999 Implementation Acknowledegment X12N - Health Care/V5010X231A1/999: 999 Implementation Acknowledgement

Company: Publication:

OIT State of New Jersey 12/2011

12/2011

Implementation Acknowledgement - 999

Table of Contents 999 Implementation Acknowledgement .................................................................................... 1 ISA Interchange Control Header .......................................................................................... 3 GS Functional Group Header ............................................................................................. 8 ST Transaction Set Header .............................................................................................. 10 AK1 Functional Group Response Header .............................................................................. 11 AK2 Transaction Set Response Header ................................................................................ 17 IK3 Error Identification .................................................................................................... 24 CTX Segment Context...................................................................................................... 26 CTX Business Unit Identifier .............................................................................................. 28 IK4 Implementation Data Element Note ............................................................................... 29 CTX Element Context ...................................................................................................... 31 IK5 Transaction Set Response Trailer ................................................................................. 33 AK9 Functional Group Response Trailer ............................................................................... 37 SE Transaction Set Trailer............................................................................................... 41 GE Functional Group Trailer ............................................................................................ 42 IEA Interchange Control Trailer ......................................................................................... 43

HIPAA - V5010X231A1 - 999 Acknowledgement

i

12/2011

Implementation Acknowledgement - 999

999

Implementation Acknowledgement Functional Group=FA

Purpose: This X12 Transaction Set contains the format and establishes the data contents of the Implementation Acknowledgement Transaction Set (999) for use within the context of an Electronic Data Interchange (EDI) environment. The transaction set can be used to define the control structures for a set of acknowledgements to indicate the results of the syntactical and relational analysis of the electronically encoded documents, based upon a full or implemented subset of X12 transaction sets. The encoded documents are the transaction sets, which are grouped in functional groups, used in defining transactions for business data interchange. This standard does not cover the semantic meaning of the information encoded in the transaction sets.

Not Defined: Pos

Id ISA GS

Segment Name Interchange Control Header Functional Group Header

Req M M

Max Use 1 1

Repeat

Notes

Usage Required Required

Id ST AK1

Segment Name Transaction Set Header Functional Group Response Header

Req M M

Max Use 1 1

Repeat

Notes N1/0100 N1/0200

Usage Required Required

>1 Transaction Set Response Header

O

1

N1/0300L N1/0300

Situational

Error Identification Segment Context Business Unit Identifier

O O O

1 9 1

Implementation Data Element Note Element Context Transaction Set Response Trailer Functional Group Response Trailer Transaction Set Trailer

O

1

O M

10 1

M

1

Required

M

1

Required

Req M M

Max Use 1 1

Heading: Pos 0100 0200

LOOP ID - AK2 0300 AK2 LOOP ID - IK3 0400 IK3 0500 CTX 0500 CTX LOOP ID - IK4 0600 IK4 0700 0800

CTX IK5

0900

AK9

1000

SE

>1

C1/0400L C1/0400

Situational Situational Situational

>1 Situational N1/0700 N1/0800

Situational Required

Not Defined: Pos

Id GE IEA

Segment Name Functional Group Trailer Interchange Control Trailer

Repeat

Notes

Usage Required Required

Notes: 1/0100

1/0200

Neither the 997 nor the 999 Acknowledgement shall be acknowledged, thereby preventing an endless cycle of acknowledgements of acknowledgements. Nor shall a Implementation Acknowledgement be sent to report errors in a previous Implementation Acknowledgement. There is only one Implementation Acknowledgement Transaction Set per acknowledged functional group. Only one acknowledgement, either a single Transaction Set 997 or a single Transaction Set 999, should be generated for a functional group unless mutually agreed upon. AK1 is used to respond to the functional group header and to start the acknowledgement for a functional group. There shall be one AK1 segment for the functional group that is being acknowledged. The Implementation Acknowledgement is generated at the point of translation, intended for the originator (not any intermediate parties). The Functional Group Header Segment (GS) is used to start the envelope for the Implementation

HIPAA - V5010X231A1 - 999 Acknowledgement

1

3/9/2011

Implementation Acknowledgement - 999

Acknowledgement Transaction Sets. In preparing the functional group of acknowledgements, the application sender's code and the application receiver's code, taken from the functional group being acknowledged, are exchanged; therefore, one acknowledgement functional group responds to only those functional groups from one application receiver's code to one application sender's code. 1/0300L AK2 is used to start the acknowledgement of a transaction set within the received functional group. The AK2 segments shall appear in the same order as the transaction sets in the functional group that has been received and is being acknowledged. 1/0300 AK2 is used to start the acknowledgement of a transaction set within the received functional group. The AK2 segments shall appear in the same order as the transaction sets in the functional group that has been received and is being acknowledged. 1/0700 The CTX Segment shall be used to disambiguate a reported error that is dependent on context. 1/0800 If any implementation guide errors have been reported in IK3 or IK4, then code I5 shall be reported in the IK5 Segment.

Comments: 1/0400L The data segments of this standard are used to report the results of the syntactical analysis of the functional groups of transaction sets; they report the extent to which the syntax complies with the standards or proper subsets of transaction sets and functional groups as expressed in compliant implementation guides. They do not report on the semantic meaning of the transaction sets (for example, on the ability of the receiver to comply with the request of the sender). 1/0400 The data segments of this standard are used to report the results of the syntactical analysis of the functional groups of transaction sets; they report the extent to which the syntax complies with the standards or proper subsets of transaction sets and functional groups as expressed in compliant implementation guides. They do not report on the semantic meaning of the transaction sets (for example, on the ability of the receiver to comply with the request of the sender).

HIPAA - V5010X231A1 - 999 Acknowledgement

2

For internal use only

12/2011

Implementation Acknowledgement - 999

Interchange Control Header

ISA

Pos: Max: 1 Not Defined - Mandatory Loop: N/A Elements: 16

User Option (Usage): Required Purpose: To start and identify an interchange of zero or more functional groups and interchange-related control segments

Element Summary: Ref ISA01

Id I01

Element Name Authorization Information Qualifier

Req M

Type ID

Min/Max 2/2

Usage Required

Description: Code identifying the type of information in the Authorization Information CodeList Summary (Total Codes: 7, Included: 7) Code Name 00 No Authorization Information Present (No Meaningful Information in I02) 01 UCS Communications ID 02 EDX Communications ID 03 Additional Data Identification 04 Rail Communications ID 05 Department of Defense (DoD) Communication Identifier 06 United States Federal Government Communication Identifier ISA02

I02

Authorization Information

M

AN

10/10

Required

Description: Information used for additional identification or authorization of the interchange sender or the data in the interchange; the type of information is set by the Authorization Information Qualifier (I01) ISA03

I03

Security Information Qualifier

M

ID

2/2

Required

Description: Code identifying the type of information in the Security Information CodeList Summary (Total Codes: 2, Included: 2) Code Name 00 No Security Information Present (No Meaningful Information in I04) 01 Password ISA04

I04

Security Information

M

AN

10/10

Required

Description: This is used for identifying the security information about the interchange sender or the data in the interchange; the type of information is set by the Security Information Qualifier (I03) ISA05

I05

Interchange ID Qualifier

M

ID

2/2

Required

Description: Code indicating the system/method of code structure used to designate the sender or receiver ID element being qualified This ID qualifies the Sender in ISA06. CodeList Summary (Total Codes: 41, Included: 41) Code Name 01 Duns (Dun & Bradstreet) 02 SCAC (Standard Carrier Alpha Code) 03 FMC (Federal Maritime Commission) 04 IATA (International Air Transport Association) 07 Global Location Number (GLN) 08 UCC EDI Communications ID (Comm ID) 09 X.121 (CCITT) 10 Department of Defense (DoD) Activity Address Code 11 DEA (Drug Enforcement Administration) HIPAA - V5010X231A1 - 999 Acknowledgement

3

3/9/2011

Implementation Acknowledgement - 999

12 13

14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34

35 36 37 38 AM NR SA SN ZZ ISA06

ISA07

Phone (Telephone Companies) UCS Code (The UCS Code is a Code Used for UCS Transmissions; it includes the Area Code and Telephone Number of a Modem; it Does Not Include Punctuation, Blanks or Access Code) Duns Plus Suffix Petroleum Accountants Society of Canada Company Code Duns Number With 4-Character Suffix American Bankers Association (ABA) Transit Routing Number (Including Check Digit, 9 Digit) Association of American Railroads (AAR) Standard Distribution Code EDI Council of Australia (EDICA) Communications ID Number (COMM ID) Health Industry Number (HIN) Integrated Postsecondary Education Data System, or (IPEDS) Federal Interagency Commission on Education, or FICE National Center for Education Statistics Common Core of Data 12-Digit Number for Pre-K-Grade 12 Institutes, or NCES The College Board's Admission Testing Program 4-Digit Code of Postsecondary Institutes, or ATP ACT, Inc. 4-Digit Code of Postsecondary Institutions. Statistics of Canada List of Postsecondary Institutions Carrier Identification Number as assigned by Health Care Financing Administration (HCFA) Fiscal Intermediary Identification Number as assigned by Health Care Financing Administration (HCFA) Medicare Provider and Supplier Identification Number as assigned by Health Care Financing Administration (HCFA) U.S. Federal Tax Identification Number Jurisdiction Identification Number Plus 4 as assigned by the International Association of Industrial Accident Boards and Commissions (IAIABC) U.S. Federal Employer Identification Number (FEIN) National Association of Insurance Commissioners Company Code (NAIC) Medicaid Provider and Supplier Identification Number as assigned by individual State Medicaid Agencies in conjunction with Health Care Financing Administration (HCFA) Statistics Canada Canadian College Student Information System Institution Codes Statistics Canada University Student Information System Institution Codes Society of Property Information Compilers and Analysts The College Board and ACT, Inc. 6-Digit Code List of Secondary Institutions Association Mexicana del Codigo de Producto (AMECOP) Communication ID National Retail Merchants Association (NRMA) - Assigned User Identification Number as assigned by the Safety and Fitness Electronic Records (SAFER) System Standard Address Number Mutually Defined

I06

Interchange Sender ID

I05

Description: Identification code published by the sender for other parties to use as the receiver ID to route data to them; the sender always codes this value in the sender ID element Interchange ID Qualifier M ID 2/2 Required

M

AN

15/15

Required

Description: Code indicating the system/method of code structure used to designate the sender or receiver ID element being qualified This ID qualifies the Receiver in ISA08. CodeList Summary (Total Codes: 41, Included: 41) HIPAA - V5010X231A1 - 999 Acknowledgement

4

For internal use only

12/2011

Implementation Acknowledgement - 999

Code 01 02 03 04 07 08 09 10 11 12 13

14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34

35 36 37 38 AM NR SA SN ZZ

HIPAA - V5010X231A1 - 999 Acknowledgement

Name Duns (Dun & Bradstreet) SCAC (Standard Carrier Alpha Code) FMC (Federal Maritime Commission) IATA (International Air Transport Association) Global Location Number (GLN) UCC EDI Communications ID (Comm ID) X.121 (CCITT) Department of Defense (DoD) Activity Address Code DEA (Drug Enforcement Administration) Phone (Telephone Companies) UCS Code (The UCS Code is a Code Used for UCS Transmissions; it includes the Area Code and Telephone Number of a Modem; it Does Not Include Punctuation, Blanks or Access Code) Duns Plus Suffix Petroleum Accountants Society of Canada Company Code Duns Number With 4-Character Suffix American Bankers Association (ABA) Transit Routing Number (Including Check Digit, 9 Digit) Association of American Railroads (AAR) Standard Distribution Code EDI Council of Australia (EDICA) Communications ID Number (COMM ID) Health Industry Number (HIN) Integrated Postsecondary Education Data System, or (IPEDS) Federal Interagency Commission on Education, or FICE National Center for Education Statistics Common Core of Data 12-Digit Number for Pre-K-Grade 12 Institutes, or NCES The College Board's Admission Testing Program 4-Digit Code of Postsecondary Institutes, or ATP ACT, Inc. 4-Digit Code of Postsecondary Institutions. Statistics of Canada List of Postsecondary Institutions Carrier Identification Number as assigned by Health Care Financing Administration (HCFA) Fiscal Intermediary Identification Number as assigned by Health Care Financing Administration (HCFA) Medicare Provider and Supplier Identification Number as assigned by Health Care Financing Administration (HCFA) U.S. Federal Tax Identification Number Jurisdiction Identification Number Plus 4 as assigned by the International Association of Industrial Accident Boards and Commissions (IAIABC) U.S. Federal Employer Identification Number (FEIN) National Association of Insurance Commissioners Company Code (NAIC) Medicaid Provider and Supplier Identification Number as assigned by individual State Medicaid Agencies in conjunction with Health Care Financing Administration (HCFA) Statistics Canada Canadian College Student Information System Institution Codes Statistics Canada University Student Information System Institution Codes Society of Property Information Compilers and Analysts The College Board and ACT, Inc. 6-Digit Code List of Secondary Institutions Association Mexicana del Codigo de Producto (AMECOP) Communication ID National Retail Merchants Association (NRMA) - Assigned User Identification Number as assigned by the Safety and Fitness Electronic Records (SAFER) System Standard Address Number Mutually Defined

5

3/9/2011

ISA08

ISA09

Implementation Acknowledgement - 999

I07

Interchange Receiver ID

I08

Description: Identification code published by the receiver of the data; When sending, it is used by the sender as their sending ID, thus other parties sending to them will use this as a receiving ID to route data to them Interchange Date M DT 6/6 Required

M

AN

15/15

Required

Description: Date of the interchange The date format is YYMMDD. ISA10

I09

Interchange Time

M

TM

4/4

Required

1/1

Required

Description: Time of the interchange The time format is HHMM. ISA11

ISA12

I65

Repetition Separator

I11

Description: Type is not applicable; the repetition separator is a delimiter and not a data element; this field provides the delimiter used to separate repeated occurrences of a simple data element or a composite data structure; this value must be different than the data element separator, component element separator, and the segment terminator Interchange Control Version Number M ID 5/5 Required

M

Description: Code specifying the version number of the interchange control segments CodeList Summary (Total Codes: 18, Included: 1) Code Name 00501 Standards Approved for Publication by ASC X12 Procedures Review Board through October 2003 ISA13

I12

Interchange Control Number

M

N0

9/9

Required

Description: A control number assigned by the interchange sender The Interchange Control Number, ISA13, must be identical to the associated Interchange Trailer IEA02. Must be a positive unsigned number and must be identical to the value in IEA02. ISA14

I13

Acknowledgement Requested

M

ID

1/1

Required

Description: Code indicating sender's request for an interchange acknowledgement See Section A.1.1.5.1 for interchange acknowledgement information. CodeList Summary (Total Codes: 2, Included: 2) Code Name 0 No Interchange Acknowledgement Requested 1 Interchange Acknowledgement Requested (TA1) ISA15

I14

Usage Indicator

M

ID

1/1

Required

Description: Code indicating whether data enclosed by this interchange envelope is test, production or information CodeList Summary (Total Codes: 3, Included: 3) Code Name I Information P Production Data T Test Data ISA16

I15

Component Element Separator

M

1/1

Required

Description: Type is not applicable; the component element separator is a delimiter and not a data element; this field provides the delimiter used to separate component data elements within a composite data structure; this value must be different than the data element separator and the segment terminator

Notes: HIPAA - V5010X231A1 - 999 Acknowledgement

6

For internal use only

12/2011

Implementation Acknowledgement - 999

1. All positions within each of the data elements must be filled. For compliant implementations under this implementation guide, ISA13, the interchange Control Number, 2. must be a positive unsigned number. Therefore, the ISA segment can be considered a fixed record length segment. 3. The first element separator defines the element separator to be used through the entire interchange. 4. The ISA segment terminator defines the segment terminator used throughout the entire interchange. 5. Spaces in the example interchanges are represented by “.” for clarity.

Example: ISA* 00* ..........* 01* SECRET....* ZZ* SUBMITTERS.ID..* ZZ*RECEIVERS.ID...* 030101* 1253* ^* 00501* 000000905* 1* T* :~

HIPAA - V5010X231A1 - 999 Acknowledgement

7

3/9/2011

Implementation Acknowledgement - 999

Functional Group Header

GS

Pos: Max: 1 Not Defined - Mandatory Loop: N/A Elements: 8

User Option (Usage): Required Purpose: To indicate the beginning of a functional group and to provide control information

Element Summary: Ref GS01

Id 479

Element Name Functional Identifier Code

Req M

Type ID

Min/Max 2/2

Usage Required

Description: Code identifying a group of application related transaction sets This is the 2-character Functional Identifier Code assigned to each transaction set by X12. The specific code for a transaction set defined by this implementation guide is presented in section 1.2, Version Information. CodeList Summary (Total Codes: 262, Included: 1) Code Name FA Functional Acknowledgement (999) GS02

142

Application Sender's Code

M

AN

2/15

Required

Description: Code identifying party sending transmission; codes agreed to by trading partners Use this code to identify the unit sending the information. GS03

124

Application Receiver's Code

M

AN

2/15

Required

Description: Code identifying party receiving transmission; codes agreed to by trading partners Use this code to identify the unit receiving the information. GS04

373

Date

M

DT

8/8

Required

Description: Date expressed as CCYYMMDD where CC represents the first two digits of the calendar year Use this date for the functional group creation date. GS05

337

Time

M

TM

4/8

Required

Description: Time expressed in 24-hour clock time as follows: HHMM, or HHMMSS, or HHMMSSD, or HHMMSSDD, where H = hours (00-23), M = minutes (00-59), S = integer seconds (00-59) and DD = decimal seconds; decimal seconds are expressed as follows: D = tenths (0-9) and DD = hundredths (00-99) Use this time for the creation time. The recommended format is HHMM. GS06

28

Group Control Number

M

N0

1/9

Required

Description: Assigned number originated and maintained by the sender For implementations compliant with this guide, GS06 must be unique within a single transmission (that is, within a single ISA to IEA enveloping structure). The authors recommend that GS06 be unique within all transmissions over a period of time to be determined by the sender. GS07

455

Responsible Agency Code

M

ID

1/2

Required

Description: Code identifying the issuer of the standard; this code is used in conjunction with Data Element 480 CodeList Summary (Total Codes: 2, Included: 1) Code Name X Accredited Standards Committee X12 GS08

480

Version / Release / Industry Identifier Code

M

AN

1/12

Required

Description: Code indicating the version, release, subrelease, and industry identifier of the HIPAA - V5010X231A1 - 999 Acknowledgement

8

For internal use only

12/2011

Implementation Acknowledgement - 999

EDI standard being used, including the GS and GE segments; if code in DE455 in GS segment is X, then in DE 480 positions 1-3 are the version number; positions 4-6 are the release and subrelease, level of the version; and positions 7-12 are the industry or trade association identifiers (optionally assigned by user); if code in DE455 in GS segment is T, then other formats are allowed This is the unique Version/Release/Industry Identifier Code assigned to an implementation by X12N. The specific code for a transaction set defined by this implementation guide is presented in section 1.2, Version Information.

Semantics: 1. GS04 is the group date. 2. GS05 is the group time. 3. The data interchange control number GS06 in this header must be identical to the same data element in the associated functional group trailer, GE02.

Comments: 1. A functional group of related transaction sets, within the scope of X12 standards, consists of a collection of similar transaction sets enclosed by a functional group header and a functional group trailer.

Notes: GS*HV*SENDER CODE*RECEIVER CODE*19940331*0802*1*X*005010X231A1~

HIPAA - V5010X231A1 - 999 Acknowledgement

9

3/9/2011

Implementation Acknowledgement - 999

Pos: 0100 Max: 1 Heading - Mandatory Loop: N/A Elements: 3

Transaction Set Header

ST

User Option (Usage): Required Purpose: To indicate the start of a transaction set and to assign a control number

Element Summary: Ref ST01

Id 143

Element Name Transaction Set Identifier Code

Req M

Type ID

Min/Max 3/3

Usage Required

4/9

Required

Description: Code uniquely identifying a Transaction Set CodeList Summary (Total Codes: 318, Included: 1) Code Name 999 Implementation Acknowledgement ST02

329

Transaction Set Control Number

M

AN

Description: Identifying control number that must be unique within the transaction set functional group assigned by the originator for a transaction set The Transaction Set Control Numbers in ST02 and SE02 must be identical. The number is assigned by the originator and must be unique within a functional group (GS-GE). The number also aids in error resolution research. For example, start with the number 0001 and increment from there. ST03

1705

Implementation Convention Reference

O

AN

1/35

Required

Description: Reference assigned to identify Implementation Convention This field contains the same value as data element GS08. This value is always 005010X231A1 when this implementation guide is utilized. Some translator products strip off the ISA and GS segments prior to application processing. Providing the information from GS08 at this level will help ensure the appropriate application mapping is utilized at translation time.

Semantics: 1. The transaction set identifier (ST01) is used by the translation routines of the interchange partners to select the appropriate transaction set definition (e.g., 810 selects the Invoice Transaction Set). 2. The implementation convention reference (ST03) is used by the translation routines of the interchange partners to select the appropriate implementation convention to match the transaction set definition. When used, this implementation convention reference takes precedence over the implementation reference specified in the GS08.

Notes: When acknowledging a healthcare implementation guide based transaction, only a single transaction set 999 can be used. When acknowledging a healthcare implementation guide based transaction, the transaction set 997 must not be used.

Example: ST*999*0001*005010X231A1~

HIPAA - V5010X231A1 - 999 Acknowledgement

10

For internal use only

12/2011

AK1

Implementation Acknowledgement - 999

0200 Max: 1 Functional Group Response Pos:Heading - Mandatory Loop: N/A Elements: 3 Header

User Option (Usage): Required Purpose: To start acknowledgement of a functional group

Element Summary: Ref AK101

Id 479

Element Name Functional Identifier Code

Req M

Type ID

Min/Max 2/2

Usage Required

Description: Code identifying a group of application related transaction sets Use the value in GS01 from the functional group to which this 999 transaction set is responding. CodeList Summary (Total Codes: 260, Included: 260) Code Name AA Account Analysis (822) AB Logistics Service Request (219) AC Associated Data (102) AD Individual Life, Annuity and Disability Application (267) AE Premium Audit Request and Return (187) AF Application for Admission to Educational Institutions (189) AG Application Advice (824) AH Logistics Service Response (220) AI Automotive Inspection Detail (928) AK Student Educational Record (Transcript) Acknowledgement (131) AL Set Cancellation (998) AM Item Information Request (893) AN Return Merchandise Authorization and Notification (180) AO Income or Asset Offset (521) AP Abandoned Property Filings (103) AQ U.S. Customs Manifest (309) AR Warehouse Stock Transfer Shipment Advice (943) AS Transportation Appointment Schedule Information (163) AT Animal Toxicological Data (249) AU U.S. Customs Status Information (350) AV U.S. Customs Carrier General Order Status (352) AW Warehouse Inventory Adjustment Advice (947) AX U.S. Customs Events Advisory Details (353) AY U.S. Customs Automated Manifest Archive Status (354) AZ U.S. Customs Acceptance/Rejection (355) BA U.S. Customs Permit to Transfer Request (356) BB U.S. Customs In-Bond Information (357) BC Business Credit Report (155) BD U.S. Customs Consist Information (358) BE Benefit Enrollment and Maintenance (834) BF Business Entity Filings (105) BL Motor Carrier Bill of Lading (211) BS Shipment and Billing Notice (857) CA Purchase Order Change Acknowledgement/Request - Seller Initiated (865) CB Unemployment Insurance Tax Claim or Charge Information (153) CC Clauses and Provisions (504) CD Credit/Debit Adjustment (812) HIPAA - V5010X231A1 - 999 Acknowledgement

11

3/9/2011

Implementation Acknowledgement - 999

CE CF CH CI CJ CK CL CM CN CO CP CQ CR CS CT CU CV CW D3 D4 D5 DA DD DF DI DM DS DX EC ED EI EN EP ER ES EV EX FA FB FC FG FR FT GC GE GF GL GP GR GT HB HC HI HN HIPAA - V5010X231A1 - 999 Acknowledgement

Cartage Work Assignment (222) Corporate Financial Adjustment Information (844 and 849) Car Handling Information (420) Consolidated Service Invoice/Statement (811) Manufacturer Coupon Family Code Structure (877) Manufacturer Coupon Redemption Detail (881) Election Campaign and Lobbyist Reporting (113) Component Parts Content (871) Coupon Notification (887) Cooperative Advertising Agreements (290) Electronic Proposal Information (251, 805) Commodity Movement Services Response (874) Rail Carhire Settlements (414) Cryptographic Service Message (815) Application Control Totals (831) Commodity Movement Services (873) Commercial Vehicle Safety and Credentials Information Exchange (285) Educational Institution Record (133) Contract Completion Status (567) Contract Abstract (561) Contract Payment Management Report (568) Debit Authorization (828) Shipment Delivery Discrepancy Information (854) Market Development Fund Allocation (883) Dealer Information (128) Equipment Order (422) Data Status Tracking (242) Direct Exchange Delivery and Return Information (894, 895) Educational Course Inventory (188) Student Educational Record (Transcript) (130) Railroad Equipment Inquiry or Advice (456) Equipment Inspection Environmental Compliance Reporting (179) Revenue Receipts Statement (170) Notice of Employment Status (540) Railroad Event Report (451) Excavation Communication (620) Functional or Implementation Acknowledgement Transaction Sets (997, 999) Freight Invoice (859) Court and Law Enforcement Information (175, 176) Motor Carrier Loading and Route Guide (217) Financial Reporting (821, 827) File Transfer (996) Damage Claim Transaction Sets (920, 924, 925, 926) General Request, Response or Confirmation (814) Response to a Load Tender (990) Intermodal Group Loading Plan (715) Grocery Products Invoice (880) Statistical Government Information (152) Grant or Assistance Application (194) Eligibility, Coverage or Benefit Information (271) Health Care Claim (837) Health Care Services Review Information (278) Health Care Information Status Notification (277) 12

For internal use only

12/2011

Implementation Acknowledgement - 999

HP HR HS HU HV IA IB IC ID IE IF IG IH IJ IM IN IO IR IS JB KM LA LB LI LN LR LS LT MA MC MD ME MF MG MH MI MJ MK MM MN MO MP MQ MR MS MT MV MW MX MY MZ NC NL NP HIPAA - V5010X231A1 - 999 Acknowledgement

Health Care Claim Payment/Advice (835) Health Care Claim Status Request (276) Eligibility, Coverage or Benefit Inquiry (270) Human Resource Information (132) Health Care Benefit Coordination Verification (269) Air Freight Details and Invoice (110, 980) Inventory Inquiry/Advice (846) Rail Advance Interchange Consist (418) Insurance/Annuity Application Status (273) Insurance Producer Administration (252) Individual Insurance Policy and Client Information (111) Direct Store Delivery Summary Information (882) Commercial Vehicle Safety Reports (284) Report of Injury, Illness or Incident (148) Motor Carrier Freight Details and Invoice (210, 980) Invoice Information (810) Ocean Shipment Billing Details (310, 312, 980) Rail Carrier Freight Details and Invoice (410, 980) Estimated Time of Arrival and Car Scheduling (421) Joint Interest Billing and Operating Expense Statement (819) Commercial Vehicle Credentials (286) Federal Communications Commission (FCC) License Application (195) Lockbox (823) Locomotive Information (436) Property and Casualty Loss Notification (272) Logistics Reassignment (536) Asset Schedule (851) Student Loan Transfer and Status Verification (144) Motor Carrier Summary Freight Bill Manifest (224) Request for Motor Carrier Rate Proposal (107) Department of Defense Inventory Management (527) Mortgage Origination (198, 200, 201, 245, 261, 262, 263, 833, 872) Market Development Fund Settlement (884) Mortgage Servicing Transaction Sets (203, 206, 259, 260, 264, 266) Motor Carrier Rate Proposal (106) Motor Carrier Shipment Status Inquiry (213) Secondary Mortgage Market Loan Delivery (202) Response to a Motor Carrier Rate Proposal (108) Medical Event Reporting (500) Mortgage Note (205) Maintenance Service Order (650) Motion Picture Booking Confirmation (159) Consolidators Freight Bill and Invoice (223) Multilevel Railcar Load Details (125) Material Safety Data Sheet (848) Electronic Form Structure (868) Material Obligation Validation (517) Rail Waybill Response (427) Material Claim (847) Response to a Cartage Work Assignment (225) Motor Carrier Package Status (240) Nonconformance Report (842) Name and Address Lists (101) Notice of Power of Attorney (157) 13

3/9/2011

Implementation Acknowledgement - 999

NR NT OC OG OR OW PA PB PC PD PE PF PG PH PI PJ PK PL PN PO PQ PR PS PT PU PV PW PY QG QM QO RA RB RC RD RE RF RG RH RI RJ RK RL RM RN RO RP RQ RR RS RT RU RV RW HIPAA - V5010X231A1 - 999 Acknowledgement

Secured Receipt or Acknowledgement (993) Notice of Tax Adjustment or Assessment (149) Cargo Insurance Advice of Shipment (362) Order Group - Grocery (875, 876) Organizational Relationships (816) Warehouse Shipping Order (940) Price Authorization Acknowledgement/Status (845) Railroad Parameter Trace Registration (455) Purchase Order Change Request - Buyer Initiated (860) Product Activity Data (852) Periodic Compensation (256) Annuity Activity (268) Insurance Plan Description (100) Pricing History (503) Patient Information (275) Project Schedule Reporting (806) Project Cost Reporting (839) and Contractor Cost Data Reporting (196) Railroad Problem Log Inquiry or Advice (452) Product Source Information (244) Purchase Order (850) Property Damage Report (112) Purchase Order Acknowledgement (855) Planning Schedule with Release Capability (830) Product Transfer and Resale Report (867) Motor Carrier Shipment Pickup Notification (216) Purchase Order Shipment Management Document (250) Healthcare Provider Information (274) Payment Cancellation Request (829) Product Information (878, 879, 888, 889, 896) Transportation Carrier Shipment Status Message (214) Ocean Shipment Status Information (313, 315) Payment Order/Remittance Advice (820) Railroad Clearance (470) Receiving Advice/Acceptance Certificate (861) Royalty Regulatory Report (185) Warehouse Stock Receipt Advice (944) Request for Routing Instructions (753) Routing Instructions (754) Railroad Reciprocal Switch File (433) Routing and Carrier Instruction (853) Railroad Mark Register Update Activity (434) Standard Transportation Commodity Code Master (435) Rail Industrial Switch List (423) Railroad Station Master File (431) Requisition Transaction (511) Ocean Booking Information (300, 301, 303) Commission Sales Report (818) Request for Quotation (840) and Procurement Notices (836) Response to Request For Quotation (843) Order Status Information (869, 870) Report of Test Results (863) Railroad Retirement Activity (429) Railroad Junctions and Interchanges Activity (437) Rail Revenue Waybill (426) 14

For internal use only

12/2011

Implementation Acknowledgement - 999

RX RY RZ SA SB SC SD SE SH SI SJ SL SM SN SO SP SQ SR SS ST SU SV SW TA TB TD TE TF TI TJ TM TN TO TP TR TS TT TU TX UA UB UC UD UI UP UW VA VB VC VD VE VH VI HIPAA - V5010X231A1 - 999 Acknowledgement

Rail Deprescription (432) Request for Student Educational Record (Transcript) (146) Response to Request for Student Educational Record (Transcript) (147) Air Shipment Information (104) Rail Carrier Services Settlement (424) Price/Sales Catalog (832) Student Loan Pre-Claims and Claims (191) Shipper's Export Declaration (601) Ship Notice/Manifest (856) Shipment Information (858) Transportation Automatic Equipment Identification (160) Student Aid Origination Record (135, 139) Motor Carrier Load Tender (204) Rail Route File Maintenance (475) Ocean Shipment Information (304, 309, 311, 317, 319, 322, 323, 324, 325, 326, 350, 352, 353, 354, 355, 356, 357, 358, 361) Specifications/Technical Information (841) Production Sequence (866) Rail Carrier Shipment Information (404, 419) Shipping Schedule (862) Railroad Service Commitment Advice (453) Account Assignment/Inquiry and Service/Status (248) Student Enrollment Verification (190) Warehouse Shipping Advice (945) Electronic Filing of Tax Return Data Acknowledgement (151) Trailer or Container Repair Billing (412) Trading Partner Profile (838) Tax or Fee Exemption Certification (283) Electronic Filing of Tax Return Data (813) Tax Information Exchange (826) Tax Jurisdiction Sourcing (158) Motor Carrier Delivery Trailer Manifest (212) Tax Rate Notification (150) Real Estate Title Services (197, 199, 265, 485, 486) Rail Rate Transactions (460, 463, 466, 468, 485, 486, 490, 492, 494) Train Sheet (161) Transportation Services Tender (602) Educational Testing and Prospect Request and Report (138) Trailer Usage Report (227) Text Message (864) Retail Account Characteristics (885) Customer Call Reporting (886) Secured Interest Filing (154) Deduction Research Report (891) Underwriting Information Services (255) Motor Carrier Pickup Manifest (215) Insurance Underwriting Requirements Reporting (186) Vehicle Application Advice (126) Vehicle Baying Order (127) Vehicle Shipping Order (120) Vehicle Damage (124) Vessel Content Details (109) Vehicle Carrier Rate Update (129) Voter Registration Information (280) 15

3/9/2011

Implementation Acknowledgement - 999

VS WA WB WG WI WL WR WT AK102

28

Vehicle Service (121) Product Service Transaction Sets (140, 141, 142, 143) Rail Carrier Waybill Interchange (417) Vendor Performance Review (501) Wage Determination (288) Well Information (625) Shipment Weights (440) Rail Waybill Request (425)

Group Control Number

M

N0

1/9

Required

Description: Assigned number originated and maintained by the sender Use the value in GS06 from the functional group to which this 999 transaction set is responding. AK103

480

Version / Release / Industry Identifier Code

O

AN

1/12

Required

Description: Code indicating the version, release, subrelease, and industry identifier of the EDI standard being used, including the GS and GE segments; if code in DE455 in GS segment is X, then in DE 480 positions 1-3 are the version number; positions 4-6 are the release and subrelease, level of the version; and positions 7-12 are the industry or trade association identifiers (optionally assigned by user); if code in DE455 in GS segment is T, then other formats are allowed IMPLEMENTATION NAME: Version, Release, or Industry Identifier Code CODE SOURCE: 881: Version / Release / Industry Identifier Code Use the value in GS08 from the functional group to which this 999 transaction set is responding. ExternalCodeList Name: 881 Description: Version / Release / Industry Identifier Code

Semantics: 1. AK101 is the functional ID found in the GS segment (GS01) in the functional group being acknowledged. 2. AK102 is the functional group control number found in the GS segment in the functional group being acknowledged. 3. AK103 is the version release industry identifier code in the GS segment (GS08) in the functional group being acknowledged.

Example: AK1*HC*0001*004010X098A1~

HIPAA - V5010X231A1 - 999 Acknowledgement

16

For internal use only

12/2011

AK2

Implementation Acknowledgement - 999

Transaction Set Response Header

Pos: 0300 Max: 1 Heading - Optional Loop: AK2 Elements: 3

User Option (Usage): Situational Purpose: To start acknowledgement of a single transaction set

Element Summary: Ref AK201

Id 143

Element Name Transaction Set Identifier Code

Req M

Type ID

Min/Max 3/3

Usage Required

Description: Code uniquely identifying a Transaction Set Use the value in ST01 from the transaction set to which this 999 transaction set is responding. CodeList Summary (Total Codes: 318, Included: 318) Code Name 100 Insurance Plan Description 101 Name and Address Lists 102 Associated Data 103 Abandoned Property Filings 104 Air Shipment Information 105 Business Entity Filings 106 Motor Carrier Rate Proposal 107 Request for Motor Carrier Rate Proposal 108 Response to a Motor Carrier Rate Proposal 109 Vessel Content Details 110 Air Freight Details and Invoice 111 Individual Insurance Policy and Client Information 112 Property Damage Report 113 Election Campaign and Lobbyist Reporting 120 Vehicle Shipping Order 121 Vehicle Service 124 Vehicle Damage 125 Multilevel Railcar Load Details 126 Vehicle Application Advice 127 Vehicle Baying Order 128 Dealer Information 129 Vehicle Carrier Rate Update 130 Student Educational Record (Transcript) 131 Student Educational Record (Transcript) Acknowledgement 132 Human Resource Information 133 Educational Institution Record 135 Student Aid Origination Record 138 Educational Testing and Prospect Request and Report 139 Student Loan Guarantee Result 140 Product Registration 141 Product Service Claim Response 142 Product Service Claim 143 Product Service Notification 144 Student Loan Transfer and Status Verification 146 Request for Student Educational Record (Transcript) 147 Response to Request for Student Educational Record (Transcript) 148 Report of Injury, Illness or Incident HIPAA - V5010X231A1 - 999 Acknowledgement

17

3/9/2011

Implementation Acknowledgement - 999

149 150 151 152 153 154 155 157 158 159 160 161 163 170 175 176 179 180 185 186 187 188 189 190 191 194 195 196 197 198 199 200 201 202 203 204 205 206 210 211 212 213 214 215 216 217 219 220 222 223 224 225 227 228 HIPAA - V5010X231A1 - 999 Acknowledgement

Notice of Tax Adjustment or Assessment Tax Rate Notification Electronic Filing of Tax Return Data Acknowledgement Statistical Government Information Unemployment Insurance Tax Claim or Charge Information Secured Interest Filing Business Credit Report Notice of Power of Attorney Tax Jurisdiction Sourcing Motion Picture Booking Confirmation Transportation Automatic Equipment Identification Train Sheet Transportation Appointment Schedule Information Revenue Receipts Statement Court and Law Enforcement Notice Court Submission Environmental Compliance Reporting Return Merchandise Authorization and Notification Royalty Regulatory Report Insurance Underwriting Requirements Reporting Premium Audit Request and Return Educational Course Inventory Application for Admission to Educational Institutions Student Enrollment Verification Student Loan Pre-Claims and Claims Grant or Assistance Application Federal Communications Commission (FCC) License Application Contractor Cost Data Reporting Real Estate Title Evidence Loan Verification Information Real Estate Settlement Information Mortgage Credit Report Residential Loan Application Secondary Mortgage Market Loan Delivery Secondary Mortgage Market Investor Report Motor Carrier Load Tender Mortgage Note Real Estate Inspection Motor Carrier Freight Details and Invoice Motor Carrier Bill of Lading Motor Carrier Delivery Trailer Manifest Motor Carrier Shipment Status Inquiry Transportation Carrier Shipment Status Message Motor Carrier Pickup Manifest Motor Carrier Shipment Pickup Notification Motor Carrier Loading and Route Guide Logistics Service Request Logistics Service Response Cartage Work Assignment Consolidators Freight Bill and Invoice Motor Carrier Summary Freight Bill Manifest Response to a Cartage Work Assignment Trailer Usage Report Equipment Inspection Report 18

For internal use only

12/2011

Implementation Acknowledgement - 999

240 242 244 245 248 249 250 251 252 255 256 259 260 261 262 263 264 265 266 267 268 269 270 271 272 273 274 275 276 277 278 280 283 284 285 286 288 290 300 301 303 304 309 310 311 312 313 315 317 319 322 323 324 325 HIPAA - V5010X231A1 - 999 Acknowledgement

Motor Carrier Package Status Data Status Tracking Product Source Information Real Estate Tax Service Response Account Assignment/Inquiry and Service/Status Animal Toxicological Data Purchase Order Shipment Management Document Pricing Support Insurance Producer Administration Underwriting Information Services Periodic Compensation Residential Mortgage Insurance Explanation of Benefits Application for Mortgage Insurance Benefits Real Estate Information Request Real Estate Information Report Residential Mortgage Insurance Application Response Mortgage Loan Default Status Real Estate Title Insurance Services Order Mortgage or Property Record Change Notification Individual Life, Annuity and Disability Application Annuity Activity Health Care Benefit Coordination Verification Eligibility, Coverage or Benefit Inquiry Eligibility, Coverage or Benefit Information Property and Casualty Loss Notification Insurance/Annuity Application Status Healthcare Provider Information Patient Information Health Care Claim Status Request Health Care Information Status Notification Health Care Services Review Information Voter Registration Information Tax or Fee Exemption Certification Commercial Vehicle Safety Reports Commercial Vehicle Safety and Credentials Information Exchange Commercial Vehicle Credentials Wage Determination Cooperative Advertising Agreements Reservation (Booking Request) (Ocean) Confirmation (Ocean) Booking Cancellation (Ocean) Shipping Instructions Customs Manifest Freight Receipt and Invoice (Ocean) Canada Customs Information Arrival Notice (Ocean) Shipment Status Inquiry (Ocean) Status Details (Ocean) Delivery/Pickup Order Terminal Information Terminal Operations and Intermodal Ramp Activity Vessel Schedule and Itinerary (Ocean) Vessel Stow Plan (Ocean) Consolidation of Goods In Container 19

3/9/2011

Implementation Acknowledgement - 999

326 350 352 353 354 355 356 357 358 361 362 404 410 412 414 417 418 419 420 421 422 423 424 425 426 429 431 432 433 434 435 436 437 440 451 452 453 455 456 460 463 466 468 470 475 485 486 490 492 494 500 501 503 504 HIPAA - V5010X231A1 - 999 Acknowledgement

Consignment Summary List Customs Status Information U.S. Customs Carrier General Order Status Customs Events Advisory Details U.S. Customs Automated Manifest Archive Status U.S. Customs Acceptance/Rejection U.S. Customs Permit to Transfer Request U.S. Customs In-Bond Information Customs Consist Information Carrier Interchange Agreement (Ocean) Cargo Insurance Advice of Shipment Rail Carrier Shipment Information Rail Carrier Freight Details and Invoice Trailer or Container Repair Billing Rail Carhire Settlements Rail Carrier Waybill Interchange Rail Advance Interchange Consist Advance Car Disposition Car Handling Information Estimated Time of Arrival and Car Scheduling Equipment Order Rail Industrial Switch List Rail Carrier Services Settlement Rail Waybill Request Rail Revenue Waybill Railroad Retirement Activity Railroad Station Master File Rail Deprescription Railroad Reciprocal Switch File Railroad Mark Register Update Activity Standard Transportation Commodity Code Master Locomotive Information Railroad Junctions and Interchanges Activity Shipment Weights Railroad Event Report Railroad Problem Log Inquiry or Advice Railroad Service Commitment Advice Railroad Parameter Trace Registration Railroad Equipment Inquiry or Advice Railroad Price Distribution Request or Response Rail Rate Reply Rate Request Rate Docket Journal Log Railroad Clearance Rail Route File Maintenance Ratemaking Action Rate Docket Expiration Rate Group Definition Miscellaneous Rates Rail Scale Rates Medical Event Reporting Vendor Performance Review Pricing History Clauses and Provisions 20

For internal use only

12/2011

Implementation Acknowledgement - 999

511 517 521 527 536 540 561 567 568 601 602 620 625 650 715 753 754 805 806 810 811 812 813 814 815 816 818 819 820 821 822 823 824 826 827 828 829 830 831 832 833 834 835 836 837 838 839 840 841 842 843 844 845 846 HIPAA - V5010X231A1 - 999 Acknowledgement

Requisition Material Obligation Validation Income or Asset Offset Material Due-In and Receipt Logistics Reassignment Notice of Employment Status Contract Abstract Contract Completion Status Contract Payment Management Report U.S. Customs Export Shipment Information Transportation Services Tender Excavation Communication Well Information Maintenance Service Order Intermodal Group Loading Plan Request for Routing Instructions Routing Instructions Contract Pricing Proposal Project Schedule Reporting Invoice Consolidated Service Invoice/Statement Credit/Debit Adjustment Electronic Filing of Tax Return Data General Request, Response or Confirmation Cryptographic Service Message Organizational Relationships Commission Sales Report Joint Interest Billing and Operating Expense Statement Payment Order/Remittance Advice Financial Information Reporting Account Analysis Lockbox Application Advice Tax Information Exchange Financial Return Notice Debit Authorization Payment Cancellation Request Planning Schedule with Release Capability Application Control Totals Price/Sales Catalog Mortgage Credit Report Order Benefit Enrollment and Maintenance Health Care Claim Payment/Advice Procurement Notices Health Care Claim Trading Partner Profile Project Cost Reporting Request for Quotation Specifications/Technical Information Nonconformance Report Response to Request for Quotation Product Transfer Account Adjustment Price Authorization Acknowledgement/Status Inventory Inquiry/Advice 21

3/9/2011

Implementation Acknowledgement - 999

847 848 849 850 851 852 853 854 855 856 857 858 859 860 861 862 863 864 865 866 867 868 869 870 871 872 873 874 875 876 877 878 879 880 881 882 883 884 885 886 887 888 889 891 893 894 895 896 920 924 925 926 928 940 HIPAA - V5010X231A1 - 999 Acknowledgement

Material Claim Material Safety Data Sheet Response to Product Transfer Account Adjustment Purchase Order Asset Schedule Product Activity Data Routing and Carrier Instruction Shipment Delivery Discrepancy Information Purchase Order Acknowledgement Ship Notice/Manifest Shipment and Billing Notice Shipment Information Freight Invoice Purchase Order Change Request - Buyer Initiated Receiving Advice/Acceptance Certificate Shipping Schedule Report of Test Results Text Message Purchase Order Change Acknowledgement/Request - Seller Initiated Production Sequence Product Transfer and Resale Report Electronic Form Structure Order Status Inquiry Order Status Report Component Parts Content Residential Mortgage Insurance Application Commodity Movement Services Commodity Movement Services Response Grocery Products Purchase Order Grocery Products Purchase Order Change Manufacturer Coupon Family Code Structure Product Authorization/De-authorization Price Information Grocery Products Invoice Manufacturer Coupon Redemption Detail Direct Store Delivery Summary Information Market Development Fund Allocation Market Development Fund Settlement Retail Account Characteristics Customer Call Reporting Coupon Notification Item Maintenance Promotion Announcement Deduction Research Report Item Information Request Delivery/Return Base Record Delivery/Return Acknowledgement or Adjustment Product Dimension Maintenance Loss or Damage Claim - General Commodities Loss or Damage Claim - Motor Vehicle Claim Tracer Claim Status Report and Tracer Reply Automotive Inspection Detail Warehouse Shipping Order 22

For internal use only

12/2011

Implementation Acknowledgement - 999

943 944 945 947 980 990 993 996 997 998 999 AK202

329

Warehouse Stock Transfer Shipment Advice Warehouse Stock Transfer Receipt Advice Warehouse Shipping Advice Warehouse Inventory Adjustment Advice Functional Group Totals Response to a Load Tender Secured Receipt or Acknowledgement File Transfer Functional Acknowledgement Set Cancellation Implementation Acknowledgement

Transaction Set Control Number

M

AN

4/9

Required

Description: Identifying control number that must be unique within the transaction set functional group assigned by the originator for a transaction set Use the value in ST02 from the transaction set to which this 999 transaction set is responding. AK203

1705

Implementation Convention Reference

O

AN

1/35

Situational

Description: Reference assigned to identify Implementation Convention Situational Rule: Required when the ST03 value is available in the transaction set to which this 999 transaction set is responding. If not required by this implementation guide, do not send. When used, this is the value in ST03 from the transaction set to which this 999 transaction set is responding.

Semantics: 1. AK201 is the transaction set ID found in the ST segment (ST01) in the transaction set being acknowledged. 2. AK202 is the transaction set control number found in the ST segment in the transaction set being acknowledged. 3. AK203 is the implementation convention reference, if any, found in the ST segment (ST03) in the transaction set being acknowledged.

Situational Rule: Required when an error is present in a transaction set contained in the functional group to which this 999 transaction set is responding. If not required by this implementation guide, may be provided at the sender’s discretion but cannot be required by the receiver.

Notes: 1. While it is not required that an AK2 loop be included for each transaction set received, it is required that an AK2 loop be included for each transaction set that contains an error. When AK2 loops are included in this transaction set, they must be in the same order as received in the functional group to which this 999 is responding.

Example: AK2*837*0001~

HIPAA - V5010X231A1 - 999 Acknowledgement

23

3/9/2011

IK3

Implementation Acknowledgement - 999

Pos: 0400 Max: 1 Heading - Optional Loop: IK3 Elements: 4

Error Identification

User Option (Usage): Situational Purpose: To report implementation errors in a data segment and identify the location of the data segment

Element Summary: Ref IK301

Id 721

Element Name Segment ID Code

Req M

Type ID

Min/Max 2/3

Usage Required

Description: Code defining the segment ID of the data segment in error (See Appendix A Number 77) CODE SOURCE: 77: X12 Directories External Code List Name: 77 Description: X12 Directories IK302

719

Segment Position in Transaction Set

M

N0

1/10

Required

Description: The numerical count position of this data segment from the start of the transaction set: the transaction set header is count position 1 The value to use in IK302 is the numerical count position of this data segment, relative to the transaction set instance (not the transaction set diagram), from the start of the transaction set. The transaction set header (i.e. ST) is count position 1. IK303

447

Loop Identifier Code

O

AN

1/4

Situational

Description: The loop ID number given on the transaction set diagram is the value for this data element in segments LS and LE Situational Rule: Required when the data segment containing the error is within an LS loop and the LS01 value is known by the submitter of this 999, or when the data segment containing the error is within another type of loop and the loop identifier value from the transaction set diagram is known by the submitter of this 999. If not required by this implementation guide, do not send. Only the first four characters of the loop identifier must be used. IK304

620

Implementation Segment Syntax Error Code

O

ID

1/3

Required

Description: Code indicating implementation error found based on the syntax editing of a segment CodeList Summary (Total Codes: 13, Included: 13) Code Name 1 Unrecognized segment ID 2 Unexpected segment 3 Required Segment Missing 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 I4 Implementation "Not Used" Segment Present I6 Implementation Dependent Segment Missing I7 Implementation Loop Occurs Under Minimum Times I8 Implementation Segment Below Minimum Use I9 Implementation Dependent "Not Used" Segment Present

Situational Rule: HIPAA - V5010X231A1 - 999 Acknowledgement

24

For internal use only

12/2011

Implementation Acknowledgement - 999

Required when an error is present in the transaction set identified in this AK2 loop and the location of the data segment containing the error can be identified by the submitter of this 999. If not required by this implementation guideline, do not send.

Example: IK3*DMG*31*2000*8~

HIPAA - V5010X231A1 - 999 Acknowledgement

25

3/9/2011

CTX

Implementation Acknowledgement - 999

Pos: 0500 Max: 9 Heading - Optional Loop: IK3 Elements: 6

Segment Context

User Option (Usage): Situational Purpose: Describes an event context in terms of the application or implementation contexts in force at the time the event occurred and the position in the EDI stream at which that context was activated

Element Summary: Ref CTX01

Id C998

Element Name Context Identification

Req M

Type Comp

Min/Max

Usage Required

AN

1/35

Required

2/3

Required

Description: Holds information to identify a context CTX01-01

9999

Context Name

M

Description: Holds the name or 'tag' of a context Always contains the value “SITUATIONAL TRIGGER”. CTX02

721

Segment ID Code

O

ID

Description: Code defining the segment ID of the data segment in error (See Appendix A Number 77) CODE SOURCE: 77: X12 Directories ExternalCodeList Name: 77 Description: X12 Directories CTX03

719

Segment Position in Transaction Set

O

N0

1/10

Required

Description: The numerical count position of this data segment from the start of the transaction set: the transaction set header is count position 1 CTX04

447

Loop Identifier Code

O

AN

1/4

Situational

Description: The loop ID number given on the transaction set diagram is the value for this data element in segments LS and LE Situational Rule: Required when the data segment containing the situational requirement is within an LS loop and the LS01 value is known by the submitter of this 999, or when the data segment containing the situational requirement is within another type of loop and the loop identifier value from the transaction set diagram is known by the submitter of this 999. If not required by this implementation guide, do not send. Only the first four characters of the loop identifier must be used. CTX05

C030

Position in Segment

O

Comp

Situational

Description: Code indicating the relative position of the simple data element or composite data structure in error within a segment, count beginning with 1 for the position immediately following the segment ID; additionally indicating the relative position of a repeating structure in error, count beginning with 1 for the position immediately following the preceding element separator; additionally indicating the relative position of a component of a composite data structure in error, count beginning with 1 for the position following the preceding element or repetition separator Situational Rule: Required when the situational requirement relates to an element. If not required by this implementation guide, do not send. CTX05-01

722

Element Position in Segment

M

N0

1/2

Required

Description: This is used to indicate the relative position of a simple data element, or the relative position of a composite data structure with the relative position of the component within the composite data structure, in error; in the data segment the count starts with 1 for the simple data element or composite data structure immediately following the segment ID CTX05-02

1528

Component Data Element Position in Composite

HIPAA - V5010X231A1 - 999 Acknowledgement

26

O

N0

1/2

Situational

For internal use only

12/2011

Implementation Acknowledgement - 999

Description: To identify the component data element position within the composite that is in error Situational Rule: Required when the situational requirement relates to a component data element within a composite data structure. If not required by this implementation guide, do not send. CTX05-03

1686

Repeating Data Element Position

O

N0

1/4

Situational

Description: To identify the specific repetition of a data element that is in error Situational Rule: Required when the situational requirement relates to a repeating data element. If not required by this implementation guide, do not send. CTX06

C999

Reference in Segment

O

Comp

Situational

Description: To hold the reference number of a data element and optionally a component data element within a composite Situational Rule: Required when CTX05 is used and the data element reference number of the data element identified in CTX05-1 is known by the sumbitter of the 999, and it is NOT a composite data element. If not required by this implementation guide, do not send. CTX06-01

725

Data Element Reference Number

M

N0

1/4

Required

Description: Reference number used to locate the data element in the Data Element Dictionary CODE SOURCE: 77: X12 Directories ExternalCodeList Name: 77 Description: X12 Directories

Situational Rule: Required when the error identified in this IK3 loop was triggered by a situational requirement of the implementation guide and the error occurs at the segment level. If not required by this implementation guide, do not send.

Notes: 1. The CTX segment is used to identify the data that triggered the situational requirement.

Example: CTX*SITUATIONAL TRIGGER*CLM*43**5:3~ CTX*SITUATIONAL TRIGGER*CLM*43**2*782~

HIPAA - V5010X231A1 - 999 Acknowledgement

27

3/9/2011

CTX

Implementation Acknowledgement - 999

Pos: 0500 Max: 1 Heading - Optional Loop: IK3 Elements: 1

Business Unit Identifier

User Option (Usage): Situational Purpose: Describes an event context in terms of the application or implementation contexts in force at the time the event occurred and the position in the EDI stream at which that context was activated

Element Summary: Ref CTX01

Id C998

Element Name Context Identification

Req M

Type Comp

Min/Max

Usage Required

AN

1/35

Required

Description: Holds information to identify a context CTX01-01

9999

Context Name

M

Description: Holds the name or 'tag' of a context This contains one of the following values, depending on the value in AK201: TRN02 269 business unit identifier TRN02 270 business unit identifier TRN02 271 business unit identifier NM109 274 business unit identifier PATIENT NAME NM109 275 business unit identifier TRN02 276 business unit identifier TRN02 277 business unit identifier SUBSCRIBER NAME NM109 278 business unit identifier ENT01 820 business unit identifier SUBSCRIBER NUMBER REF02 834 business unit identifier TRN02 835 business unit identifier CLM01 837 business unit identifier CTX01-02

9998

Context Reference

O

AN

1/35

Required

Description: Holds a reference to or for a context This contains the value from the business unit identifier specified in CTX01-1.

Situational Rule: Required when the error reported in this IK3 loop is within a business unit and the business unit identifier is known by the submitter of the 999. If not required by this implementation guide, do not send.

Notes: 1. Valid values for the business unit identifier are: TRN02 269 business unit identifier TRN02 270 business unit identifier TRN02 271 business unit identifier NM109 274 business unit identifier PATIENT NAME NM109 275 business unit identifier TRN02 276 business unit identifier TRN02 277 business unit identifier SUBSCRIBER NAME NM109 278 business unit identifier ENT01 820 business unit identifier SUBSCRIBER NUMBER REF02 834 business unit identifier TRN02 835 business unit identifier CLM01 837 business unit identifier

Example: CTX*CLM01:123456789~

HIPAA - V5010X231A1 - 999 Acknowledgement

28

For internal use only

12/2011

IK4

Implementation Acknowledgement - 999

Implementation Data Element Note

Pos: 0600 Max: 1 Heading - Optional Loop: IK4 Elements: 4

User Option (Usage): Situational Purpose: To report implementation errors in a data element or composite data structure and identify the location of the data element

Element Summary: Ref IK401

Id C030

Element Name Position in Segment

Req M

Type Comp

Min/Max

Usage Required

Description: Code indicating the relative position of the simple data element or composite data structure in error within a segment, count beginning with 1 for the position immediately following the segment ID; additionally indicating the relative position of a repeating structure in error, count beginning with 1 for the position immediately following the preceding element separator; additionally indicating the relative position of a component of a composite data structure in error, count beginning with 1 for the position following the preceding element or repetition separator IK401-01

722

Element Position in Segment

M

N0

1/2

Required

Description: This is used to indicate the relative position of a simple data element, or the relative position of a composite data structure with the relative position of the component within the composite data structure, in error; in the data segment the count starts with 1 for the simple data element or composite data structure immediately following the segment ID IK401-02

1528

Component Data Element Position in Composite

O

N0

1/2

Situational

Description: To identify the component data element position within the composite that is in error Situational Rule: Required when the error described in this segment relates to a component data element within a composite data structure. If not required by this implementation guide, do not send. IK401-03

1686

Repeating Data Element Position

O

N0

1/4

Situational

Description: To identify the specific repetition of a data element that is in error Situational Rule: Required when the error described in this segment relates to a repeating data element. If not required by this implementation guide, do not send. IK402

725

Data Element Reference Number

O

N0

1/4

Situational

Description: Reference number used to locate the data element in the Data Element Dictionary Situational Rule: Required when the data element reference number for the errored data is known. If not required by this implementation guide, do not send. CODE SOURCE: 77: X12 Directories ExternalCodeList Name: 77 Description: X12 Directories IK403

621

Implementation Data Element Syntax Error Code

M

ID

1/3

Required

Description: Code indicating the implementation error found after syntax edits of a data element CodeList Summary (Total Codes: 18, Included: 18) Code Name 1 Required Data Element Missing 2 Conditional Required Data Element Missing HIPAA - V5010X231A1 - 999 Acknowledgement

29

3/9/2011

Implementation Acknowledgement - 999

3 4 5 6 7 8 9 10 12 13 I6 I9 I10 I11 I12 I13 IK404

724

Too Many Data Elements Data Element Too Short Data Element Too Long Invalid Character In Data Element Invalid Code Value Invalid Date Invalid Time Exclusion Condition Violated Too Many Repetitions Too Many Components Code Value Not Used in Implementation Implementation Dependent Data Element Missing Implementation "Not Used" Data Element Present Implementation Too Few Repetitions Implementation Pattern Match Failure Implementation Dependent "Not Used" Data Element Present

Copy of Bad Data Element

O

AN

1/99

Situational

Description: This is a copy of the data element in error Situational Rule: Required unless invalid characters are present, data is missing, or the data is from a binary data element. If not required by this implementation guide, do not send.

Situational Rule: Required when the error in the segment described in the IK3 segment applies to a data element and the location of the data element containing the error can be identified by the submitter of the 999. If not required by this implementation guideline, do not send.

Example: IK4*3*1068*7*B~

HIPAA - V5010X231A1 - 999 Acknowledgement

30

For internal use only

12/2011

CTX

Implementation Acknowledgement - 999

Pos: 0700 Max: 10 Heading - Optional Loop: IK4 Elements: 6

Element Context

User Option (Usage): Situational Purpose: Describes an event context in terms of the application or implementation contexts in force at the time the event occurred and the position in the EDI stream at which that context was activated

Element Summary: Ref CTX01

Id C998

Element Name Context Identification

Req M

Type Comp

Min/Max

Usage Required

AN

1/35

Required

2/3

Required

Description: Holds information to identify a context CTX01-01

9999

Context Name

M

Description: Holds the name or 'tag' of a context Always contains the value “SITUATIONAL TRIGGER”. CTX02

721

Segment ID Code

O

ID

Description: Code defining the segment ID of the data segment in error (See Appendix A Number 77) CODE SOURCE: 77: X12 Directories ExternalCodeList Name: 77 Description: X12 Directories CTX03

719

Segment Position in Transaction Set

O

N0

1/10

Required

Description: The numerical count position of this data segment from the start of the transaction set: the transaction set header is count position 1 CTX04

447

Loop Identifier Code

O

AN

1/4

Situational

Description: The loop ID number given on the transaction set diagram is the value for this data element in segments LS and LE Situational Rule: Required when the data segment containing the situational requirement is within an LS loop and the LS01 value is known by the submitter of this 999, or when the data segment containing the situational requirement is within another type of loop and the loop identifier value from the transaction set diagram is known by the submitter of this 999. If not required by this implementation guide, do not send. Only the first four characters of the loop identifier must be used. CTX05

C030

Position in Segment

O

Comp

Situational

Description: Code indicating the relative position of the simple data element or composite data structure in error within a segment, count beginning with 1 for the position immediately following the segment ID; additionally indicating the relative position of a repeating structure in error, count beginning with 1 for the position immediately following the preceding element separator; additionally indicating the relative position of a component of a composite data structure in error, count beginning with 1 for the position following the preceding element or repetition separator Situational Rule: Required when the situational requirement relates to an element. If not required by this implementation guide, do not send. CTX05-01

722

Element Position in Segment

M

N0

1/2

Required

Description: This is used to indicate the relative position of a simple data element, or the relative position of a composite data structure with the relative position of the component within the composite data structure, in error; in the data segment the count starts with 1 for the simple data element or composite data structure immediately following the segment ID CTX05-02

1528

Component Data Element Position in Composite

HIPAA - V5010X231A1 - 999 Acknowledgement

31

O

N0

1/2

Situational

3/9/2011

Implementation Acknowledgement - 999

Description: To identify the component data element position within the composite that is in error Situational Rule: Required when the situational requirement relates to a component data element within a composite data structure. If not required by this implementation guide, do not send. CTX05-03

1686

Repeating Data Element Position

O

N0

1/4

Situational

Description: To identify the specific repetition of a data element that is in error Situational Rule: Required when the situational requirement relates to a repeating data element. If not required by this implementation guide, do not send. CTX06

C999

Reference in Segment

O

Comp

Situational

Description: To hold the reference number of a data element and optionally a component data element within a composite Situational Rule: Required when CTX05 is used and the data element reference number of the data element identified in CTX05-1 is known by the sumbitter of the 999, and it is NOT a composite data element. If not required by this implementation guide, do not send. CTX06-01

725

Data Element Reference Number

M

N0

1/4

Required

Description: Reference number used to locate the data element in the Data Element Dictionary CODE SOURCE: 77: X12 Directories ExternalCodeList Name: 77 Description: X12 Directories

Situational Rule: Required when the error identified in this IK4 loop was triggered by a situational requirement of the implementation guide and the error occurs at the element level. If not required by this implementation guide, do not send.

Notes: 1. The CTX segment is used to identify the data that triggered the situational requirement.

Example: CTX*SITUATIONAL TRIGGER*CLM*43**5:3~ CTX*SITUATIONAL TRIGGER*CLM*43**2*782~

HIPAA - V5010X231A1 - 999 Acknowledgement

32

For internal use only

12/2011

IK5

Implementation Acknowledgement - 999

Transaction Set Response Trailer

Pos: 0800 Max: 1 Heading - Mandatory Loop: AK2 Elements: 6

User Option (Usage): Required Purpose: To acknowledge acceptance or rejection and report implementation errors in a transaction set

Element Summary: Ref IK501

Id 717

Element Name Transaction Set Acknowledgement Code

Req M

Type ID

Min/Max 1/1

Usage Required

Description: Code indicating accept or reject condition based on the syntax editing of the transaction set CodeList Summary (Total Codes: 6, Included: 6) Code Name A Accepted E Accepted But Errors Were Noted The transaction set indicated in this AK2 loop contained errors, but was forwarded for further processing. M Rejected, Message Authentication Code (MAC) Failed R Rejected The transaction set indicated in this AK2 loop contained errors, and was NOT forwarded for further processing. It will need to be corrected and resubmitted. W Rejected, Assurance Failed Validity Tests X Rejected, Content After Decryption Could Not Be Analyzed IK502

618

Implementation Transaction Set Syntax Error Code

O

ID

1/3

Situational

Description: Code indicating implementation error found based on the syntax editing of a transaction set Situational Rule: Required when IK501 = E or R. If not required by this implementation guide, do not send. CodeList Summary (Total Codes: 25, Included: 25) Code Name 1 Transaction Set Not Supported 2 Transaction Set Trailer Missing 3 Transaction Set Control Number in Header and Trailer Do Not Match 4 Number of Included Segments Does Not Match Actual Count 5 One or More Segments in Error 6 Missing or Invalid Transaction Set Identifier 7 Missing or Invalid Transaction Set Control Number 8 Authentication Key Name Unknown 9 Encryption Key Name Unknown 10 Requested Service (Authentication or Encrypted) Not Available 11 Unknown Security Recipient 12 Incorrect Message Length (Encryption Only) 13 Message Authentication Code Failed 15 Unknown Security Originator 16 Syntax Error in Decrypted Text 17 Security Not Supported 18 Transaction Set not in Functional Group 19 Invalid Transaction Set Implementation Convention Reference HIPAA - V5010X231A1 - 999 Acknowledgement

33

3/9/2011

Implementation Acknowledgement - 999

23 24 25 26 27 I5 I6 IK503

618

Transaction Set Control Number Not Unique within the Functional Group S3E Security End Segment Missing for S3S Security Start Segment S3S Security Start Segment Missing for S3E Security End Segment S4E Security End Segment Missing for S4S Security Start Segment S4S Security Start Segment Missing for S4E Security End Segment Implementation One or More Segments in Error Implementation Convention Not Supported

Implementation Transaction Set Syntax Error Code

O

ID

1/3

Situational

Description: Code indicating implementation error found based on the syntax editing of a transaction set Situational Rule: Required when IK501 = E or R, and IK502 has been used, and there are additional error codes to report. If not required by this implementation guide, do not send. CodeList Summary (Total Codes: 25, Included: 25) Code Name 1 Transaction Set Not Supported 2 Transaction Set Trailer Missing 3 Transaction Set Control Number in Header and Trailer Do Not Match 4 Number of Included Segments Does Not Match Actual Count 5 One or More Segments in Error 6 Missing or Invalid Transaction Set Identifier 7 Missing or Invalid Transaction Set Control Number 8 Authentication Key Name Unknown 9 Encryption Key Name Unknown 10 Requested Service (Authentication or Encrypted) Not Available 11 Unknown Security Recipient 12 Incorrect Message Length (Encryption Only) 13 Message Authentication Code Failed 15 Unknown Security Originator 16 Syntax Error in Decrypted Text 17 Security Not Supported 18 Transaction Set not in Functional Group 19 Invalid Transaction Set Implementation Convention Reference 23 Transaction Set Control Number Not Unique within the Functional Group 24 S3E Security End Segment Missing for S3S Security Start Segment 25 S3S Security Start Segment Missing for S3E Security End Segment 26 S4E Security End Segment Missing for S4S Security Start Segment 27 S4S Security Start Segment Missing for S4E Security End Segment I5 Implementation One or More Segments in Error I6 Implementation Convention Not Supported IK504

618

Implementation Transaction Set Syntax Error Code

O

ID

1/3

Situational

Description: Code indicating implementation error found based on the syntax editing of a transaction set Situational Rule: Required when IK501 = E or R, and IK502 and IK503 have been used, and there are additional error codes to report. If not required by this implementation guide, do not send. CodeList Summary (Total Codes: 25, Included: 25) Code Name 1 Transaction Set Not Supported 2 Transaction Set Trailer Missing 3 Transaction Set Control Number in Header and Trailer Do Not Match 4 Number of Included Segments Does Not Match Actual Count HIPAA - V5010X231A1 - 999 Acknowledgement

34

For internal use only

12/2011

Implementation Acknowledgement - 999

5 6 7 8 9 10 11 12 13 15 16 17 18 19 23 24 25 26 27 I5 I6 IK505

618

One or More Segments in Error Missing or Invalid Transaction Set Identifier Missing or Invalid Transaction Set Control Number Authentication Key Name Unknown Encryption Key Name Unknown Requested Service (Authentication or Encrypted) Not Available Unknown Security Recipient Incorrect Message Length (Encryption Only) Message Authentication Code Failed Unknown Security Originator Syntax Error in Decrypted Text Security Not Supported Transaction Set not in Functional Group Invalid Transaction Set Implementation Convention Reference Transaction Set Control Number Not Unique within the Functional Group S3E Security End Segment Missing for S3S Security Start Segment S3S Security Start Segment Missing for S3E Security End Segment S4E Security End Segment Missing for S4S Security Start Segment S4S Security Start Segment Missing for S4E Security End Segment Implementation One or More Segments in Error Implementation Convention Not Supported

Implementation Transaction Set Syntax Error Code

O

ID

1/3

Situational

Description: Code indicating implementation error found based on the syntax editing of a transaction set Situational Rule: Required when IK501 = E or R, and IK502, IK503, and IK504 have been used, and there are additional error codes to report. If not required by this implementation guide, do not send. CodeList Summary (Total Codes: 25, Included: 25) Code Name 1 Transaction Set Not Supported 2 Transaction Set Trailer Missing 3 Transaction Set Control Number in Header and Trailer Do Not Match 4 Number of Included Segments Does Not Match Actual Count 5 One or More Segments in Error 6 Missing or Invalid Transaction Set Identifier 7 Missing or Invalid Transaction Set Control Number 8 Authentication Key Name Unknown 9 Encryption Key Name Unknown 10 Requested Service (Authentication or Encrypted) Not Available 11 Unknown Security Recipient 12 Incorrect Message Length (Encryption Only) 13 Message Authentication Code Failed 15 Unknown Security Originator 16 Syntax Error in Decrypted Text 17 Security Not Supported 18 Transaction Set not in Functional Group 19 Invalid Transaction Set Implementation Convention Reference 23 Transaction Set Control Number Not Unique within the Functional Group 24 S3E Security End Segment Missing for S3S Security Start Segment 25 S3S Security Start Segment Missing for S3E Security End Segment 26 S4E Security End Segment Missing for S4S Security Start Segment 27 S4S Security Start Segment Missing for S4E Security End Segment I5 Implementation One or More Segments in Error HIPAA - V5010X231A1 - 999 Acknowledgement

35

3/9/2011

Implementation Acknowledgement - 999

I6 IK506

618

Implementation Convention Not Supported

Implementation Transaction Set Syntax Error Code

O

ID

1/3

Situational

Description: Code indicating implementation error found based on the syntax editing of a transaction set Situational Rule: Required when IK501 = E or R, and IK502, IK503, IK504, and IK505 have been used, and there are additional error codes to report. If not required by this implementation guide, do not send. CodeList Summary (Total Codes: 25, Included: 25) Code Name 1 Transaction Set Not Supported 2 Transaction Set Trailer Missing 3 Transaction Set Control Number in Header and Trailer Do Not Match 4 Number of Included Segments Does Not Match Actual Count 5 One or More Segments in Error 6 Missing or Invalid Transaction Set Identifier 7 Missing or Invalid Transaction Set Control Number 8 Authentication Key Name Unknown 9 Encryption Key Name Unknown 10 Requested Service (Authentication or Encrypted) Not Available 11 Unknown Security Recipient 12 Incorrect Message Length (Encryption Only) 13 Message Authentication Code Failed 15 Unknown Security Originator 16 Syntax Error in Decrypted Text 17 Security Not Supported 18 Transaction Set not in Functional Group 19 Invalid Transaction Set Implementation Convention Reference 23 Transaction Set Control Number Not Unique within the Functional Group 24 S3E Security End Segment Missing for S3S Security Start Segment 25 S3S Security Start Segment Missing for S3E Security End Segment 26 S4E Security End Segment Missing for S4S Security Start Segment 27 S4S Security Start Segment Missing for S4E Security End Segment I5 Implementation One or More Segments in Error I6 Implementation Convention Not Supported

Example: IK5*R*5~

HIPAA - V5010X231A1 - 999 Acknowledgement

36

For internal use only

12/2011

Implementation Acknowledgement - 999

0900 Max: 1 Functional Group Response Pos:Heading - Mandatory Loop: N/A Elements: 9 Trailer

AK9

User Option (Usage): Required Purpose: To acknowledge acceptance or rejection of a functional group and report the number of included transaction sets from the original trailer, the accepted sets, and the received sets in this functional group

Element Summary: Ref AK901

Id 715

Element Name Functional Group Acknowledge Code

Req M

Type ID

Min/Max 1/1

Usage Required

Description: Code indicating accept or reject condition based on the syntax editing of the functional group CodeList Summary (Total Codes: 7, Included: 7) Code Name A Accepted This code value can only be used if there are no AK2 loops or all IK501 values = ‘A’. E Accepted, But Errors Were Noted. The functional group indicated in this 999 contained errors, but was forwarded for further processing. M Rejected, Message Authentication Code (MAC) Failed P Partially Accepted, At Least One Transaction Set Was Rejected R Rejected The functional group indicated in this 999 contained errors, and was NOT forwarded for further processing. It will need to be corrected and resubmitted. W Rejected, Assurance Failed Validity Tests X Rejected, Content After Decryption Could Not Be Analyzed AK902

97

Number of Transaction Sets Included

M

N0

1/6

Required

Description: Total number of transaction sets included in the functional group or interchange (transmission) group terminated by the trailer containing this data element AK903

123

Number of Received Transaction Sets

M

N0

1/6

Required

N0

1/6

Required

Description: Number of Transaction Sets received AK904

2

Number of Accepted Transaction Sets

M

Description: Number of accepted Transaction Sets in a Functional Group AK905

716

Functional Group Syntax Error Code

O

ID

1/3

Situational

Description: Code indicating error found based on the syntax editing of the functional group header and/or trailer Situational Rule: Required when AK901 = E or R, and the error is at the functional group level. If not required by this implementation guide, do not send. CodeList Summary (Total Codes: 20, Included: 20) Code Name 1 Functional Group Not Supported 2 Functional Group Version Not Supported 3 Functional Group Trailer Missing 4 Group Control Number in the Functional Group Header and Trailer Do Not Agree 5 Number of Included Transaction Sets Does Not Match Actual Count 6 Group Control Number Violates Syntax HIPAA - V5010X231A1 - 999 Acknowledgement

37

3/9/2011

Implementation Acknowledgement - 999

10 11 12 13 14 15 16 17 18 19 23 24 25 26 AK906

716

Authentication Key Name Unknown Encryption Key Name Unknown Requested Service (Authentication or Encryption) Not Available Unknown Security Recipient Unknown Security Originator Syntax Error in Decrypted Text Security Not Supported Incorrect Message Length (Encryption Only) Message Authentication Code Failed Functional Group Control Number not Unique within Interchange S3E Security End Segment Missing for S3S Security Start Segment S3S Security Start Segment Missing for S3E End Segment S4E Security End Segment Missing for S4S Security Start Segment S4S Security Start Segment Missing for S4E Security End Segment

Functional Group Syntax Error Code

O

ID

1/3

Situational

Description: Code indicating error found based on the syntax editing of the functional group header and/or trailer Situational Rule: Required when AK901 = E or R, and AK905 has been used, and there are additional error codes to report. If not required by this implementation guide, do not send. CodeList Summary (Total Codes: 20, Included: 20) Code Name 1 Functional Group Not Supported 2 Functional Group Version Not Supported 3 Functional Group Trailer Missing 4 Group Control Number in the Functional Group Header and Trailer Do Not Agree 5 Number of Included Transaction Sets Does Not Match Actual Count 6 Group Control Number Violates Syntax 10 Authentication Key Name Unknown 11 Encryption Key Name Unknown 12 Requested Service (Authentication or Encryption) Not Available 13 Unknown Security Recipient 14 Unknown Security Originator 15 Syntax Error in Decrypted Text 16 Security Not Supported 17 Incorrect Message Length (Encryption Only) 18 Message Authentication Code Failed 19 Functional Group Control Number not Unique within Interchange 23 S3E Security End Segment Missing for S3S Security Start Segment 24 S3S Security Start Segment Missing for S3E End Segment 25 S4E Security End Segment Missing for S4S Security Start Segment 26 S4S Security Start Segment Missing for S4E Security End Segment AK907

716

Functional Group Syntax Error Code

O

ID

1/3

Situational

Description: Code indicating error found based on the syntax editing of the functional group header and/or trailer Situational Rule: Required when AK901 = E or R, and AK905 and AK906 have been used, and there are additional error codes to report. If not required by this implementation guide, do not send. CodeList Summary (Total Codes: 20, Included: 20) Code Name 1 Functional Group Not Supported 2 Functional Group Version Not Supported 3 Functional Group Trailer Missing HIPAA - V5010X231A1 - 999 Acknowledgement

38

For internal use only

12/2011

Implementation Acknowledgement - 999

4 5 6 10 11 12 13 14 15 16 17 18 19 23 24 25 26 AK908

716

Group Control Number in the Functional Group Header and Trailer Do Not Agree Number of Included Transaction Sets Does Not Match Actual Count Group Control Number Violates Syntax Authentication Key Name Unknown Encryption Key Name Unknown Requested Service (Authentication or Encryption) Not Available Unknown Security Recipient Unknown Security Originator Syntax Error in Decrypted Text Security Not Supported Incorrect Message Length (Encryption Only) Message Authentication Code Failed Functional Group Control Number not Unique within Interchange S3E Security End Segment Missing for S3S Security Start Segment S3S Security Start Segment Missing for S3E End Segment S4E Security End Segment Missing for S4S Security Start Segment S4S Security Start Segment Missing for S4E Security End Segment

Functional Group Syntax Error Code

O

ID

1/3

Situational

Description: Code indicating error found based on the syntax editing of the functional group header and/or trailer Situational Rule: Required when AK901 = E or R, and AK905, AK906, and AK907 have been used, and there are additional error codes to report. If not required by this implementation guide, do not send. CodeList Summary (Total Codes: 20, Included: 20) Code Name 1 Functional Group Not Supported 2 Functional Group Version Not Supported 3 Functional Group Trailer Missing 4 Group Control Number in the Functional Group Header and Trailer Do Not Agree 5 Number of Included Transaction Sets Does Not Match Actual Count 6 Group Control Number Violates Syntax 10 Authentication Key Name Unknown 11 Encryption Key Name Unknown 12 Requested Service (Authentication or Encryption) Not Available 13 Unknown Security Recipient 14 Unknown Security Originator 15 Syntax Error in Decrypted Text 16 Security Not Supported 17 Incorrect Message Length (Encryption Only) 18 Message Authentication Code Failed 19 Functional Group Control Number not Unique within Interchange 23 S3E Security End Segment Missing for S3S Security Start Segment 24 S3S Security Start Segment Missing for S3E End Segment 25 S4E Security End Segment Missing for S4S Security Start Segment 26 S4S Security Start Segment Missing for S4E Security End Segment AK909

716

Functional Group Syntax Error Code

O

ID

1/3

Situational

Description: Code indicating error found based on the syntax editing of the functional group header and/or trailer Situational Rule: Required when AK901 = E or R, and AK905, AK906, AK907, and AK908 have been used, and there are additional error codes to report. If not required by this implementation guide, do not send. HIPAA - V5010X231A1 - 999 Acknowledgement

39

3/9/2011

Implementation Acknowledgement - 999

CodeList Summary (Total Codes: 20, Included: 20) Code Name 1 Functional Group Not Supported 2 Functional Group Version Not Supported 3 Functional Group Trailer Missing 4 Group Control Number in the Functional Group Header and Trailer Do Not Agree 5 Number of Included Transaction Sets Does Not Match Actual Count 6 Group Control Number Violates Syntax 10 Authentication Key Name Unknown 11 Encryption Key Name Unknown 12 Requested Service (Authentication or Encryption) Not Available 13 Unknown Security Recipient 14 Unknown Security Originator 15 Syntax Error in Decrypted Text 16 Security Not Supported 17 Incorrect Message Length (Encryption Only) 18 Message Authentication Code Failed 19 Functional Group Control Number not Unique within Interchange 23 S3E Security End Segment Missing for S3S Security Start Segment 24 S3S Security Start Segment Missing for S3E End Segment 25 S4E Security End Segment Missing for S4S Security Start Segment 26 S4S Security Start Segment Missing for S4E Security End Segment

Comments: 1. If AK901 contains the value "A" or "E", then the transmitted functional group is accepted.

Example: AK9*R*1*1*0~

HIPAA - V5010X231A1 - 999 Acknowledgement

40

For internal use only

12/2011

Implementation Acknowledgement - 999

Pos: 1000 Max: 1 Heading - Mandatory Loop: N/A Elements: 2

Transaction Set Trailer

SE

User Option (Usage): Required Purpose: To indicate the end of the transaction set and provide the count of the transmitted segments (including the beginning (ST) and ending (SE) segments)

Element Summary: Ref SE01

Id 96

Element Name Number of Included Segments

Req M

Type N0

Min/Max 1/10

Usage Required

Description: Total number of segments included in a transaction set including ST and SE segments SE02

329

Transaction Set Control Number

M

AN

4/9

Required

Description: Identifying control number that must be unique within the transaction set functional group assigned by the originator for a transaction set The Transaction Set Control Numbers in ST02 and SE02 must be identical. The number is assigned by the originator and must be unique within a functional group (GS-GE). The number also aids in error resolution research. For example, start with the number 0001 and increment from there.

Comments: 1. SE is the last segment of each transaction set.

Example: SE*53*0001~

HIPAA - V5010X231A1 - 999 Acknowledgement

41

3/9/2011

Implementation Acknowledgement - 999

Pos: Max: 1 Not Defined - Mandatory Loop: N/A Elements: 2

Functional Group Trailer

GE

User Option (Usage): Required Purpose: To indicate the end of a functional group and to provide control information

Element Summary: Ref GE01

Id 97

Element Name Number of Transaction Sets Included

Req M

Type N0

Min/Max 1/6

Usage Required

Description: Total number of transaction sets included in the functional group or interchange (transmission) group terminated by the trailer containing this data element GE02

28

Group Control Number

M

N0

1/9

Required

Description: Assigned number originated and maintained by the sender

Semantics: 1. The data interchange control number GE02 in this trailer must be identical to the same data element in the associated functional group header, GS06.

Comments: 1. The use of identical data interchange control numbers in the associated functional group header and trailer is designed to maximize functional group integrity. The control number is the same as that used in the corresponding header.

Notes: GE*1*1~

HIPAA - V5010X231A1 - 999 Acknowledgement

42

For internal use only

12/2011

Implementation Acknowledgement - 999

Interchange Control Trailer

IEA

Pos: Max: 1 Not Defined - Mandatory Loop: N/A Elements: 2

User Option (Usage): Required Purpose: To define the end of an interchange of zero or more functional groups and interchange-related control segments

Element Summary: Ref IEA01

Id I16

Element Name Number of Included Functional Groups

Req M

Type N0

Min/Max 1/5

Usage Required

Description: A count of the number of functional groups included in an interchange IEA02

I12

Interchange Control Number

M

N0

9/9

Description: A control number assigned by the interchange sender

Notes: IEA*1*000000905~

HIPAA - V5010X231A1 - 999 Acknowledgement

43

Required