New: Drop-in replacement for Change Healthcare APIs

EDI 824 X186A1 - Application Advice

Functional Group AG

X12F Finance Subcommittee

ancial institution.

Heading

1. 0100 · ST · Transaction Set Header · Max 1 · Mandatory

   To indicate the start of a transaction set and to assign a control number

2. 0200 · BGN · Beginning Segment · Max 1 · Mandatory

   To indicate the beginning of a transaction set

3. 1000A Loop Mandatory Repeat 1

   1. 0300 · N1 · Submitter Name · Max 1 · Mandatory

      To identify a party by type of organization, name, and code

      This segment identifies the information about the Submitter of the 824 transaction set.

   2. 0700 · REF · Submitter Secondary Indentifier · Max 1 · Optional

      To specify identifying information

      Required when the entity identified in Loop 1000A (Submitter Name) is submitting this 824 on behalf of a sub-component, such as a branch or department within the submitter organization. If not required by this implementation guide, do not send.
      This REF segment identifies the sub-component within the submitter organization, as appropriate.

   3. 0800 · PER · Submitter EDI Contact Information · Max 2 · Optional

      To identify a person or office to whom administrative communications should be directed

      When the communication number represents a telephone number in the United States and other countries using the North American Dialing Plan (for voice, data, fax, etc.), the communication number must always include the area code and phone number using the format AAABBBCCCC where AAA is the area code, BBB is the telephone number prefix, and CCCC is the telephone number (e.g., (534) 224-2525 would be represented as 5342242525). The extension, if known, must be included in the communication number data element immediately after the telephone number.
      The PER segment must be filled from left to right. PER04 must be present before PER06. The PER06 must be present before using PER08.
      Only one of each type of communication number may be sent. In order to send all four types, repeat the PER segment for the fourth communication number. The PER02 must not be used in the second PER.
      The second repetition of the PER must not occur unless the first is full, if the information applies to the same contact.
      Required when contact information is other than indicated in the Trading Partner Agreement/profile. If not required by this implementation guide, do not send.

4. 1000B Loop Mandatory Repeat 1

   1. 0300 · N1 · Receiver Name · Max 1 · Mandatory

      To identify a party by type of organization, name, and code

      This segment identifies the information about the Receiver of the 824 transaction set.

Detail

1. 2000 Loop Mandatory Repeat >1

   1. 0100 · OTI · Original Transaction Identification · Max 1 · Mandatory

      To identify the edited transaction set and the level at which the results of the edit are reported, and to indicate the accepted, rejected, or accepted-with-change edit result

      An 824 transaction set may be used to report acceptance or rejection of an entire transaction set, an item within a transaction set, or a subordinate portion of a transaction set that contains one or more items. The OTI segment is used as the primary means to identify the portion (or all) of the received transaction set which is being reported upon. For example, if an entire transaction set (i.e. ST/SE) is being rejected, then the OTI segment would likely indicate the ST control number to identify which ST/SE transaction set of the received file is being rejected. If part of the transaction set is being rejected (e.g. a single claim status request in a 276 transaction set), then the OTI segment could indicate the Submitter Trace number in the TRN segment of the rejected portion.
      When reporting with this 824 transaction set, the terms `acceptance' and `rejection' refer to edits at the application level.

   2. 0200 · REF · Reference Information · Max 1 · Optional

      To specify identifying information

      Required when additional information is necessary to identify the portion (or all) of the transaction set that is being reported in this Loop 2000 (OTI). If not required by this implementation guide, may be provided at the sender's discretion but cannot be required by the receiver.
      For example, if the Loop 2000 (OTI) is being used to define a provider loop, the REF segment could be used to identify the actual provider number, indicating the specific provider loop within the transaction set.
      The sender should consider `minimum necessary' privacy requirements in deciding to use this discretionary segment.

   3. 0300 · DTM · Date/Time Reference · Max 2 · Optional

      To specify pertinent dates and times

      Required when date information is necessary to identify the portion (or all) of the transaction set that is being reported in this Loop 2000 (OTI). If not required by this implementation guide, may be provided at the sender's discretion but cannot be required by the receiver.
      For example, if the Loop 2000 (OTI) is being used to define a particular insurance policy, the DTM segment could be used to identify the policy effective date, helping indicate the specific policy within the transaction set.

   4. 0500 · AMT · Monetary Amount Information · Max 3 · Optional

      To indicate the total monetary amount

      Required when monetary information is necessary to identify the portion (or all) of the transaction set that is being reported in this Loop 2000 (OTI). If not required by this implementation guide, may be provided at the sender's discretion but cannot be required by the receiver.
      For example, if the Loop 2000 (OTI) is being used to define a premium payment, the AMT segment could be used to identify the premium amount, helping to indicate the specific premium payment within the transaction set.

   5. 0600 · QTY · Quantity Information · Max 3 · Optional

      To specify quantity information

      Required when quantity information is necessary to identify the portion (or all) of the transaction set that is being reported in this Loop 2000 (OTI). If not required by this implementation guide, may be provided at the sender's discretion but cannot be required by the receiver.
      For example, if the LOOP 2000 (OTI) is being used to define a particular 2000 Loop in an 835 remittance advice, the QTY segment could be used to identify the total number of segments in that particular loop. This, along with corresponding REF and NM1 segments (to identify the particular provider in that loop) would help to indicate the specific 2000 Loop in that transaction set.

   6. 0650 · NM1 · Individual or Organizational Name · Max 6 · Optional

      To supply the full name of an individual or organizational entity

      Required when names are necessary to identify the portion (or all) of the transaction set that is being reported in this Loop 2000 (OTI). If not required by this implementation guide, may be provided at the sender's discretion but cannot be required by the receiver.
      For example, if the Loop 2000 (OTI) is being used to define a specific dependent within an enrollment transaction set, the NM1 segment could be used to identify the specific dependent within the transaction set.
      The sender should consider `minimum necessary' privacy requirements in deciding to use this discretionary segment.

   7. 2100 Loop Optional Repeat >1

      1. 0700 · TED · Error or Informational Message Location · Max 1 · Mandatory

         To identify the error and, if feasible, the erroneous segment, or data element, or both

         Required when OTI01 is equal to "BR", "IR", "TR", "BC", "IC", "TC", "BE", "IE", "TE", "BP", "IP", or "TP". If not required by this implementation guide, do not send.
         The TED Loop is used to report errors or warnings about the data referenced in this OTI Loop. Errors indicate rejection of all or part of the data referenced in the OTI Loop. Warnings do not indicate rejection of the data referenced in the OTI Loop, but may result in rejection in the future.

      2. 0750 · CTX · Situational Context Location · Max 10 · Optional

         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

         Required when the error in RED06 was triggered by a situational requirement of the business application and the submitter of the 824 knows the segment ID and segment position within the original transaction set of the data that triggered the situation. If not required by this implementation guide, do not send.
         The CTX is used to identify the situational Requirement.

      3. 0820 · RED · Error or Informational Message · Max 100 · Mandatory

         To provide business data related to an item within a transaction to which a business application editing process has been applied, and an error condition has resulted

2. 0900 · SE · Transaction Set Trailer · Max 1 · Mandatory

   To indicate the end of the transaction set and provide the count of the transmitted segments (including the beginning (ST) and ending (SE) segments)