02=ON
AE.SBR03=ON
AE.SBR04=ON
AE.SBR05=ON
AE.SBR06=ON
AE.SBR07=ON
AE.SBR08=ON
AE.SBR09=ON,ZZ
Reference Identification (SITUATIONAL)
INDUSTRY: Insured Group or Policy Number
ALIAS: Group or Policy Number
SEMANTIC: SBR03 is policy or group number
Required if the subscriber’s payer identification includes Group or
Plan Number. This data element is intended to carry the
subscriber’s Group Number, not the number that uniquely
identifies the subscriber
In the BCU mapping file INSGRP is the field that will need to be
populated.
To test to see if this is working after a conversion you can use the
patient account
screens or look in the command.log.
In the C1.CFG here is what we should have.
AE.SBR=ON
AE.SBR01=ON
AE.SBR02=ON
AE.SBR03=ON
AE.SBR04=ON
AE.SBR05=ON
AE.SBR06=ON
AE.SBR07=ON
AE.SBR08=ON
AE.SBR09=ON,ZZ
> We started testing today with Highmark
>
>
> Here are some useful linkshttps://www.highmark.com/edi/hipaa/index.shtml
> EDI Reference Guideshttps://www.highmark.com/edi/resources/guides/index.shtml
> v5010 Provider Companion Guidehttps://www.highmark.com/edi/pdfs/Companion_Guide_5010_0410.pdf
> EDI Reference Guideshttps://www.highmark.com/edi/resources/guides/index.shtml
Com1 Software
Sep 15, 2011, 12:19:16 PM9/15/11
to Command Line Translator
If all the claims are in the same group, then you can get by with
hard coding the group number in the c1.cfg as outlined below.
AE.SBR=ON
AE.SBR01=ON
AE.SBR02=ON
AE.SBR03=ON,111111111
wrote:
hard coding the group number in the c1.cfg as outlined below.
AE.SBR=ON
AE.SBR01=ON
AE.SBR02=ON
AE.SBR03=ON,111111111
AE.SBR04=ON
AE.SBR05=ON
AE.SBR06=ON
AE.SBR07=ON
AE.SBR08=ON
AE.SBR09=ON,ZZ
On Sep 15, 10:45 am, Com1 Software <informat...@com1software.com>
AE.SBR05=ON
AE.SBR06=ON
AE.SBR07=ON
AE.SBR08=ON
AE.SBR09=ON,ZZ
wrote:
Monkeyboy
Sep 19, 2011, 10:53:11 AM9/19/11
to Command Line Translator
I have this AE.SBR segment in my CFG file... however I don't have any
group numbers in any of my claims - they're all Medicare B claims...
do you think hard-coding the 11111111 into my CFG file would change
anything? Fixin' to submit another test file today.
On Sep 15, 12:19 pm, Com1 Software <informat...@com1software.com>
group numbers in any of my claims - they're all Medicare B claims...
do you think hard-coding the 11111111 into my CFG file would change
anything? Fixin' to submit another test file today.
On Sep 15, 12:19 pm, Com1 Software <informat...@com1software.com>
Monkeyboy
Sep 19, 2011, 11:30:14 AM9/19/11
to Command Line Translator
Ok... submitted with the lots of 1's revision as you have stated
(though I have a suspicion that's not needed) - I get a TA1 file back
with the same 024 error code (GS Segment errors).
Flummoxed...
On Sep 15, 12:19 pm, Com1 Software <informat...@com1software.com>
(though I have a suspicion that's not needed) - I get a TA1 file back
with the same 024 error code (GS Segment errors).
Flummoxed...
On Sep 15, 12:19 pm, Com1 Software <informat...@com1software.com>
Com1 Software
Sep 19, 2011, 2:14:21 PM9/19/11
to Command Line Translator
I would agree. In the back of my mind I was wondering if that would
make a difference.
The issue based on the error is something in the GS. Like I said
before the GS looks good to me at fist glance.
Since it is the start of the week I will take a look at it again and
see if we missed anything.
You might want to touch base with them and see if they have ideas as
to what is wrong with the GS.
make a difference.
The issue based on the error is something in the GS. Like I said
before the GS looks good to me at fist glance.
Since it is the start of the week I will take a look at it again and
see if we missed anything.
You might want to touch base with them and see if they have ideas as
to what is wrong with the GS.
Com1 Software
Sep 27, 2011, 7:25:53 AM9/27/11
to Command Line Translator
Step 1 Tell Highmark "my vendor doesn't have any other Highmark
clients so I'm helping out"
Now we know that the GS error was in ISA11
it was coming across as a "U" and should be a "^"
modified C1.CFG to read ISA11=ON,^
now able to get a 999 response!
On Sep 19, 2:14 pm, Com1 Software <informat...@com1software.com>
clients so I'm helping out"
Now we know that the GS error was in ISA11
it was coming across as a "U" and should be a "^"
modified C1.CFG to read ISA11=ON,^
now able to get a 999 response!
On Sep 19, 2:14 pm, Com1 Software <informat...@com1software.com>
Com1 Software
Sep 27, 2011, 8:13:34 AM9/27/11
to Command Line Translator
Current Open Issues:
1) ST Segment won't put version number in ST03 (should be 5010X222A1
2) NM1*87 segment, last two, 08 and 09, should be XX*ProvNPI.
Only get the XX to show up
- have to manually type NPI (or as you see here hard code it, but
shouldn't $provnpi work? (didn't work)
3) AE.SBR03 line needs legitimate numbers
On Sep 27, 7:25 am, Com1 Software <informat...@com1software.com>
1) ST Segment won't put version number in ST03 (should be 5010X222A1
2) NM1*87 segment, last two, 08 and 09, should be XX*ProvNPI.
Only get the XX to show up
- have to manually type NPI (or as you see here hard code it, but
shouldn't $provnpi work? (didn't work)
3) AE.SBR03 line needs legitimate numbers
On Sep 27, 7:25 am, Com1 Software <informat...@com1software.com>
Com1 Software
Sep 27, 2011, 4:17:19 PM9/27/11
to Command Line Translator
Looks like we might need to add $provnpi
http://com1software.com/c1a3f297.htm#0495
Valid Fields:
$CARRIERID - Carrier ID
$ALTBATCHID - Alternat Batch ID
$RENPROVID - Rendering Provider ID
$PROVID - Provider ID
$PROVTAXID - Provider Tax ID
$PROVSSN - Provider Social Security Number
$PROVALTID - Provider Alternate ID
Valid Segments:
NM1
REF
On Sep 27, 8:13 am, Com1 Software <informat...@com1software.com>
http://com1software.com/c1a3f297.htm#0495
Valid Fields:
$CARRIERID - Carrier ID
$ALTBATCHID - Alternat Batch ID
$RENPROVID - Rendering Provider ID
$PROVID - Provider ID
$PROVTAXID - Provider Tax ID
$PROVSSN - Provider Social Security Number
$PROVALTID - Provider Alternate ID
Valid Segments:
NM1
REF
On Sep 27, 8:13 am, Com1 Software <informat...@com1software.com>
Com1 Software
Nov 14, 2011, 2:26:37 PM11/14/11
to Command Line Translator
Tried to contact Highmark via phone (800) 992-0246 was told that if
this is Medicare to call
(866) 488-0546
When we call that number we are told to have our NPI PTAN or SubID
ready.
Select
1 for Part B
2 for Part A
We selected B
Next option is
1 General Question / Information
2) PC-Ace Support
3) Policy Guidlines.
We select 1
We are told that have too much volume and the call is dropped.
Looks like you really don't need your NPI PTAN or SubID ready.
On Sep 27, 7:13 am, Com1 Software <informat...@com1software.com>
this is Medicare to call
(866) 488-0546
When we call that number we are told to have our NPI PTAN or SubID
ready.
Select
1 for Part B
2 for Part A
We selected B
Next option is
1 General Question / Information
2) PC-Ace Support
3) Policy Guidlines.
We select 1
We are told that have too much volume and the call is dropped.
Looks like you really don't need your NPI PTAN or SubID ready.
On Sep 27, 7:13 am, Com1 Software <informat...@com1software.com>
Com1 Software
Nov 15, 2011, 1:22:07 PM11/15/11
to Command Line Translator
Success getting in touch by calling (866)488-0546
On Nov 14, 2:26 pm, Com1 Software <informat...@com1software.com>
On Nov 14, 2:26 pm, Com1 Software <informat...@com1software.com>
Com1 Software
Dec 15, 2011, 10:08:00 AM12/15/11
to Command Line Translator
Regarding the problem of missing Payer City, ST, and Zip,
the following options can be applied to the c1.cfg
the following options can be applied to the c1.cfg
AL.N3=ON
AL.N301=ON
AL.N302=ON
AL.N4=ON
AL.N401=ON
AL.N402=ON
AL.N403=ON
or
AL.N3=ON
AL.N301=ON,123 street
AL.N302=ON
AL.N4=ON
AL.N401=ON,city
AL.N402=ON,st
AL.N403=ON,11111
On Nov 15, 1:22 pm, Com1 Software <informat...@com1software.com>
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