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What happens to claims once they are received at ASK? (see diagram )

  1. Claims are submitted to ASK by the trading partner. A trading partner could be a provider office, clearinghouse or billing service.
  2. Claim files are stored on the EDI system in the trading partner’s electronic mailbox.
  3. Claim files begin their journey through the EDI system by the acknowledgement of a readable file. The Transaction Acknowledgment (TRN) is generated at this point.
  4. If the file is acknowledged as a readable claim file a 999 Acknowledgment will generate. This acknowledgement provides the status of files after file level editing has occurred.
  5. Claim files that successfully pass the file level editing (999) will be subject to extensive claim level editing.
  6. The results of the claim level editing will be provided on the 277CA Claims Acknowledgement sent to the trading partner mailbox.
  7. All claims that pass the claim level editing will be forwarded to the payer for adjudication.

 

I’ve submitted my claims - now what???

Acknowledgements generated by the EDI system are returned to the electronic mailbox of the user (trading partner) who submitted the file. It is the responsibility of the provider to review and take action on the reports.

  1. If a provider is submitting claims directly to ASK, the acknowledgements will be returned to the provider’s electronic mailbox.
  2. If a provider utilizes a clearinghouse, the acknowledgements are returned back to the clearinghouse. Then the clearinghouse should deliver these acknowledgements back to the provider for review.

Transaction Acknowledgement (TRN) – This acknowledgement is generated as soon as the file enters the EDI system. The TRN acknowledges whether or not the file is readable. If the following notation does not appear on this report please contact the EDI HelpDesk:

***No input validation problems***subsequent reports to follow***

999 Acknowledgment – The 999 Acknowledgment will also generate with each file sent through the EDI system. It is important to always review the 999 even if you receive the 277CA, since files may be partially accepted. 

 

What is the 277CA?

The purpose of the 277CA (Claims Acknowledgement) transaction is to provide a claim level acknowledgement of all claims received into the pre-processing system before submitting claims into a payer's adjudication system.  The 277CA is an electronically formatted report and will need to be translated to a readable format.  The 277CA is generated by the EDI system usually within four hours of the receipt of the claims file.

 

Why are the 999 and the 277CA important?

Claims received electronically are subject to “front-end editing.”   All errors identified on the 999 and the 277CA must be corrected and resubmitted.  Rejected claims or files will not be forwarded to the payer for payment.

Note: Claims accepted by the EDI system and passed to the payer may still be denied by the payer for various reasons.
* For more information regarding acknowledgements, please refer to the Acknowledgements Manual.

 

Who do I contact if I do not receive my acknowledgements?

  1. If a provider is utilizing a clearinghouse, inquiry should be made to the clearinghouse regarding the acknowledgments and their delivery schedule.
  2. Some vendors automate the downloading process. In this case, a provider should contact the vendor for instruction on this process.
  3. If a provider is utilizing a billing service, inquiry should be made to the billing service on whether acknowledgments are being received and reviewed.
  4. If a provider has been assigned a trading partner number, the EDI HelpDesk may be contacted regarding any questions on acknowledgements. When making inquiries through the EDI HelpDesk, if the trading partner number is not known, an assigned NPI must be identified in order to receive assistance.

Note: Reports are only available for 30 days after transmission
* For more information regarding acknowledgments, please refer to the Acknowledgements Manual.