Wisconsin Medicaid HIPAA Companion Document to HIPAA
Implementation Guide — X12 TA1 Interchange Acknowledgement
PHC 13051 (5/03)
PDF (106 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 value will be "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. |
|
TA1 |
Interchange Acknowledgment |
A TA1 will only be sent to identify interchange
level errors. |
|
TA101 |
Interchange Control Number |
This element contains the value from ISA13 for the
interchange on which it is reporting. |
|
TA102 |
Interchange Date |
This element contains the date from ISA09 for the
interchange on which it is reporting. |
|
TA103 |
Interchange Time |
This element contains the time from the ISA10 for
the interchange on which it is reporting. |
|
TA104 |
Interchange Acknowledgment Code |
This element contains the status of the
interchange. The only value used is "R," ISA
or IEA Interchange had critical errors and the
exchange was not accepted. Correct errors and resend. |
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