Tag Archives: X12

Important Changes for X12 Version 5010 HIPAA Transactions

In my last blog I discussed the final rule adopting X12 Version 5010 for HIPAA transactions.  There are key differences that should be noted besides the many changes to segments and elements.  Three of the important changes for version 005010 are Version/industry group ID (GS08), ST03 element, and the 999 Implementation Acknowledgment.  The three sections to follow will address each of these areas. Continue reading

The 997: It’s More “Functional” Than You Might Think

For many EDI analysts, the “997 Functional Acknowledgment” [EDI transaction] is a necessary, but little observed, piece of the overall EDI process…one that informs recipients that an EDI transaction has been received.  But, there is much more to the 997 than you might think as it is, after all, called a “Functional” Acknowledgement.  So what exactly are its’ functions?

The 997 acknowledges receipt of one or more transactions; it reports specifically based on X12 Syntax (not backend application) data compliance.  The 997 (could) use up to a total of six different segment types in the “body” of the transaction (between the ST and SE segments), and is dependent on the level of detail being reported.  At minimum, the AK1 (Functional Group Response Header) and AK9 (Functional Group Response Trailer) segments must be present.  These simply report that a specific Functional Group (GS/GE envelope) has been received.  This segment pair also includes the number of transaction sets received and accepted [e.g. Accepted, Accepted with Errors, or Rejected].  This is considered a simple or “Summary” 997 since it references an entire group of transactions (e.g. IN-Invoices) rather than to individual transactions (e.g. 810-Invoices). Continue reading

X12 Version 5010 for HIPAA transactions

On January 16, 2009, United States Department of Health and Human Services published a final rule adopting X12 Version 5010 for HIPAA transactions.

The compliance dates for Version 5010 for all covered entities, is January 1, 2012.  This gives the industry time to test the standards internally to ensure that systems have been appropriately updated, and then to test with trading partners before the compliance date.

This final rule adopts updated versions of the standards for electronic transactions originally adopted under the Administrative Simplification Subtitle of the Health Insurance Portability and Accountability Act of 1996.  In addition, this final rule adopts two standards for billing retail pharmacy supplies and professional services, and clarifies who the ‘‘senders’’ and ‘‘receivers’’ are in the descriptions of certain transactions.

The improved eligibility responses will improve efficiency for providers and reduce phone calls for both providers and health plans. Continue reading

Version Conversion

The Healthcare industry is being mandated by the Government and HIPAA legislation to convert from X12 version 4010 to version 5010. Most companies aren’t being mandated by the government to switch versions, but by their strongly influential Trading Partners.

I think back to the late nineties when version 4010 came out and what a struggle it was for many Trading Partners to convert to that version. Most EDI Coordinators are fearful of those same struggles when going from 4010 to 5010 or any other version. Converting from one version to another version doesn’t have to be a major headache.

There are two main areas of consideration during your Version Conversion project:  translation support and application support.   Continue reading

B2B to Be

For my inaugural post on this blog, I want to revisit one of those “solved problems” that still dogs many of the companies we talk with, namely, how to handle B2B integration requirements that don’t involve standard EDI. Companies still find it difficult to cope with the full range of B2B connections and content types needed to integrate with large and small trading partners, including:

  • Standard EDI (and in some cases, EDI that does not fully conform to standards)
  • “Standard” XML, which ranges from well-developed, horizontal standards like RosettaNet to hundreds of loosely-defined vertical transaction sets
  • EDI-like flat file standards (most of these are older, vertically-focused cases)
  • EDI-based web forms
  • Proprietary, partner-defined flat files
  • Proprietary, partner-defined spreadsheets
  • Proprietary, partner-defined web portals
  • Proprietary, partner-defined documents sent by email or fax

Did I miss any? Probably. But the point is that standard EDI is just one of numerous conventions used for B2B integration.  Of course, standard X12 and EDIFACT EDI are still the mainstay of B2B integration. And there is little evidence to suggest that companies are ready to invest in replacing all of their EDI connections with something “better”.  In fact, EDI adoption is increasing.

Continue reading