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Wisconsin Medicaid HIPAA Companion Document to HIPAA Implementation Guide — X12 997 Functional Acknowledgement

PHC 13050 (5/03)
PDF (103 KB)

Companion Document Audience

Companion documents are intended for information technology and/or systems staff who will be coding billing systems or software for compliance with the federal Health Insurance Portability and Accountability Act of 1996 (HIPAA).

Purpose of Companion Documents

The information contained in this companion document applies to Wisconsin Medicaid, BadgerCare, and SeniorCare, although the companion document only refers to Wisconsin Medicaid.

The companion documents are designed to be used with HIPAA Implementation Guides. Companion documents provide Wisconsin Medicaid-specific information that details the way to create HIPAA transactions for Wisconsin Medicaid and explains how Wisconsin Medicaid creates HIPAA transactions. Companion documents clarify the HIPAA-designated standards usage but are not intended to supercede them. The purpose of companion documents is to provide trading partners with a guide to communicate the Wisconsin Medicaid-specific information required to successfully exchange transactions electronically with Wisconsin Medicaid.

Wisconsin Medicaid will accept and process any HIPAA-compliant transaction. However, a compliant transaction that doesn’t contain Wisconsin Medicaid-specific information, though processed, may be denied for payment. For example, a compliant 837 claim created without a Wisconsin Medicaid recipient identification number will be processed by Wisconsin Medicaid, but will be denied payment.

Companion documents highlight the data elements significant for Wisconsin Medicaid. For transactions created by Wisconsin Medicaid, companion documents explain how certain data elements are processed. Please refer to the companion document first if there is a question about how Wisconsin Medicaid processes a HIPAA transaction. For further information, contact the Division of Health Care Financing (DHCF) Electronic Data Interchange (EDI) Department at (608) 221-9036.

Element

Name

Instructions

ISA

Interchange Control Header

The ISA is a fixed-length record with fixed-length elements.

ISA05

Interchange ID (Sender) Qualifier

This element contains a value of "ZZ," mutually defined.

ISA06

Interchange Sender ID

This element contains an identifier representing the program sending the file. The following value will be sent: "WISC_TXIX," Wisconsin Medicaid.

ISA07

Interchange ID (Receiver) Qualifier

This element contains a value of "ZZ," mutually defined.

ISA08

Interchange Receiver ID

This element contains the eight-digit numeric vendor number assigned by Wisconsin Medicaid.

ISA13

Interchange Control Number

This element contains a distinct tracking number for this file.

GS02

Application Sender's Code

This element contains the same value as ISA06, the identification code for the program sending the file.

GS03

Application Receiver's Code

The value is the same value as ISA08, the eight-digit numeric vendor number assigned by Wisconsin Medicaid.

GS08

Version/Release/Industry Identifier Code

This element contains the GS08 value from the functional group it is reporting on. For example: If the 997 was reporting on a 837 professional group the value would be "004010X098A1."

AK102

Group Control Number

This element contains the value from the GS06 being acknowledged (i.e., the Group Control Number).

AK202

Transaction Set Control Number

This element contains the value from the ST02 being acknowledged (i.e., the Transaction Set Control Number).

AK301

Segment ID Code

This element contains the identification of the data segment in error (e.g., "NM1" or "SV1").

AK302

Segment Position in Transaction Set

This element contains the location of the segment in error from the "ST" segment. The third segment after the "ST" would have a value of "4" (one for the "ST" plus three more).

AK303

Loop Identifier Code

This element contains the number of the segment in error (e.g., "2310").

AK304

Segment Syntax Error Code

This element contains the error noted for the segment. The codes and descriptions are:

  • "1" Unrecognized segment ID.
  • "2" Unexpected segment.
  • "3" Mandatory segment missing. This error message maybe caused because:
    • Loop occurrence is less than minimum occurrence.
    • Segment occurrence is less than minimum occurrence.
  • "4" Loop occurs over maximum times.
  • "5" Segment exceeds maximum use.
  • "6" Segment not in defined transaction set.
  • "7" Segment not in proper sequence.
  • "8" Segment has data element errors.

AK401-1

Element Position in Segment

This composite element contains the position in the segment of the element in error. If CLM03 was in error, the value would be "3."

AK401-2

Component Data Element Position in Composite

This composite element contains the position of the composite in error within its component structure.

AK403

Data Element Syntax Error Code

This element contains the code indicating the error found. The values and descriptions are:

  • "1" Mandatory data element missing. This error message may be caused because:
    • Element is required but missing.
    • Component is required but missing.
  • "2" Conditionally required data element missing. This error message may be caused because:
    • Condition requires one or more data elements.
    • Paired data element missing. (If A is present then B must also be present.)
  • "3" Too many data elements. This error message may be caused because:
    • Root level HL segment should not be subordinate to any HL segment.
    • Cannot find the HL segment’s parent HL segment.
    • The number of data elements inside the segment exceeds the standard.
    • The number of components inside the composite exceeds the standard.
    • The element is not used by the standard.
    • The component is not used by the standard.
  • "4" Data element too short. This error message may be caused because:
    • The length is less than the minimum size.
    • The length is less than the required size.
    • A repeatable element’s occurrence is less than the minimum occurrences.
    • A repeatable component occurrence is less than the minimum occurrences.
  • "5" Data element too long. This error message may be caused because:
    • The data element is too long.
    • A repeatable element’s occurrences exceed the maximum occurrences.
    • A repeatable component’s occurrences exceed the maximum occurrences.
  • "6" Invalid character in data element. This error message may be caused because:
    • The element has the wrong format.
    • The element has the wrong value.
    • Trailing element separator(s) found.
    • Trailing component separator(s) found.
    • Found a character not in the HIPAA basic or extended character set.
    • The data has unnecessary trailing spaces.
    • A number field contains a plus, "+," sign.
    • A number field contains a decimal point, ".," without any significant digits to the right of the decimal point.
    • Invalid non-numeric data is found in a number field.
    • Found unnecessary leading zero(s) in a number field.
  • "7" Invalid code value. This error message may be caused because:
    • The value cannot be found in the code source.
    • The value must begin with "1" and be incremented by one.
    • The value must be unique within the transaction set.
    • The data does not balance as required by the standard.
    • The HL01, Hierarchy ID Number, must be unique.
    • A loop’s required subordinate loop is missing.
    • The value must be unique among elements.
  • "8" Invalid date. This error message may be caused because:
    • Date does not match specified format.
    • Data is not a valid date.
  • "9" Invalid time. This error message may be caused because:
    • Time does not match specified format.
    • Data is not a valid time.
  • "10" Exclusion condition violated.

AK404

Copy of Bad Data Element

This element contains a copy of the data in error. Not sent if bad data will affect usage/validity of this 997 (i.e., make the 997 noncompliant).

AK501

Transaction Set Acknowledgment Code

This element contains the status of the transaction set. The values and descriptions used are:

  • "A" Accepted.
  • "R" Rejected with explanation.

AK901

Functional Group Acknowledge Code

This element contains the status of functional group. The values and descriptions used are:

  • "A" Accepted.
  • "R" Rejected with explanation.

AK902

Number of Transaction Sets Included

This element contains the value from the original (file being acknowledged) GE01.

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