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TABLEOFCONTENTSUNDERSTANDINGGPNET2Submissions2TechnicalSupport2ANSI837COMPLETIONINFORMATION3Version50103PayerIDInformation3ResponseExamples4NETWORKDATAMOVER(NDM)SPECIFICATIONS5NDMNodeConnection5ReportRetrieval5837ClaimsSubmissionDatasetNames6CONNECTUSINGSFTP7ConnecttoCGSusingSFTP:7Sendingfiles:7CONNECTUSINGSFTPCLIENTSERVER9ConnecttoCGSusingaSFTPClientServer9SendingandReceivingFiles105010RESPONSES11TA11199911277CA11ACCEPTED12REJECTED1383513GPNetCommunicationsManualPLEASENOTE:TheGPNetCommunicationsManualissubjecttochange.
WewillpostupdatedversionofthisandotherEDIrelateddocumentsonourwebsite.
PleasevisttheCGSWebpageathttp://www.
cgsmedicare.
com.
PAGE2RevisedJune30,2016.
UNDERSTANDINGGPNETGPNetistheEDIgatewaytoCGS.
GPNETsupportsfiletransfersviaConnect:Direct,alsoknownasNetworkDataMover(NDM)andthroughaNetworkServiceVendor(NSV).
Specificationsontheseoptionsareincludedlaterinthismanual.
Inaddition,weencouragetheuseofPKZIPcompatiblecompressionsoftware.
GPNetisdefaultedtosenduncompressedfiles;therefore,ifyouwishtoreceiveallofyourfilesinacompressedformat,contacttheEDIHelpdeskformaintenancetothedatabase.
SubmissionsGPNetcurrentlysupportsversions5010A1/A2oftheANSI(AmericanNationalStandardsInstitute)ASCX12N-837claimsubmission.
.
ASCX12TR3ImplementationGuidesforv5010transactionsareavailablethroughhttp://store.
x12.
org/.
TheGPNetplatformisavailable24hoursaday,sevendaysaweek,withtheexceptionofinfrequentmaintenanceperformedonSundays.
Therealtimeeditingsystemisdownfrom11:30p.
m.
to5:00a.
m.
EST.
Iftheeditingsystemisnotavailable,youmaystilluploadafiletoGPNet.
Assoonastheeditingsystemresumesprocessing,filesinGPNetwillbeedited.
Theresponsefileswillbebuiltandloadedintoyourmailboxforretrievalatyourconveniencewithinonebusinessday.
ANSIv5010AnANSI999FunctionalAcknowledgementwillbereturnedtoyouuponcompletionofinitialediting.
Ifthefilewasaccepted,a277CAwillalsobegenerated.
TechnicalSupportIfyouhavequestionsregardingHIPAAanditsimplementationrequirements,pleasecalltheCGSEDISupportDeskat.
OhioandKentuckyPartB1.
866.
276.
9558OhioandKentuckyPartA1.
866.
590.
6703HomeHealth&Hospice1.
877.
299.
4500PAGE3RevisedJune30,2016.
ANSI837COMPLETIONINFORMATIONToensurethatyourclaimfilesareprocessedcorrectly,pleaseincludethefollowinginformationintheappropriateANSIfields:Version5010ANSIFieldTestClaimFileProductionClaimFileISA06GS02EnteryourSubmitterID.
ISA08GS031000B/NM1092010BB/NM109EntertheappropriatePayerID(seePayerIDchartbelow).
ISA15EnterTwhensubmittingatestclaimfile.
EnterPwhensubmittingaproductionclaimfile.
GS08InstitutionalClaims(PartA)Enter005010X223A2whensubmittingatestclaimfileProfessionalClaims(PartB)Enter005010X222A1whensubmittingatestclaimfile.
PayerIDInformationEntertheappropriatePayerID:LineofBusinessPayerIDOhioPartB15202HomeHealth+Hospice15004OhioPartA15201KentuckyPartB15102KentuckyPartA15101ListFilesinMailboxAllfileslistedinyourmailboxarepresentedinasimilarformat;theDOS-compliant,downloadfilenamefollowedbyafiledescription.
Examplesareshowninthefollowingtable:MailboxListingDescriptionssssss.
.
Tnnnnn.
INVInvalidFileHeader(seeResponseExample)ssssss.
.
Tnnnnn.
INVUnabletoProcessThisZippedFilessssss.
.
Tnnnnn.
RSPLoginIDandSubmitterIDinfiledonotmatch(seeResponseExample)ssssss.
.
Tnnnnn.
835MedicareASCZ12835ElectronicRemittanceFilessssss.
.
Tnnnnn.
835.
ZIPMedicareASCX12835ElectronicRemittanceFile-Zippedssssss.
.
Tnnnnn.
MSGMessage-TranslationErrororotherinformationalmessage(seeResponseExample)ssssss.
.
Tnnnnn.
PDFEDICorrespondence/Notificationsssssss.
.
Tnnnnn.
PDF.
ZIPEDICorrespondence/Notificiations-Zippedssssss.
.
Tnnnnn.
INV5010Invalidtextorproductionclaim(seeINVMessageexamplebelow)ssssss.
.
Tnnnnn.
TA1TA1InterchangeAcknowledgementResponsessssss.
.
Tnnnnn.
999999FunctionalAcknowledgementResponsessssss.
.
Tnnnnn.
277CA277CAClaimResponseFilessssss.
.
Tnnnnn.
277CA.
ZIP277CAClaimResponseFile-Zippedssssss.
.
Tnnnnn.
277277ClaimStatusInquiryResponsessssss.
.
Tnnnnn.
277.
ZIP277ClaimStatusInquiryResponse-ZippedPAGE4RevisedJune30,2016.
nnnnnrepresentsasequentialnumber.
ssssssrepresentsthesubmitteridrepresentsthedatefilewascreated.
Formatis3alphamonthand2digitdate(Ex:MAR05)ExampleofINVMessage:InterchangeControlNumber407330100forReceiverID00884cannotbeprocessedatthistimeduetothefollowingerror:Notaccepting5010transactionsforReceiverID00884ResponseExamplesINFORMATIONALMESSAGEssssss.
.
Tnnnnn.
MSGWhenthefilesubmittedisunabletobetranslated,youwillreceivethefollowingresponsemessage:WEATTEMPTEDTOTRANSLATEYOURFILEBUTITHASFAILED.
PLEASECALLYOUREDIHELPDESKFORDETAILS.
INVALIDFILEHEADER(ssssss.
.
Tnnnnn.
INV)ThefirstthreecharactersofthefilemustequalISAoryouwillreceivethefollowingresponse:INVALID_FILE_HDR=REJECTEDID(ssssss.
.
Tnnnnn.
RSP)TheGPNetLoginIDusedwhenloggingintoGPNetandSubmitterIDincludedinthefilemustmatchoryouwillreceivethefollowingresponse:SUBMITTERIDINFILEDOESNOTMATCHTHELOGINIDSUBMITTER_ID=(submitterIDinfilewilldisplay)LOGIN_ID=(submitterIDloggedinwithwilldisplay)PAGE5RevisedJune30,2016.
NETWORKDATAMOVER(NDM)SPECIFICATIONSIfyouuseNDMforclaimsubmission,pleasecompletethispageandfaxittothefollowingnumber:HH+H1.
615.
664.
5947KentuckyPartB1.
615.
664.
5917OhioPartB1.
615.
664.
5927KentuckyPartA1.
615.
664.
5943OhioPartA1.
615.
664.
5945NDMNodeConnectionTheNDMNodeconnectionisdefinedasfollows:NETID:SCANODEID:A70NDM.
MCAPPLID:A70NDMMCAT&TGNSID:PGBAPleaseenteryourNDMinformation(required):NETID:NODEID:APPLID:AT&TGNSID:YourNDMUserIDandpassword(ifdatasetsareRACFprotected):UserID:Password:ReportRetrievalWewillbereturningourreportstoyouinthefollowingDatasetNames(DSNs):1.
Edit/TransmissionReports(ProfessionalandInstitutionalfront-endreportsgotosamedataset)Frequency:DailyDSN:ResponsesReportsRemittances*X12Reports:DCB=(DSORG=PS,LRECL=100,RECFM=FB,BLKSIZE=27900)PAGE6RevisedJune30,2016.
837ClaimsSubmissionDatasetNamesLOBTestingProductionPartAMAB.
PROD.
NDM.
ECS.
TCLMA.
UBF.
submitter(+1)MAB.
PROD.
NDM.
ECS.
CLMA.
UBF.
submitter(+1)PartBMAB.
PROD.
NDM.
ECS.
TCLMA.
NSF.
submitter(+1)MAB.
PROD.
NDM.
ECS.
CLMA.
NSF.
submitter(+1)IntheDSNnotedabove,submitterequalsyourSubmitterID.
DISP:(NEW,CATLG,DELETE)UNIT:SYSDGSPACE:(CYL,(75,10),RLSE)DCB:(RECFM=FB,LRECL=80,BLKSIZE=27920)PAGE7RevisedJune30,2016.
CONNECTUSINGSFTPConnecttoCGSusingSFTP:ThePORTIDmustequal:22andtheHOSTIDhasnotchanged.
ForinformationregardingtheHOSTID,pleasecontacttheCGSEDIHelpdesk.
PleaseconsultwithyourNetworkServiceProviderifutilizingSFTP.
OnceconnectedviaSFTP,youwillbepromptedforapassword.
Currentpasswordswillbetransferredtothenewapplication.
Theformatforuseridisasfollows:userid/useridBasicftpcommandswillwork.
An"ls"commandshows"inbox"and"outbox.
"InboxisforREPORTS(999's,277CA's,277's,and835's)thatwillberetrieved,andoutboxisforsubmissionofFILES(837's,276's).
Belowarestepsforsubmissionandretrieval.
Sendingfiles:Atthesftp>commandprompttype:cdoutbox/EZComm/BC/1.
0/NotifyToshowcurrentworkingdirectorytypepwdOnceintheoutbox/EZComm/BC/1.
0/Notifydirectory,usingthe"put"command,enterthefilenametoupload.
Forexample:putx12claims.
txt.
Thescreenwillshowthefileuploadingandthesftp>promptwillappearonceuploadingiscompleted.
Receivingfiles:Ifyoumaintaintheconnectionfromsendingfiles,changetotheinboxdirectorybytyping:cd/inboxNOTE:IfaseparateIDisutilizedforreceiving835's,thecustomerMUSTloginusingthereceiverid.
PleaserefertotheConnecttoCGSusingSFTPforlogininformation.
Onceintheinbox/EZComm/BC/1.
0/Notifydirectory,usingthe"get"commandenterthefilenametodownload.
Forexample:get*.
*.
Thescreenwillshowthefiledownloadingandthesftp>promptwillappearonceuploadingiscompleted.
PAGE8RevisedJune30,2016.
PAGE9RevisedJune30,2016.
CONNECTUSINGSFTPCLIENTSERVERConnecttoCGSusingaSFTPClientServer:ThePORTIDmustequal:22andtheHOSTIDhasnotchanged.
ForinformationregardingtheHOSTID,pleasecontacttheCGSEDIHelpDesk.
BelowisanexampleofhowscreensmaylooklikeifusingFileZilla(awidelyavailableftpclientapplication).
CGSrecommendsconsultingwiththeNetworkServiceVendoronacompatibleSFTPClientServerApplication.
CustomerswillberequiredtoentertheirsubmitterIDandpasswordissuedtothem.
Pleaseutilizetheuserid/useridformatwhenenteringthesubmitterID.
Onceconnected,theright-handsideofthescreenprovidesinformationforthe"remotesite.
"RemotesiteisPalmettoGBA.
Twofolderswillbelisted.
InboxisforREPORTS(999's,277CA's,277'sand835's)thatwillberetrieved,andoutboxisforsubmissionofFILES(837's,276's).
PAGE10RevisedJune30,2016.
SendingandReceivingFiles:Tosendfiles(837,276)toCGS/PalmettoGBA,pleaseexpandallfolderslistedunderneaththeOUTBOX.
Toreceivereports(999,277CA,277and835)fromCGS/PalmettoGBA,pleaseexpandallfolderslistedunderneathINBOX.
PleaseconsulttheFileZilla(orotherFTPclientserver)userguideforinstructiontoTransfer/Send/Receivefiles.
PAGE11RevisedJune30,2016.
5010RESPONSESBelowisalistoftheANSIv5010transactionsandversionnumbers:ANSITransactionDescriptionBaseVersionErrataVersion270/271HealthCareEligibilityBenefitInquiryandResponse005010X279A1837PHealthCareClaim:Professional005010X222A1837IHealthCareClaim:Institutional005010X223A2999ImplementationAcknowledgmentForHealthCareInsurance005010X231A1835HealthCareClaimPayment/Advice005010X221A1276/277StatusInquiryandResponse005010X212N/A277CAClaimAcknowledgement005010X214N/AThe999(FunctionalAcknowledgement)and277CA(ClaimsAcknowledgement)maynotbereadablewithouttranslationsoftware.
WhilethesetransactionsarenotHIPAA-mandated,theCentersforMedicare&MedicaidServices(CMS)requirethesetransactionsforallMedicarebusiness.
TheTA1InterchangeAcknowledgementreportwillbeproducedforX12v5010transactionsonlywhentheinterchangeisrejected.
Thereportwillalsonotbereadablewithouttranslationsoftware.
Itisimportantforproviderstoensuretheirsoftwarewillbeabletoaccommodatethesenewfiles.
TA1TheTA1InterchangeAcknowledgementreportwillbeproducedforX12v5010transactionsonlywhentheinterchangeisrejected.
Thereportwillalsonotbereadablewithouttranslationsoftware.
WhenaTA1isreceived,youwillneedtocorrectandresubmittheentireISA-IEAInterchange.
Note:TheTA1willonlybeproducediftheinterchangeisrejected.
999Whena999isreceived,youmay:(1)recognizeerrorsoccurredandbeginacorrect/resubmitaction,or(2)recognizethatalltransactionswereaccepted.
A999reflectstechnicalproblemsthatmustbeaddressedbythesoftwarepreparingtheEDItransmission.
NOTE:"Troubletickets"willlikelybeaddressedbytechnicalresourcestoidentifycorrectionneededbeforeresubmission.
ISA*00**00**27*PPPPPP*27*XXXXXX*100914*1025*^*00501*000000218*0*T*:~GS*FA*PPPPPP*XXXXXX*20100914*10251463*3*X*005010X231~ST*999*3001*005010X231~AK1*HC*2145001*005010X222~AK2*837*000000001*005010X222~IK5*A~AK9*A*1*1*1~SE*5*3001~GE*1*3~IEA*1*000000218~277CAWhena277CAisreceived,(1)recognizeerrorsthatoccurredandbeginacorrect/resubmitactiononspecificclaims,(2)recognizetransactionswereacceptedand(3)usereturnedclaimnumbersforfuturestatusinquiries.
A277CAreflectsadataproblemthatmustbeaddressedbyresourcesintheprovider'sbillingarea.
Yourbillingstaffwilllikelyneedreportstobeproducedinordertoidentifyclaimcorrectionsbeforeresubmission.
PAGE12RevisedJune30,2016.
ACCEPTEDISA*00**00**28*PPPPP*28*XXXXXX*100915*1002*^*00501*091536298*0*T*:~GS*HN*PPPPP*0*20100915*100208*26*X*005010X214~ST*277*000000001*005010X214~BHT*0085*08*091536332*20100915*09153600*TH~HL*1**20*1~NM1*PR*2*CARRIERNAME*****PI*PPPPP~TRN*1*PPPPP20100915000003~DTP*050*D8*20100915~DTP*009*D8*20100915~HL*2*1*21*1~NM1*41*2*TESTSUBMITTER*****46*XXXXXX~TRN*2*000008~STC*A1:19:PR*20100915*WQ*4500~QTY*90*1~AMT*YU*4500~HL*3*2*19*1~NM1*85*2*PROVIDERNAME*****XX*1234567890~TRN*1*IA92330H1.
.
0001~STC*A1:19:PR**WQ*4500~QTY*QA*1~AMT*YU*4500~HL*4*3*PT~NM1*QC*1*TEST**PART**A*MI*111111111F~TRN*2*IA92330H1.
.
0001~STC*A2:20:PR*20100915*WQ*4500~REF*1K*21025800000107TST~REF*BLT*131~DTP*472*RD8*20090701-20090701~SE*27*000000001~GE*1*26~IEA*1*091536298~PAGE13RevisedJune30,2016.
REJECTEDISA*00**00**ZZ*PPPPP*ZZ*XXXXX*100907*1219*^*00501*000000001*0*P*:~GS*HN*PPPPP*0*20100907*121959*12*X*005010X214~ST*277*000000001*005010X214~BHT*0085*08*10250*20100907*11360400*TH~HL*1**20*1~NM1*PR*2*CARRIERNAME*****46*PPPPP~TRN*1*PPPPP20100907000001~DTP*050*D8*20100903~DTP*009*D8*20100907~HL*2*1*21*1~NM1*41*2*SUBMITTERNAME*****46*XXXXX~TRN*2*PA92430XX.
SVD03-4~STC*A1:19:PR*20100907*WQ*50~QTY*AA*1~AMT*YY*50~HL*3*2*19*0~NM1*85*2*PROVIDERNAME*****XX*1234567890~TRN*1*0~STC*A7:500:85**U*50~STC*A8:562:85**U*50******A8:128:85~STC*A7:562:85**U*50~STC*A8:496:85**U*50~QTY*QC*1~AMT*YY*50~SE*2323*000000001~GE*1*12~IEA*1*000000001~835TheCentersforMedicare&MedicaidServices(CMS)hasconvertedfromANSIversion4010A1toANSIversion5010baseanderrata.
ThisconversionprocesswillimpacttheHealthCareClaimPayment/Advice835electronicremittancetransaction.
Notablechangesbetweentheseversionsinclude:Requirementrefinement:strongerdefinitionsandusagerulesEnhancedcontenttopromoteclarity:frontmattersectionshavebeenupdatedtoprovidebetterdirectionChangestodescriptions,usage,lengthandrepeatsStandardizeduseofPLBreasoncodes,ClaimAdjustmentReasonCodesandRemittanceAdviceRemarkCodes:mayprovideincreasedautomationaswellascostreductionasaresultofeliminatingphonecallsandcorrespondenceLoopSegment(Identifier/Qualifier)ElementDescriptionVariousN407CountrySubdivisionCodeID1000APER(BL)PayerTechnicalContactInformation1000APER(IC)Payerwebsite1000BRDMRemittanceDeliveryMethod(NotUsedbyMedicare)2100CLP14Yes/NoConditionorResponseCode(NotUsed)2100CAS07–13ClaimAdjustmentGroupCode,ReasonCode,Amount,andQuantityRepeatsPAGE14RevisedJune30,2016.
LoopSegment(Identifier/Qualifier)ElementDescription2100NM1(QC)12NM1(74)12NM1(82)12NM1(TT)12NM1(PR)12NameLastorOrganizationName(NotUsed)2100NM1(GB)OtherSubscriberName2100DTM(232or233)01-02StatementFromorToDate2100DTM(036)01–02CoverageExpirationDate2100DTM(050)01–02ClaimReceivedDate2110SVC01-8SVC06-8ProductServiceID(NotUsed)2110REF(6R)01–02LineItemControlNumber2110REF(0K)01–02HealthCarePolicyIdentificationThefollowingareexamplesofanelectronicremittancetransactioninANSIVersion5010Base.
Theseexamplesaresubjecttochangeandarenotinclusive.
Yourdatawilldiffer.
Example1–ShowingPaymentST*835*000000001~BPR*I*297.
66*C*ACH*CCP*01*111000012*DA*00000001234567894*1123456789**01*062001319*DA*8765431190*20090901~TRN*1*888881234*1112345678~REF*EV*SSSSSS~DTM*405*20090828~N1*PR*MEDICAREPARTB~N3*1234ANYSTREET~N4*ANYTOWN*SC*292011234~REF*2U*PPPPP~PER*CX*MEDICAREPARTB*TE*8665551212~PER*BL*PROVIDERSUPPORT*TE*8665551212*TE*8665551212*FX*8035551212~N1*PE*PHYSICIANSLTD*XX*111111111~N3*ONEMAINSTREET~N4*ANYTOWN*SC*292011234~REF*TJ*1123456789~LX*1~CLP*A9800078*19*2000*297.
66*74.
41*MB*2209229100360*11*1~NM1*QC*1*SAMPLE*PATIENT*G***HN*111111111F~NM1*74*1**PATIENCE~NM1*TT*2*CROSSOVERCOMPANY*****PI*11111~MOA***MA01*MA18~REF*EA*797828~DTM*050*20090817~SVC*HC:72141*2000*297.
66**1~DTM*472*20090815~CAS*CO*45*1627.
93~CAS*PR*2*74.
41~REF*LU*11~REF*6R*20793~AMT*B6*372.
07~SE*31*000000001~PAGE15RevisedJune30,2016.
Example2–ShowingnopaymentST*835*000000006~BPR*H*0*C*NON*20090901~TRN*1*300000973*1112345678~REF*EV*SSSSSS~DTM*405*20090828~N1*PR*MEDICAREPARTB~N3*1234ANYSTREET~N4*ANYTOWN*SC*292011234~REF*2U*PPPPP~PER*CX*MEDICAREPARTB*TE*8665551212~PER*BL*PROVIDERSUPPORT*TE*8665551212*TE*8665551212*FX*8035551212~PER*IC**UR*WWW.
CIGNAGOVERNMENTSERVICES.
COM~N1*PE*JOHNSMITHMD*XX*111111111~N3*TWOANYSTREET~N4*ANYTOWN*SC*292011234~REF*TJ*1123456789~LX*0~CLP*0*1*2500*0*0*MB*2709181280010*22~NM1*QC*1*SAMPLE*PATIENCE****HN*111111111F~NM1*74*1***M~MOA***MA28~DTM*050*20090630~SVC*HC:66984:RT*2500*0**0~DTM*472*20090222~CAS*CO*50*2500~REF*LU*22~REF*6R*01~REF*0K*L26793~LQ*HE*M26~LQ*HE*N115~SE*89*000000006~
WewillpostupdatedversionofthisandotherEDIrelateddocumentsonourwebsite.
PleasevisttheCGSWebpageathttp://www.
cgsmedicare.
com.
PAGE2RevisedJune30,2016.
UNDERSTANDINGGPNETGPNetistheEDIgatewaytoCGS.
GPNETsupportsfiletransfersviaConnect:Direct,alsoknownasNetworkDataMover(NDM)andthroughaNetworkServiceVendor(NSV).
Specificationsontheseoptionsareincludedlaterinthismanual.
Inaddition,weencouragetheuseofPKZIPcompatiblecompressionsoftware.
GPNetisdefaultedtosenduncompressedfiles;therefore,ifyouwishtoreceiveallofyourfilesinacompressedformat,contacttheEDIHelpdeskformaintenancetothedatabase.
SubmissionsGPNetcurrentlysupportsversions5010A1/A2oftheANSI(AmericanNationalStandardsInstitute)ASCX12N-837claimsubmission.
.
ASCX12TR3ImplementationGuidesforv5010transactionsareavailablethroughhttp://store.
x12.
org/.
TheGPNetplatformisavailable24hoursaday,sevendaysaweek,withtheexceptionofinfrequentmaintenanceperformedonSundays.
Therealtimeeditingsystemisdownfrom11:30p.
m.
to5:00a.
m.
EST.
Iftheeditingsystemisnotavailable,youmaystilluploadafiletoGPNet.
Assoonastheeditingsystemresumesprocessing,filesinGPNetwillbeedited.
Theresponsefileswillbebuiltandloadedintoyourmailboxforretrievalatyourconveniencewithinonebusinessday.
ANSIv5010AnANSI999FunctionalAcknowledgementwillbereturnedtoyouuponcompletionofinitialediting.
Ifthefilewasaccepted,a277CAwillalsobegenerated.
TechnicalSupportIfyouhavequestionsregardingHIPAAanditsimplementationrequirements,pleasecalltheCGSEDISupportDeskat.
OhioandKentuckyPartB1.
866.
276.
9558OhioandKentuckyPartA1.
866.
590.
6703HomeHealth&Hospice1.
877.
299.
4500PAGE3RevisedJune30,2016.
ANSI837COMPLETIONINFORMATIONToensurethatyourclaimfilesareprocessedcorrectly,pleaseincludethefollowinginformationintheappropriateANSIfields:Version5010ANSIFieldTestClaimFileProductionClaimFileISA06GS02EnteryourSubmitterID.
ISA08GS031000B/NM1092010BB/NM109EntertheappropriatePayerID(seePayerIDchartbelow).
ISA15EnterTwhensubmittingatestclaimfile.
EnterPwhensubmittingaproductionclaimfile.
GS08InstitutionalClaims(PartA)Enter005010X223A2whensubmittingatestclaimfileProfessionalClaims(PartB)Enter005010X222A1whensubmittingatestclaimfile.
PayerIDInformationEntertheappropriatePayerID:LineofBusinessPayerIDOhioPartB15202HomeHealth+Hospice15004OhioPartA15201KentuckyPartB15102KentuckyPartA15101ListFilesinMailboxAllfileslistedinyourmailboxarepresentedinasimilarformat;theDOS-compliant,downloadfilenamefollowedbyafiledescription.
Examplesareshowninthefollowingtable:MailboxListingDescriptionssssss.
.
Tnnnnn.
INVInvalidFileHeader(seeResponseExample)ssssss.
.
Tnnnnn.
INVUnabletoProcessThisZippedFilessssss.
.
Tnnnnn.
RSPLoginIDandSubmitterIDinfiledonotmatch(seeResponseExample)ssssss.
.
Tnnnnn.
835MedicareASCZ12835ElectronicRemittanceFilessssss.
.
Tnnnnn.
835.
ZIPMedicareASCX12835ElectronicRemittanceFile-Zippedssssss.
.
Tnnnnn.
MSGMessage-TranslationErrororotherinformationalmessage(seeResponseExample)ssssss.
.
Tnnnnn.
PDFEDICorrespondence/Notificationsssssss.
.
Tnnnnn.
PDF.
ZIPEDICorrespondence/Notificiations-Zippedssssss.
.
Tnnnnn.
INV5010Invalidtextorproductionclaim(seeINVMessageexamplebelow)ssssss.
.
Tnnnnn.
TA1TA1InterchangeAcknowledgementResponsessssss.
.
Tnnnnn.
999999FunctionalAcknowledgementResponsessssss.
.
Tnnnnn.
277CA277CAClaimResponseFilessssss.
.
Tnnnnn.
277CA.
ZIP277CAClaimResponseFile-Zippedssssss.
.
Tnnnnn.
277277ClaimStatusInquiryResponsessssss.
.
Tnnnnn.
277.
ZIP277ClaimStatusInquiryResponse-ZippedPAGE4RevisedJune30,2016.
nnnnnrepresentsasequentialnumber.
ssssssrepresentsthesubmitteridrepresentsthedatefilewascreated.
Formatis3alphamonthand2digitdate(Ex:MAR05)ExampleofINVMessage:InterchangeControlNumber407330100forReceiverID00884cannotbeprocessedatthistimeduetothefollowingerror:Notaccepting5010transactionsforReceiverID00884ResponseExamplesINFORMATIONALMESSAGEssssss.
.
Tnnnnn.
MSGWhenthefilesubmittedisunabletobetranslated,youwillreceivethefollowingresponsemessage:WEATTEMPTEDTOTRANSLATEYOURFILEBUTITHASFAILED.
PLEASECALLYOUREDIHELPDESKFORDETAILS.
INVALIDFILEHEADER(ssssss.
.
Tnnnnn.
INV)ThefirstthreecharactersofthefilemustequalISAoryouwillreceivethefollowingresponse:INVALID_FILE_HDR=REJECTEDID(ssssss.
.
Tnnnnn.
RSP)TheGPNetLoginIDusedwhenloggingintoGPNetandSubmitterIDincludedinthefilemustmatchoryouwillreceivethefollowingresponse:SUBMITTERIDINFILEDOESNOTMATCHTHELOGINIDSUBMITTER_ID=(submitterIDinfilewilldisplay)LOGIN_ID=(submitterIDloggedinwithwilldisplay)PAGE5RevisedJune30,2016.
NETWORKDATAMOVER(NDM)SPECIFICATIONSIfyouuseNDMforclaimsubmission,pleasecompletethispageandfaxittothefollowingnumber:HH+H1.
615.
664.
5947KentuckyPartB1.
615.
664.
5917OhioPartB1.
615.
664.
5927KentuckyPartA1.
615.
664.
5943OhioPartA1.
615.
664.
5945NDMNodeConnectionTheNDMNodeconnectionisdefinedasfollows:NETID:SCANODEID:A70NDM.
MCAPPLID:A70NDMMCAT&TGNSID:PGBAPleaseenteryourNDMinformation(required):NETID:NODEID:APPLID:AT&TGNSID:YourNDMUserIDandpassword(ifdatasetsareRACFprotected):UserID:Password:ReportRetrievalWewillbereturningourreportstoyouinthefollowingDatasetNames(DSNs):1.
Edit/TransmissionReports(ProfessionalandInstitutionalfront-endreportsgotosamedataset)Frequency:DailyDSN:ResponsesReportsRemittances*X12Reports:DCB=(DSORG=PS,LRECL=100,RECFM=FB,BLKSIZE=27900)PAGE6RevisedJune30,2016.
837ClaimsSubmissionDatasetNamesLOBTestingProductionPartAMAB.
PROD.
NDM.
ECS.
TCLMA.
UBF.
submitter(+1)MAB.
PROD.
NDM.
ECS.
CLMA.
UBF.
submitter(+1)PartBMAB.
PROD.
NDM.
ECS.
TCLMA.
NSF.
submitter(+1)MAB.
PROD.
NDM.
ECS.
CLMA.
NSF.
submitter(+1)IntheDSNnotedabove,submitterequalsyourSubmitterID.
DISP:(NEW,CATLG,DELETE)UNIT:SYSDGSPACE:(CYL,(75,10),RLSE)DCB:(RECFM=FB,LRECL=80,BLKSIZE=27920)PAGE7RevisedJune30,2016.
CONNECTUSINGSFTPConnecttoCGSusingSFTP:ThePORTIDmustequal:22andtheHOSTIDhasnotchanged.
ForinformationregardingtheHOSTID,pleasecontacttheCGSEDIHelpdesk.
PleaseconsultwithyourNetworkServiceProviderifutilizingSFTP.
OnceconnectedviaSFTP,youwillbepromptedforapassword.
Currentpasswordswillbetransferredtothenewapplication.
Theformatforuseridisasfollows:userid/useridBasicftpcommandswillwork.
An"ls"commandshows"inbox"and"outbox.
"InboxisforREPORTS(999's,277CA's,277's,and835's)thatwillberetrieved,andoutboxisforsubmissionofFILES(837's,276's).
Belowarestepsforsubmissionandretrieval.
Sendingfiles:Atthesftp>commandprompttype:cdoutbox/EZComm/BC/1.
0/NotifyToshowcurrentworkingdirectorytypepwdOnceintheoutbox/EZComm/BC/1.
0/Notifydirectory,usingthe"put"command,enterthefilenametoupload.
Forexample:putx12claims.
txt.
Thescreenwillshowthefileuploadingandthesftp>promptwillappearonceuploadingiscompleted.
Receivingfiles:Ifyoumaintaintheconnectionfromsendingfiles,changetotheinboxdirectorybytyping:cd/inboxNOTE:IfaseparateIDisutilizedforreceiving835's,thecustomerMUSTloginusingthereceiverid.
PleaserefertotheConnecttoCGSusingSFTPforlogininformation.
Onceintheinbox/EZComm/BC/1.
0/Notifydirectory,usingthe"get"commandenterthefilenametodownload.
Forexample:get*.
*.
Thescreenwillshowthefiledownloadingandthesftp>promptwillappearonceuploadingiscompleted.
PAGE8RevisedJune30,2016.
PAGE9RevisedJune30,2016.
CONNECTUSINGSFTPCLIENTSERVERConnecttoCGSusingaSFTPClientServer:ThePORTIDmustequal:22andtheHOSTIDhasnotchanged.
ForinformationregardingtheHOSTID,pleasecontacttheCGSEDIHelpDesk.
BelowisanexampleofhowscreensmaylooklikeifusingFileZilla(awidelyavailableftpclientapplication).
CGSrecommendsconsultingwiththeNetworkServiceVendoronacompatibleSFTPClientServerApplication.
CustomerswillberequiredtoentertheirsubmitterIDandpasswordissuedtothem.
Pleaseutilizetheuserid/useridformatwhenenteringthesubmitterID.
Onceconnected,theright-handsideofthescreenprovidesinformationforthe"remotesite.
"RemotesiteisPalmettoGBA.
Twofolderswillbelisted.
InboxisforREPORTS(999's,277CA's,277'sand835's)thatwillberetrieved,andoutboxisforsubmissionofFILES(837's,276's).
PAGE10RevisedJune30,2016.
SendingandReceivingFiles:Tosendfiles(837,276)toCGS/PalmettoGBA,pleaseexpandallfolderslistedunderneaththeOUTBOX.
Toreceivereports(999,277CA,277and835)fromCGS/PalmettoGBA,pleaseexpandallfolderslistedunderneathINBOX.
PleaseconsulttheFileZilla(orotherFTPclientserver)userguideforinstructiontoTransfer/Send/Receivefiles.
PAGE11RevisedJune30,2016.
5010RESPONSESBelowisalistoftheANSIv5010transactionsandversionnumbers:ANSITransactionDescriptionBaseVersionErrataVersion270/271HealthCareEligibilityBenefitInquiryandResponse005010X279A1837PHealthCareClaim:Professional005010X222A1837IHealthCareClaim:Institutional005010X223A2999ImplementationAcknowledgmentForHealthCareInsurance005010X231A1835HealthCareClaimPayment/Advice005010X221A1276/277StatusInquiryandResponse005010X212N/A277CAClaimAcknowledgement005010X214N/AThe999(FunctionalAcknowledgement)and277CA(ClaimsAcknowledgement)maynotbereadablewithouttranslationsoftware.
WhilethesetransactionsarenotHIPAA-mandated,theCentersforMedicare&MedicaidServices(CMS)requirethesetransactionsforallMedicarebusiness.
TheTA1InterchangeAcknowledgementreportwillbeproducedforX12v5010transactionsonlywhentheinterchangeisrejected.
Thereportwillalsonotbereadablewithouttranslationsoftware.
Itisimportantforproviderstoensuretheirsoftwarewillbeabletoaccommodatethesenewfiles.
TA1TheTA1InterchangeAcknowledgementreportwillbeproducedforX12v5010transactionsonlywhentheinterchangeisrejected.
Thereportwillalsonotbereadablewithouttranslationsoftware.
WhenaTA1isreceived,youwillneedtocorrectandresubmittheentireISA-IEAInterchange.
Note:TheTA1willonlybeproducediftheinterchangeisrejected.
999Whena999isreceived,youmay:(1)recognizeerrorsoccurredandbeginacorrect/resubmitaction,or(2)recognizethatalltransactionswereaccepted.
A999reflectstechnicalproblemsthatmustbeaddressedbythesoftwarepreparingtheEDItransmission.
NOTE:"Troubletickets"willlikelybeaddressedbytechnicalresourcestoidentifycorrectionneededbeforeresubmission.
ISA*00**00**27*PPPPPP*27*XXXXXX*100914*1025*^*00501*000000218*0*T*:~GS*FA*PPPPPP*XXXXXX*20100914*10251463*3*X*005010X231~ST*999*3001*005010X231~AK1*HC*2145001*005010X222~AK2*837*000000001*005010X222~IK5*A~AK9*A*1*1*1~SE*5*3001~GE*1*3~IEA*1*000000218~277CAWhena277CAisreceived,(1)recognizeerrorsthatoccurredandbeginacorrect/resubmitactiononspecificclaims,(2)recognizetransactionswereacceptedand(3)usereturnedclaimnumbersforfuturestatusinquiries.
A277CAreflectsadataproblemthatmustbeaddressedbyresourcesintheprovider'sbillingarea.
Yourbillingstaffwilllikelyneedreportstobeproducedinordertoidentifyclaimcorrectionsbeforeresubmission.
PAGE12RevisedJune30,2016.
ACCEPTEDISA*00**00**28*PPPPP*28*XXXXXX*100915*1002*^*00501*091536298*0*T*:~GS*HN*PPPPP*0*20100915*100208*26*X*005010X214~ST*277*000000001*005010X214~BHT*0085*08*091536332*20100915*09153600*TH~HL*1**20*1~NM1*PR*2*CARRIERNAME*****PI*PPPPP~TRN*1*PPPPP20100915000003~DTP*050*D8*20100915~DTP*009*D8*20100915~HL*2*1*21*1~NM1*41*2*TESTSUBMITTER*****46*XXXXXX~TRN*2*000008~STC*A1:19:PR*20100915*WQ*4500~QTY*90*1~AMT*YU*4500~HL*3*2*19*1~NM1*85*2*PROVIDERNAME*****XX*1234567890~TRN*1*IA92330H1.
.
0001~STC*A1:19:PR**WQ*4500~QTY*QA*1~AMT*YU*4500~HL*4*3*PT~NM1*QC*1*TEST**PART**A*MI*111111111F~TRN*2*IA92330H1.
.
0001~STC*A2:20:PR*20100915*WQ*4500~REF*1K*21025800000107TST~REF*BLT*131~DTP*472*RD8*20090701-20090701~SE*27*000000001~GE*1*26~IEA*1*091536298~PAGE13RevisedJune30,2016.
REJECTEDISA*00**00**ZZ*PPPPP*ZZ*XXXXX*100907*1219*^*00501*000000001*0*P*:~GS*HN*PPPPP*0*20100907*121959*12*X*005010X214~ST*277*000000001*005010X214~BHT*0085*08*10250*20100907*11360400*TH~HL*1**20*1~NM1*PR*2*CARRIERNAME*****46*PPPPP~TRN*1*PPPPP20100907000001~DTP*050*D8*20100903~DTP*009*D8*20100907~HL*2*1*21*1~NM1*41*2*SUBMITTERNAME*****46*XXXXX~TRN*2*PA92430XX.
SVD03-4~STC*A1:19:PR*20100907*WQ*50~QTY*AA*1~AMT*YY*50~HL*3*2*19*0~NM1*85*2*PROVIDERNAME*****XX*1234567890~TRN*1*0~STC*A7:500:85**U*50~STC*A8:562:85**U*50******A8:128:85~STC*A7:562:85**U*50~STC*A8:496:85**U*50~QTY*QC*1~AMT*YY*50~SE*2323*000000001~GE*1*12~IEA*1*000000001~835TheCentersforMedicare&MedicaidServices(CMS)hasconvertedfromANSIversion4010A1toANSIversion5010baseanderrata.
ThisconversionprocesswillimpacttheHealthCareClaimPayment/Advice835electronicremittancetransaction.
Notablechangesbetweentheseversionsinclude:Requirementrefinement:strongerdefinitionsandusagerulesEnhancedcontenttopromoteclarity:frontmattersectionshavebeenupdatedtoprovidebetterdirectionChangestodescriptions,usage,lengthandrepeatsStandardizeduseofPLBreasoncodes,ClaimAdjustmentReasonCodesandRemittanceAdviceRemarkCodes:mayprovideincreasedautomationaswellascostreductionasaresultofeliminatingphonecallsandcorrespondenceLoopSegment(Identifier/Qualifier)ElementDescriptionVariousN407CountrySubdivisionCodeID1000APER(BL)PayerTechnicalContactInformation1000APER(IC)Payerwebsite1000BRDMRemittanceDeliveryMethod(NotUsedbyMedicare)2100CLP14Yes/NoConditionorResponseCode(NotUsed)2100CAS07–13ClaimAdjustmentGroupCode,ReasonCode,Amount,andQuantityRepeatsPAGE14RevisedJune30,2016.
LoopSegment(Identifier/Qualifier)ElementDescription2100NM1(QC)12NM1(74)12NM1(82)12NM1(TT)12NM1(PR)12NameLastorOrganizationName(NotUsed)2100NM1(GB)OtherSubscriberName2100DTM(232or233)01-02StatementFromorToDate2100DTM(036)01–02CoverageExpirationDate2100DTM(050)01–02ClaimReceivedDate2110SVC01-8SVC06-8ProductServiceID(NotUsed)2110REF(6R)01–02LineItemControlNumber2110REF(0K)01–02HealthCarePolicyIdentificationThefollowingareexamplesofanelectronicremittancetransactioninANSIVersion5010Base.
Theseexamplesaresubjecttochangeandarenotinclusive.
Yourdatawilldiffer.
Example1–ShowingPaymentST*835*000000001~BPR*I*297.
66*C*ACH*CCP*01*111000012*DA*00000001234567894*1123456789**01*062001319*DA*8765431190*20090901~TRN*1*888881234*1112345678~REF*EV*SSSSSS~DTM*405*20090828~N1*PR*MEDICAREPARTB~N3*1234ANYSTREET~N4*ANYTOWN*SC*292011234~REF*2U*PPPPP~PER*CX*MEDICAREPARTB*TE*8665551212~PER*BL*PROVIDERSUPPORT*TE*8665551212*TE*8665551212*FX*8035551212~N1*PE*PHYSICIANSLTD*XX*111111111~N3*ONEMAINSTREET~N4*ANYTOWN*SC*292011234~REF*TJ*1123456789~LX*1~CLP*A9800078*19*2000*297.
66*74.
41*MB*2209229100360*11*1~NM1*QC*1*SAMPLE*PATIENT*G***HN*111111111F~NM1*74*1**PATIENCE~NM1*TT*2*CROSSOVERCOMPANY*****PI*11111~MOA***MA01*MA18~REF*EA*797828~DTM*050*20090817~SVC*HC:72141*2000*297.
66**1~DTM*472*20090815~CAS*CO*45*1627.
93~CAS*PR*2*74.
41~REF*LU*11~REF*6R*20793~AMT*B6*372.
07~SE*31*000000001~PAGE15RevisedJune30,2016.
Example2–ShowingnopaymentST*835*000000006~BPR*H*0*C*NON*20090901~TRN*1*300000973*1112345678~REF*EV*SSSSSS~DTM*405*20090828~N1*PR*MEDICAREPARTB~N3*1234ANYSTREET~N4*ANYTOWN*SC*292011234~REF*2U*PPPPP~PER*CX*MEDICAREPARTB*TE*8665551212~PER*BL*PROVIDERSUPPORT*TE*8665551212*TE*8665551212*FX*8035551212~PER*IC**UR*WWW.
CIGNAGOVERNMENTSERVICES.
COM~N1*PE*JOHNSMITHMD*XX*111111111~N3*TWOANYSTREET~N4*ANYTOWN*SC*292011234~REF*TJ*1123456789~LX*0~CLP*0*1*2500*0*0*MB*2709181280010*22~NM1*QC*1*SAMPLE*PATIENCE****HN*111111111F~NM1*74*1***M~MOA***MA28~DTM*050*20090630~SVC*HC:66984:RT*2500*0**0~DTM*472*20090222~CAS*CO*50*2500~REF*LU*22~REF*6R*01~REF*0K*L26793~LQ*HE*M26~LQ*HE*N115~SE*89*000000006~
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