Acknowledgments identify the workflow status of an EDI transaction. The following ASC X12 transactions are the most common acknowledgments used in health care electronic data interchange workflow.
The TA1 is used to acknowledge the receipt of an ASC X12 interchange header and trailer pair (ISA/IEA) and to report the technical and syntactical correctness of the ISA/IEA. The TA1 Interchange Acknowledgment is described in the ASC X12 publication X12.5 Interchange Control Structures.
This transaction is used to report the syntactical and structural integrity of the functional groups (GS/GE) within a single transmission, and to indicate whether the transmission was accepted or rejected. The Functional Acknowledgment does not evaluate content.
This transaction is used to report the syntactical and structural integrity of the functional groups (GS/GE) within a single transmission, and to indicate whether the transmission was accepted or rejected. The Implementation Acknowledgment also reports Implementation Guide conformance (WEDI SNIP Type 1 and 2 errors). The Implementation Acknowledgment should not be used to reject transactions that cannot be processed at the receiver’s application level (for example, invalid codes from external code sets).
The transaction acknowledges the validity of an ASC X12N Health Care Claim: Institutional (837I), Professional (837P), or Dental (837D) transaction at the receiver’s application level and informs the submitter whether the claim was accepted for adjudication or rejected.
The ASC X12 Acknowledgement Reference Model provides guidance on the use of health care ASC X12 Acknowledgments.
Visit the ASC X12 Store to purchase Technical Reports Type 3 (TR3’s) for the transactions listed above, the X12.5 Interchange Control Structures, and the ASC X12 Acknowledgment Reference Model.
Change Healthcare supports the ASC X12 health care acknowledgments. We strongly recommend that claims submitters accept 277 health care claim level acknowledgments and that payers return functional or implementation acknowledgments and 277 health care claim level acknowledgments.
The Department of Health and Human Services (HHS) has not adopted the ASC X12 health care acknowledgments as HIPAA standards.
To use acknowledgments in conjunction with the current mandated versions (5010) of the HIPAA named transactions, refer to the following Technical Report Type 3 (TR3) specifications, available from the ASC X12 Store:
The next anticipated version of the ASC X12C Implementation Acknowledgment for Health Care Insurance (999) transaction and the ASC X12N Health Care Claim Acknowledgment (277CA) is 7030™.
Note: A 7030™ version of the Functional Acknowledgment for a Health Care Insurance (997) transaction has not been developed.
Although the CAQH CORE operating rules require the use of acknowledgments for their voluntary certification program, the Department of Health and Human Services (HHS) excluded the use of acknowledgments from the two operating rule mandates issued to date in these rules: Administrative Simplification: Adoption of Operating Rules for Eligibility for a Health Plan and Health Care Claim Status Transactions; Interim Final Rule and The Administrative Simplification: Adoption of Operating Rules for Health Care Electronic Funds Transfers (EFT) and Remittance Advice Transactions; Final Rule.
All CAQH CORE voluntary certification programs (Phase I, II, III, and IV) require the use of the ASC X12C Implementation Acknowledgment for Health Insurance (999) transaction. Additionally, the Phase IV voluntary certification program requires the use of the ASC X12N Health Care Claim Acknowledgment (277CA) in response to a Health Care Claim transaction (837P, 837I, and 837D).
See the following pages for more information: