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.
- XML message communication message
- TA1 transaction interchange validation
- 999 Acknowledgement Response
- 271 Eligibility Response
- 277CA Claim Acknowledgement
- 277 Claim Response
- 277 Pend
- 277 U (Unsolicited)
- 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
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. | 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. | 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. | 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. | 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.
- 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.
- 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:
- Communication messages are required to be sent before any front end editing occurs.
- 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
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