National Heritage Insurance

Company
ANSI’S ASC X12 User Technical
Specifications Manual

Introduction

DOCUMENT 1 of 7
Updated October 15, 1998

Communications Procedures
ANSI ASC X12 Introduction
ASC X12 and CMS Global Requirements
 Introduction to ANSI'S ASC X12 Specifications for CMS

Document 1 - Introduction
Table of Contents
CMS AND ASC X12 OVERVIEW......................................................................................................................4
UPDATES TO MANUAL..........................................................................................................................................5
CORRESPONDENCE...............................................................................................................................................5
COMMUNICATIONS PROCEDURES...............................................................................................................6
WHAT IS THE PRODUCTION BULLETIN BOARD SYSTEM? ........................................................................................6
REQUIREMENTS FOR USING THE PRODUCTION BBS...............................................................................................6
Production BBS Telephone Numbers ..............................................................................................................8
Downloading and Uploading from the Production BBS ..................................................................................9
LOGGING ON TO THE BBS INTERFACE ..................................................................................................................9
Uploading (UL) a Batch Transaction .........................................................................................................................11
Downloading (DN) a Batch Transaction ....................................................................................................................13
LOGGING OFF THE PRODUCTION BBS.................................................................................................................15
To Log off the BBS .......................................................................................................................................15
HOW DO I ACCESS THE CMS - TEXMEDNET BULLETIN BOARD SYSTEM? ..............................................................16
ANSI ASC X12 - AN INTRODUCTION............................................................................................................18
VERSION ...........................................................................................................................................................18
BUSINESS USE AND DEFINITIONS ........................................................................................................................18
UNDERSTANDING EDI TRANSMISSION LEVELS ....................................................................................................18
The Transmission File Structure ...............................................................................................................................18
Interchange Envelopes ..............................................................................................................................................18
Functional Group Envelope.......................................................................................................................................19
Transaction Set Envelope..........................................................................................................................................19
TRANSACTION SET CONTROL STRUCTURE DEFINITIONS AND CONCEPTS...............................................................19
Data Element............................................................................................................................................................20
Numeric ...............................................................................................................................................................20
Quantity and Dollar Amounts ...............................................................................................................................21
Decimal ...............................................................................................................................................................21
Identifier ..............................................................................................................................................................21
String...................................................................................................................................................................21
Date .....................................................................................................................................................................21
Time ....................................................................................................................................................................22
UNDERSTANDING THE TRANSACTION SET ...........................................................................................................22
Transaction Set Header and Trailer .............................................................................................................22
Data Segment Groups...................................................................................................................................22
Repeated Occurrences of Single Data Segments ........................................................................................................22
Loops of Data Segments............................................................................................................................................22
Unbounded Loops ................................................................................................................................................22
Bounded Loops (Used only in the ASC X12 271) .................................................................................................23
X12 MAPPING SAMPLE ......................................................................................................................................24
EDI TRANSMISSIONS AND TRANSLATION SOFTWARE...........................................................................................24
Translators...................................................................................................................................................25
Selection of Software....................................................................................................................................25
Sample Questions in Determining the Right Translation Software Program..................................................25
COMMERCIALLY AVAILABLE TRANSLATOR SOFTWARE PROGRAMS ......................................................................26
ASC X12 AND CMS GLOBAL FILE FORMATTING REQUIREMENTS....................................................26
MORE ABOUT THE DATA SEGMENTS IN A TRANSACTION SET ...............................................................................26
Data Segment Requirement Designators....................................................................................................................26
Data Segment Position ..............................................................................................................................................27

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Data Segment Occurrence .........................................................................................................................................27

Data Segments and the Composite Data Structure .....................................................................................................27
Data Segment.......................................................................................................................................................28
Reference Designator ...........................................................................................................................................28
Delimiters.................................................................................................................................................................28
NHIC/CMS GENERAL REQUIREMENTS ...............................................................................................................29
Signature Requirements................................................................................................................................29
Testing Requirements ...................................................................................................................................29
ELECTRONIC CLAIMS MANAGEMENT SYSTEM (ECMS) HEADER ..........................................................................30
ECMS COMPLIANCE EDITS................................................................................................................................30

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CMS and ASC X12 Overview

The Texas Department of Human Services (TDHS), Texas Department of Mental Health and Mental
Retardation (TDMHMR), and National Heritage Insurance Company (NHIC) are working together to
include ANSI’s ASC X12 (hereby referred to as ASC X12) file formatting and transmission standards into
the Long Term Care Claims Management System (CMS). The basis of this decision is to comply with
potential Federal regulations set out by the Health Insurance Portability and Accountability Act of 1996
(HIPAA) and associated rules to be released in 1998.

ASC X12 standards are formulated to minimize the need for electronic data interchange users to
reprogram their data processing systems for multiple formats. Standards allow data interchange through
the use of a common interchange structure. This technical specifications manual has been created to
establish the requirements needed to exchange electronic data between ASC X12 trading partners and
CMS.

The manual consists of the following documents:

I. Introduction to ANSI’s ASC X12 Specifications for CMS
◊ Communications procedures
◊ ANSI ASC X12 Introduction
◊ ASC X12 and CMS global file formatting requirements

II. ASC X12 997 Functional Acknowledgment

◊ Acknowledgment File Layout
◊ ASC X12 997 Specifications
◊ Error Code Tables

III. Medicaid Eligibility and Service Authorization Verification (MESAV) Batch and Interactive
Request and Response / ASC X12 270/271
◊ MESAV Request File Layout
◊ ASC X12 270 Specifications
◊ MESAV Response File Layout
◊ ASC X12 271 Specifications
◊ Interactive Communications

III. Claims Batch Submission and Response / ASC X12 837/277(Unsolicited)

◊ Claims Submission File Layout
◊ ASC X12 837 Specifications
◊ Claims Response File Layout
◊ ASC X12 277(Unsolicited) Specifications

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IV. Remittance and Status (R&S) Non-pending and Pending / ASC X12 835/277(Pending)

◊ Non-Pending File Layout

◊ ASC X12 835 Specifications
◊ Pending File Layout
◊ ASC X12 277(Pending) Specifications

V. Glossary

VI. Appendix

◊ Code tables specific to Mesav

◊ Code tables specific to Claims
◊ Code tables specific to the Remittance and Status Report

Updates to Manual
NHIC will make periodic changes to this manual. For the latest updates check the CMSFORMT
directory within the Library on the TexMedNet Bulletin Board System (BBS).

Correspondence
All correspondence concerning this manual is welcomed and should be addressed to:

National Heritage Insurance Company

11044 Research Boulevard, Building C
Austin, TX 78759
ATTN: Provider Automation

or call:

The Help Desk

1-800-626-4117
1-512-231-9753

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Communications Procedures

There are three (3) methods of submitting and receiving information electronically:
1. The Production Bulletin Board System - this system is used for uploading and
downloading all ASC X12 transactions.
2. The TexMedNet* Bulletin Board System- this system is used for up-to-date
communications, documentation, and information.
3. Interactive Transmission System- this system is used for transmitting in real time a
single ASC X12 270 and 271 and is a part of the Production Bulletin Board System.
(See Document 3 for specific information on interactive transmissions)

What is the Production Bulletin Board System?

The Production Bulletin Board System (BBS) allows dial-up users to send batch files to and receive
batch files from ECMS/NHIC. It will be the primary medium for sending (uploading) and receiving
(downloading) transactions to the Claims Management System (CMS). It allows the user to:
◊ Upload electronic commerce batch files from user’s computer to ECMS/NHIC
◊ Download electronic commerce batch files from the BBS to the user’s computer

The primary purpose of the BBS is to transfer files to and from users. The BBS is not intended as a
long-term repository of mail, bulletins and files for an individual user. It is set up to store information
for a relatively short period of time and allows users to download information via file transfer.
Because of this, files are retained for a maximum of 30 calendar days.

Requirements for Using the Production BBS

NHIC Provider Automation will issue trading partner Submitter/Receiver identification numbers to all
users of the BBS. Required information at the time of the request will include a provider number,
provider address, tax ID and the ANSI standard format version 4010 installed. Submitter ID’s cannot be
issued without this information. Production supports asynchronous transmissions with standard
protocols. Bisynchronous and tape submissions are not available.

Zipped files are permissible using a utility compatible with pkzip v. 2.04. Files must not exceed 10 MB
unzipped.

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Equipment and Software

Before accessing the BBS, the user will need to have the following:
◊ A computer
◊ A modem that runs at 2400 bps or greater
◊ Dial-up communications software that allows the user to perform terminal emulation using
one of the following file transfer protocols: KERMIT, X-Modem, Y-Modem, or Z-Modem
◊ Submitter/Receiver ID and password: Call the TexMedNet Help Desk for information on
obtaining a Trading Partner (Submitter/Receiver) ID 1-800-626-4117

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Setting Communications Parameters

When setting up a communications session for the first time, check these parameters:

This parameter..... Should be set to this value.....

Parity N
Data Bits 8
Stop Bits 1 (N81)
Flow Control Hardware Flow Control (RTS/CTS)
BBS Telephone Number (see Production BBS Telephone Numbers in next section)
Error Correction ON
Data Compression ON

Production BBS Telephone Numbers

To access the Production BBS dial one of the following local area numbers using a modem and modem
software.

Amarillo 806-342-4103
Austin 512-476-7055
Bryan 409-775-1770
Corpus Christi 512-883-8775
Dallas (214 area only) 214-821-0187
Fort Worth 817-335-1708
Houston (713 area only) 713-757-7943
Longview 903-753-3554
Lubbock 806-749-0150
San Antonio 210-354-3799
Waco 254-752-5512

Please note, these phone numbers should be used by users residing in these cities. Users residing
outside these cities should dial 1-800-328-2427 to connect to the Production BBS.

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Downloading and Uploading from the Production BBS

The BBS provides frequent opportunities for downloading and uploading files from the user’s
computer to the BBS.
. Your communications software will probably suggest or allow you to choose a location on your computer
for storing downloaded files. You should be aware of this location to view the files you have downloaded.

To upload a file, specify the name of the file to upload, including its full path. For example, if using
an IBM-compatible PC to upload a file called MYCLIENT.TXT in the FILES sub-directory on the C:
drive, the name of the file for upload purposes will be C:\FILES\MYCLIENT.TXT.

Finally, when downloading or uploading files, the BBS will prompt that the files are ready for
uploading or downloading to the user’s computer. Instructions for uploading and downloading to
the user’s computer can be found in the local communications software manual. Most
communications programs provide a command, menu option, or icon to receive or send files.

Logging On to the BBS Interface

Step 1:
Enter the necessary commands or select the option or icon in the user’s communications
program to start a communications session.
Dial into the BBS using the appropriate telephone number (previously defined). Make sure the modem is
turned on and ready to initiate communications.

v Messages should display from user’s local communications program indicating that it is initiating the
communications session, dialing the number, and, communicating with AT&T InterSpan.
v When connecting with AT&T InterSpan, a welcome message will display followed by a prompt
requesting the user’s network sign-on ID.

11/1/95 5:06PM Connected to 9,950-1288, 14400/14400 bps, V.42 (LAPM), V.42 bis
WELCOME TO AT&T INFORMATION ACCESS SERVICE

Please Sign-on:

Step 2:
At the sign-on ‘prompt’type TXCP press [ENTER].

Step 3:
At the menu screen choose 1 to access the BBS Production Batch.

Step 4:
At the User Name ‘prompt’type the assigned Submitter/Receiver ID. At the Password ‘prompt’type the
previously assigned password.

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Step 5:
If the password is valid, and there are files to download, the log-on message will display.

Logging on USER uuuu

You have x file(s) available for download

Next is the BBS “Message of the Day” where file maintenance times are displayed. To continue, press
[ENTER].

Step 6:
Press [ENTER] to complete the log-in process, the BBS main menu will appear.

##################################################################
### ###
### MAIN MENU ###
### --------- ###
### ###
### 1. ECMS Main BBS ###
### 2. Account Selection Menu ###
### Q. Quit (Log-off) ###
### ###
### ###
##################################################################
Enter Selection or ?:

Choose Selection 1 to enter the ECMS Main (Production) BBS.

Step 7:
The ECMS Menu allows access to global BBS functions

##################################################################
### ###
### ECMS MENU ###
### -------------------- ###
### ###
### EM. EMAIL MENU ###
### EL. ECMS Library MENU ###
### EB. ECMS Bulletin MENU ###
### DN. DOWNLOAD MENU ###
### UL. UPLOAD MENU ###
### PC. PC Software MENU ###
### CP. Change Password ###
### SP. Support MENU ###
### Q. Quit (Logoff) ###
### ###
### ###
##################################################################
Enter Selection or ?:

To send a transaction to ECMS, type “UL”

To receive a posted transaction from the BBS, type “DN”

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Uploading (UL) a Batch Transaction

Note: This section covers multiple provider/client transactions. Interactive transmissions are explained
in Document 3 - Medicaid Eligibility and Service Authorization Verification (MESAV). Only the ASC X12
270 and the ASC X12 271 are available in interactive mode.

Step 8:
To send a transaction to ECMS, type “UL” to access the upload menu. At the upload menu always
choose Fast Batch (FB).
##################################################################
### ###
### UPLOAD BATCH MENU ###
### ----------------- ###
### ###
### EB. Event Driven Batch ###
### FB. Fast Batch ###
### SB. Standard Batch ###
### Q. Return to Previous MENU ###
### ###
### ###
##################################################################
Enter Selection or ?:

Step 9:
Specify a file transfer protocol. Enter the number of the appropriate protocol. (Z modem is
recommended)

Transmission Protocol Menu:

1) X-modem
2) Y-modem
3) Z-modem
4) Kermit
5) Exit

Enter Selection:

Step 10:
To continue to upload the batch, press [ENTER]
v The following message appears:
Starting to send.
Please start the transmission on your system now.

Š__B010000012f4ced

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Step 11:
Start send procedures in local communications program.
. There are approximately 20 to 40 seconds to start the sending program before the
BBS times out and stops the transmission.
. Most communication programs display status messages when an upload is in
process.
v When the upload is complete, the BBS will prompt:
File received.

Transmission #: ECMSPUSER C8300272.30

Number of bytes received: 1114484

Press <return> to continue:

Press [ENTER] to return to the Upload Batch Menu.

. Information on uploads is also posted to the user’s mail box. Here is an example of
a mail listing that results from an upload.

Mail Box for: EDS ECMSPCUSER

0-unread 1-total 215-bytes

Date Time Size Subject Sender

a.Oct10/95 13:17 215 Upload Confirmation XFER,FILE
b.
c.
d.
e.
f.
g.
h.
i.
j.

a-?)read, s)end, r)emove, +-)page, t)xt_srch, dn)dwnload, q)uit:

NHIC requires users to capture this information for tracking and audit purposes. To capture the
information, simply choose to download the message from the email option on the BBS menu.

Here is an example of an upload confirmation message:

Mail number: 9
From: FILE XFER
Date: Tue Oct 10 13:17:18 EDT 1995
Subject: Upload Confirmation

File received.

Transmission #: ECMSPCUSER.C8300272.30
Number of bytes received: 1114484

File Sent as FAST Batch

(End *******, Press RETURN to Continue):

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Step 12:
To log off, press “q” (quit), three times. Then press “d” (disconnect) to break the connection and log off
the BBS.

Downloading (DN) a Batch Transaction

To begin downloading a batch transaction, repeat the first 7 steps as previously described.

Step 8:
To download a transaction from the BBS, type “DN” to access the download menu.
v The Download Menu will appear.
##################################################################
### ###
### DOWNLOAD MENU ###
### ------------- ###
### ###
### DL. DIR Listing ###
### DN. Download File ###
### RM. Delete File ###
### Q. Return to Previous MENU ###
### ###
### ###
##################################################################
Enter Selection or ?:

The following table describes the options on the Download Menu:

Using this option . . . You can . . .

DIR Listing Display a list of the files in the library
Download File Download a file from any authorized library to your PC

The Download Menu also allows the user to type q and press [ENTER] to return to the ECMS
Menu.

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Step 9:
Type “DN” and press [ENTER].
v The BBS will display a message that shows how many files are available for downloading. This
message is followed by a listing of up to 10 files. Here’s a sample:
# Name Size Date
------------------------------------------
37) TESTHDR3.ZZZ 624 Jun 20 1995
38) TESTHDR4.Z07 0 Jun 19 1995
Select a file number or name to download,
<return> for the next page, or 'q' to quit:

Step 10:
Perform one of the following steps:
◊ If user decides not to download anything right now, type q and press [ENTER] to
return to the Download Menu.
◊ If user has more than 10 files available for download and the file to download is not
displayed, press [ENTER].
• The BBS will display up to 10 more files. This step will repeat until the user
selects a file to download or chooses to quit without downloading.
◊ When the file to download is displayed, type the number or name of the file and
press [ENTER].
◊ If the mail item to download is not displayed, and the name of the file is known, type
the name of the file and press [ENTER].
◊ The user may also use a “naming mask”to select multiple files of the same type.
For example, enter *.ZZZ to select for download all files with the extension ZZZ.
The mask *.* may also be used to download all listed files in the download directory.
v The BBS will ask you to confirm your selection. For example:
Maskcount = 1
Download files with mask “*.ZZZ” <y/n> ?

Step 11:
Perform one of the following steps:
◊ To continue downloading, type y and press [ENTER].
◊ To quit without downloading files, type n and press [ENTER] to return to the
Download Menu
v The BBS will confirm your selection. For example:
Downloading "*.ZZZ"

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v The BBS will display the Transmission Protocol Menu:

Transmission Protocol Menu:

1) X-modem
2) Y-modem
3) Z-modem
4) Kermit
5) Exit

Enter Selection:

Step 12:
Perform one of the following steps:
◊ To quit without downloading, type a “5” to exit and press [ENTER] to return to the
Download Menu.
◊ To continue downloading, type the number of the protocol to use (from 1 to 4) and
press [ENTER]. Z-modem is recommended.
v The BBS will prompt:
Please press enter when you want us to start the
send process.

◊ Press [ENTER}.

v The following message appears:

Starting to send.
Please start the receive procedures on your system.

Logging Off the Production BBS

When tasks are completed on the BBS, log off and end the connection. User must be on the Main
Menu to do this. If not on the Main Menu, type end and press [ENTER] to return there. The BBS
logs off automatically if there are no commands or responses to prompts within a five (5) minute
span.

To Log off the BBS

When the ECMS Main Menu is displayed, do one of the following:

Type end and press [ENTER] OR

Type q and press [ENTER].

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What is the CMS - TexMedNet Bulletin Board System?

The CMS - TexMedNet Bulletin Board System (BBS) furnishes electronic mail (Email) and library
capabilities. Currently, within the BBS library, are the following topics:

CMSBANPG CMS Banner Page

CMSDHS CMS DHS Provider Information
CMSFORMT CMS File Format Documentation
CEMSGENIN CMS Provider Information
CMSMHMR CMS MHMR Provider Information
CMSREFCD CMSconnect Reference File Codes
CMSSOFT CMSconnect Software Updates
CMSSTART CMS Startup Information

How do I access the CMS - TexMedNet bulletin board system?

For initial access to the CMS - TexMedNet BBS, follow the procedures listed below. A userid is required
to access the BBS. Contact the help desk if you do not have a userid.

File Library
The CMS -TexMedNet Bulletin Board System (BBS) maintains a File Library of electronic files to
download to a personal computer (PC).

Download Procedures
To login and download an electronic file from the CMSFORMT library, complete the steps listed below.
Step 1:
Dial the CMS - TexMedNet BBS at (512) 342-4895.
Upon connection, the system displays (1) English/ANSI and (2) English /RIP selection message.

Step 2:
Type “1” and press the [Enter] key to select the English/ANSI language and protocol.
The system displays a welcome message and requests the User ID:

Step 3:
Type the User ID and press [Enter]. The start up User ID is: “New Vendor”

Step 4:
Type the previously assigned password at the prompt and press [Enter].
If there is mail in the user’s mailbox, the system displays a greeting and the message:

“There is new mail in your mailbox! Do you want to see it now (Y/N)?”

Step 5: (The Mailbox)

The first log-on to the BBS has a welcome message waiting in the user’s mailbox. Type a “Y” at the
message prompt to read the mail message or type “N” to read it later.

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If choosing to read the message immediately, follow the on-line instructions to either display or
download the message.
Type an “X” at the Exit prompt to exit the mailbox and display the Main Menu.

Step 6: (The Main Menu)

From the Main Menu, choose from the following tasks:
◊ To select “File Libraries”, type “L” and press [Enter]
◊ To select a specific library, type “S” and press [Enter]
◊ To list available libraries, type “?” and press [Enter]
◊ To select the CMSFORMT library, type “CMSFORMT” and press [Enter].

• If the CMSFORMT library is selected, listed files may be displayed by typing “L”and pressing
[Enter].
• Type “L”and press [Enter] to list files, by file name, in alphabetical order.
• Press [Enter] to display the list from the beginning.
• Type “C” to list the current library (CMSFORMT). The system displays a list of available
electronic files in the CMSFORMT library
• To view the files in the CMSFORMT library, Acroread 3.0 (Acrobat Reader), a common
shareware program, is required. Go to the SOFTWARE library to download Acroread.
Acrobat Reader can also be obtained from the Internet.

Step 7: (Downloading files)

Type the letter corresponding to the file to download and press [Enter]. The system displays a screen
with the file name and details.
◊ Press [Ctrl] + [D] to download the file. The system displays a list of download
options.
◊ Type “Z”and press [Enter] to select the “Z Modem”as the download option. (The Z
Modem offers the most error-free transmission.)

When the transmission is complete, the system displays the message:

“Transfer Successful! Hit any key to return.”
◊ Press any key to return to the download screen.
◊ To download another file, type “C”to continue or “X”to go back to the file library.

Step 8: (Quitting the BBS)

To quit, type “Q” and follow the instructions to exit the library and BBS.

Please direct questions to the TexMedNet Help Desk at 1(800)626-4117.

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ANSI ASC X12 - An Introduction

Version
The official version of an ASC X12 standard is a key ingredient in the agreement between business
partners to exchange business documents. Each partner must implement and conform to the same
version to ensure that data can be successfully exchanged. The official Version for CMS is 004010X098.
These are the Draft standards approved through October 1998.

Business Use and Definitions

The ASC X12 standards are formulated to minimize the need for users to reprogram their data
processing systems for multiple formats by allowing data interchange through the use of a common
interchange structure. This document does not define the method in which interchange partners should
establish the required electronic media communication link, nor the hardware and translation software
requirements needed for Electronic Data Interchange (EDI). Each trading partner must provide these
specific requirements separately. They will not be provided by CMS.

The intent of the ASC X12 standards is to provide assistance in developing and executing the electronic
transfer of health claim data. The standards’developers recognize that some payers/receivers have
submission guidelines that have more features than the standards portray. However, those additional
guidelines' features must be transmitted within the framework outlined in the standards to remain
compliant with ASC X12.

Understanding EDI Transmission Levels

EDI transmission levels are the components that make up an exchange of information between one
computer system and another. These components are also known as transmission envelopes. This
section will give a brief description of the different envelopes that are present in every EDI transmission
including ASC X12 transmissions.

The Transmission File Structure

ISA Interchange Header

GS Functional Group Header
ST Transaction Set Header
SE Transaction Set Trailer
GE Functional Group Trailer
IEA Interchange Trailer

Fig. A: Envelope levels: (1) Interchange ISA/IEA (2) Functional Group GS/GE (3) Transaction Set ST/SE

Interchange Envelopes
The outermost envelope level is the Interchange Envelope. It is defined by ISA and IEA segments. The
ISA/IEA and their associated data elements are defined in their own ASC X12 standard. The purpose of
this envelope is to identify data from one sender to one receiver. There will only be one Interchange
Envelope per transmission. All files must contain an ISA and corresponding IEA segment. This envelope
contains the following types of information:

◊ ISA Segment includes:

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• Structured (BBS) mailbox address of the sender and the receiver

• Interchange control number
• Date/time stamp
• Format and version of the interchange envelopes
• Character sets in this interchange used for data element separators and segment
terminators (delimiters)

◊ IEA Segment includes:

• Interchange control number contained in the ISA segment
• Counts of the functional groups within the interchange

Functional Group Envelope

The second (middle) level of enveloping is the Function Group Envelope, defined by the GS/GE
segments. The purpose is to group similar types of transaction sets within a transmission. There will
only be one Function Group Envelope per transmission. All files must contain a GS and corresponding
GE segment. This envelope contains the following types of information:
◊ GS Segment includes:
• Functional group ID
• Transaction set counts and functional group control number
• Format and version of the document and date/time stamp

◊ GE Segment includes:
• Number of transaction sets included
• Functional group control number contained in the GS segment

Transaction Set Envelope

The innermost level of enveloping is the Transaction Set Envelope, defined by the ST/SE segments.
This level provides transaction control via segment counts and control numbers. This is the beginning of
the data exchanged for CMS. There can be only one transaction set envelope per transmission file.
This envelope contains the following types of information:
◊ ST Segment includes:
• Transaction set ID [this identifies the transaction set being enveloped using a 3 digit
Transaction set ID (i.e. 837)]
• Transaction set control number [this number is assigned by the Sender’s computer and is
part of the control mechanism (i.e. transmission ID)]

◊ SE Segment includes:
• Number of segments in the transaction (including the ST and SE segments).
• Transaction set control number contained in the ST Segment

The following sections will give more detailed information about the enveloping structures, their
components, and definitions with regard to ASC X12 guidelines.

Transaction Set Control Structure Definitions and Concepts

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The ASC X12 standards define commonly used business transactions (such as a health care claim) in a
formal structure called “transaction sets.” A transaction set is composed of a header control segment,
one or more data segments, and trailer control segment. Each segment contains the following:
◊ A unique segment ID
◊ One or more logically related data elements, each preceded by a data element
separator
◊ A segment terminator

Data Element

The data element is the smallest named unit of information in the ASC X12 standard. Data elements are
assigned a unique reference number. Each data element has a name, description, type, minimum length,
and maximum length. Each data element includes a minimum and maximum length. The length of the
data element value is the number of character positions used except as noted for numeric, decimal, and
binary elements. The following are the symbols and their descriptions used within the standards to
identify the data format.

SYMBOL DESCRIPTION
N 0-n Numeric (places to right of the
decimal)
R Decimal (two places to the right of the
decimal implied)
ID Identifier
AN String (alphanumeric)
DT Date
TM Time
B Binary

Numeric
A numeric data element is represented by one or more digits with an optional leading sign representing a
value in the normal base of 10. The value of a numeric data element includes an implied decimal point.
Use numeric when the position of the decimal point within the data is permanently fixed and not
transmitted with the data. The representation for this data element type is “Nn” where N indicates that it
is numeric and n indicates the number of decimal positions to the right of the implied decimal point. If n
is 0, it need not appear in the specification; N is equivalent to N0. For negative values, the leading minus
sign (-) is used. Absence of a sign indicates a positive value. Do not transmit the (+) sign.

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Quantity and Dollar Amounts

Quantity and dollar Amount fields must be submitted in the format specified and according to X12
Standards.

For quantity fields: The field requirements for quantity in these specifications are illustrated with the
minimum and maximum field lengths for X12. The NHIC maximum field length is adjacent to the X12
length. The field is titled NHIC Max. For example: The X12 minimum field length is 2 and the
maximum is 20 (2/20). The NHIC Max field length is 16. This means that NHIC will process the claim
with the first 16 bytes.

For dollar amount fields: X12 standards always assumes a whole dollar amount unless a decimal is
present within the submitted data.

If the value is............... Value entered into field should be ................

$9,999,999.99 9999999.99
$9,999,999.90 9999999.9
$9,999,999.00 9999999

Decimal
A decimal data element may contain an explicit decimal point for numeric values that have a varying
number of decimal positions. This data element type is represented as “R.” The decimal point always
appears in the character stream if the decimal point is at any place other than the right end. If the value
is an integer (decimal point at the right end), omit the decimal point. For negative values, the leading
minus sign (-) is used. Absence of a sign indicates a positive value. Do not transmit the positive (+) sign.

Identifier
An identifier data element always contains a value from a predefined list of codes that is maintained by
the ASC X12 Committee or some other body recognized by the Committee. Trailing spaces should be
suppressed unless they are necessary to satisfy a minimum length. An identifier is always left justified.
The representation for this data element type is “ID.”

String
A string data element is a sequence of any characters from the basic or extended character sets. The
significant characters shall be left justified. Leading spaces, when they occur, are presumed to be
significant characters. Trailing spaces should be suppressed unless they are necessary to satisfy a
minimum length. The representation for this data element type is “AN.”

Date
A date data element is used to express the standard date in YYMMDD format in which YY is the year in
the century (00 to 99), MM is the month (01 to 12), and DD is the day in the month (01 to 31). The
representation for this data element type is “DT.” This format ONLY applies to the Interchange Segment
(ISA/IEA). All other formats within the transmission will be in CCYYMMDD format where CC is the
Century and:
CC = 00-99
YY = 00-99
MM = 01-12
DD = 01-31 if MM = 01,03,05,07,08,10, or 12
01-30 if MM = 03,06,09,11
01-29 if MM = 02 and YY is divisible by 4
01-28 if MM = 02 and YY is not divisible by 4

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Time
A time data element is used to express the ISO standard time HHMMSS format in which HH is the hour
for a 24 hour clock (00 to 23), MM is the minute (00 to 59), SS is the second (00 to 59). The
representation for this data element type is “TM.” The length of the data element determines the format
of the transmitted time. CMS time fields are a required length of 4 bytes and translate into a HHMM
format.

Understanding the Transaction Set

The transaction set is the smallest meaningful set of information exchanged between trading partners.
The transaction set consists of a transaction set header segment, one or more data segments in a
specified order, and a transaction set trailer segment.

Transaction Set Header and Trailer

A transaction set identifier uniquely identifies a transaction set. This identifier is the first data element of
the Transaction Set Header Segment (ST). A user assigned transaction set control number in the header
must match the control number in the Trailer Segment (SE) for any given transaction set. The value for
the number of included segments in the SE segment is the total number of segments in the transaction
set, including the ST and SE segments.

Data Segment Groups

The data segments in a transaction set may be repeated as individual data segments or as unbounded or
bounded loops.

Repeated Occurrences of Single Data Segments

When a single data segment is allowed to be repeated, it may have a specified maximum number of
occurrences defined at each specified position within a given transaction set standard. Alternatively, a
segment may be allowed to repeat an unlimited number of times. The notation for an unlimited number
of repetitions is “>1.”

Loops of Data Segments

Loops are groups of semantically related segments. Data segment loops may be unbounded or bounded.

Unbounded Loops
To establish the iteration of a loop, the first data segment in the loop must appear only once in each
iteration. Loops may have a specified maximum number of repetitions. Alternatively, the loop may be
specified as having an unlimited number of iterations. The notation for an unlimited number of repetitions
is “>1.” A specified sequence of segments is in the loop. Loops themselves are optional or mandatory.
The requirement designator of the beginning segment of a loop indicates whether at least one
occurrence of the loop is required. Each appearance of the beginning segment defines an occurrence of
the loop. The requirement designator of any segment within the loop after the beginning segment
applies to that segment for each occurrence of the loop. If there is a mandatory requirement designator
for any data segment within the loop after the beginning segment, that data segment is mandatory for
each occurrence of the loop. If the loop is optional, the mandatory segment only occurs if the loop
occurs.

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Bounded Loops (Used only in the ASC X12 271)

The characteristics of unbounded loops described previously also apply to bounded loops. In addition,
bounded loops require a Loop Start Segment (LS) to appear before the first occurrence and a Loop End
Segment (LE) to appear after the last occurrence of the loop. If the loop does not occur, the LS and LE
segments are suppressed.

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X12 Mapping Sample

All ASC X12 transmission files will look similar in their layout. The specific data that is included within
each map will be different. This manual provides in a matrix format the file specifications needed for all
transactions that are to be transmitted in the ASC X12 format. Once the users’systems are programmed
to create CMS transactions in the ASC X12 format, the output files should look similar to the
example given below.

The following example is for an eligibility and service authorization verification (MESAV) request, an
ASC X12 270 Inquiry.

Actual Data:
Provider Number - 123456789, Client Name - Jane Doe, Client ID - 901234567, Client Name - Nancy
Doe, DOB - 08/12/1961, SSN - 490921111, From Date of Service - 09/01/1996, To Date of Service -
09/03/1996

ASC X12 270 Translation:

ISA*00* *00* *ZZ*745983652 *ZZ*586254789 *980330*0900*U*00200*0398*0*P*>
GS*HS*745983652*586254789*19980330*0900*0301*X*004010
ST*270*1A11
BHT*0016*13
HL*1**21
NM1*IP*2******PC*123456789
HL*2**22
NM1*IL*1*DOE*JANE
REF*TP*P
REF*23*901234567
EQ*30
DTP*472*RD8*1996090119960903
HL*3*22
NM1*IL*1*DOE*NANCY****34*490921111
DMG*D8*19610812
EQ*30
DTP*472*RD8*1996090119960903
SE*16*1A11
GE*1*0301
IEA*1*0398

For a sample of other X12 transactions, refer to the related documentation.

EDI Transmissions and Translation Software

The purpose of this section is to explain to the reader the function of a translator, and to provide insight
into the selection/formulation of EDI translation software for X12 standards. For this section, it is
assumed that the words “translator” and “translation software” have the same meaning.

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Translators
The primary objective of translation software is to convert X12 formats from/to application formats. This
conversion must satisfy the overall business needs of the trading partner relative to the exchange of
information. Functionality must be assessed to ensure that the translation software will support these
needs.

Selection of Software
To properly evaluate commercially available EDI translation software or to develop “in house” or “home
grown” software, industry guidelines should be consulted. Included are guidelines that were developed
by the Healthcare Subcommittee of X12.

Standards-based transactions are created and maintained by the X12N subcommittee of ASC X12.
Utilization of ANSI ASC X12 standard transaction format necessitates computer software to convert
from/to a trading partner's application format from/to the X12 standard format. Many commercial EDI
translation software (translator) products are available for this task.
The selection of an EDI translation software vendor must be as objective and quantitative as possible.
Areas to be evaluated include technical functionality, capability, and sophistication. User friendliness is
also important, but is subjective in nature. As products are evaluated against one another, the criteria for
user friendliness becomes more and more subjective.

Sample Questions in Determining the Right Translation Software Program

The following is a list of questions that have been prepared as an initial evaluation tool for evaluating
your translation software as well as the associated related services.
1. Is full compliance checking performed? If yes, what types of compliance checking are performed?

2. Is there a mapping feature that non-programming personnel may utilize to map business information
to the ANSI ASC X12 transactions? If yes, is this feature on-line and dynamic? Can this functionality
be performed simultaneously while the software is executing?
3. Is the software table driven? If yes, are the tables maintained on-line? Do they have dynamic update
capability? Please stipulate what is contained in the trading partner table and what information can
be modified dynamically. Is there a copy capability within the table, for example can a map for one
trading partner be copied and then modified for another?
4. Are there trading partner file(s) or table(s)? If yes, is maintenance of the table(s) or file(s) an on-line
function?

5. Does the software support the full set of ANSI ASC X12 transactions? If yes, are multiple versions of
the transaction sets supported concurrently? Can the version be stipulated at run time?
6. Are the health care transaction sets (ANSI ASC X12 --- 834, 835, 837 etc.) supported?
7. Are the customized versions of the health care transaction sets supported?
8. How does the software company accommodate U.S. legislative, HCFA, and WEDI implementation
time frames?
9. Does the software support health care messages?
10. How does error processing occur? Are there capabilities to suspend (place in error status)
interchanges, functional groups, and documents? Is there an on-line function for error correction?
11. Is the translator compatible with other translators?

12. Are reports or reporting capabilities provided? If so what types of reports are provided?

13. What security features are present in the software? Does the software provide encryption
capabilities? If yes, at what level can encryption be performed .... interchange, functional group,
document...? Does your product interface with other security packages?
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14. Are backup and recovery procedures provided? If so, what are they? For IBM environments, do you
provide the JCL for these procedures as well as the JCL for execution of the translator?
15. What audit and control features are there?

Commercially Available Translator Software Programs

For a list of commercially available translation software programs, consult your local computer software
vendor and the Internet. To assist in the search for an appropriate software program EC WORLD,
August 1997 published a directory of electronic commerce software programs. This list can be obtained
by contacting EC WORLD on the Internet at:

www.ecomworld.com .

ASC X12 and CMS Global File Formatting Requirements

More About the Data Segments in a Transaction Set

When data segments are combined to form a transaction set, three characteristics are applied to each
data segment: a requirement designator, a position in the transaction set, and a maximum occurrence.

Data Segment Requirement Designators

A data segment, or loop, has one of the following requirements indicating its appearance in the data
stream of a transmission. These requirement designators are represented by a single character code as
described below.

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REQUIREMENT DESIGNATOR DESCRIPTION

M – Mandatory. This data segment must be included in the transaction set (Note that a
data segment may be mandatory in a loop of data segments, but the loop itself is
optional if the beginning segment of the loop is designated as optional)
O – Optional. The presence of this data segment is the option of the sending party
X – Conditional. The presence of this data segment is conditional on the presence of
another data segment being present

Data Segment Position

The ordinal positions of the segments in a transaction set are explicitly specified for that transaction.
Subject to the flexibility provided by the optional requirement designators of the segments, this
positioning must be maintained. This information is only used with translation software, and may be
ignored if a translator is not being used.

Data Segment Occurrence

A data segment may have a maximum occurrence of one, a finite number greater than one, or an
unlimited number indicated by “>1.”

Data Segments and the Composite Data Structure

The composite data structure is an intermediate unit of information in a segment. Composite data
structures are composed of one or more logically related simple data elements, each, except the last,
followed by a sub-element separator. The final data element is followed by the next data element
separator or the segment terminator. Each simple data element within a composite is called a
component. Each composite data structure has a unique four-character identifier, a name, and a
purpose. The identifier serves as a label for the composite. A composite data structure can be further
defined through the use of syntax notes, semantic notes, and comments. Each component within the
composite is further characterized by a reference designator and a condition designator. The reference
designators and the condition designators are described below.

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Data Segment
A data segment consists of a segment identifier, one or more composite data structures or simple data
elements each preceded by a data element separator and succeeded by a segment terminator. Each
data segment has a unique two- or three-character identifier, a name, and a purpose. The identifier
serves as a label for the data segment. A segment can be further defined through the use of syntax
notes, semantic notes, and comments. Each simple data element or composite data structure within the
segment is further characterized by a reference designator and a condition designator.

Reference Designator
Each simple data element or composite data structure in a segment is provided a structured code that
indicates the segment in which it is used and the sequential position within the segment. The code is
composed of the segment identifier followed by a two-digit number that defines the position of the simple
data element or composite data structure in that segment. For purposes of creating reference
designators, the composite data structure is viewed as the hierarchical equal of the simple data element.
Each component data element in a composite data structure is identified by a suffix appended to the
reference designator for the composite data structure of which it is a member. This suffix is a two-digit
number, prefixed with a hyphen, that defines the position of the component data element in the
composite data structure.

EXAMPLE: The first simple element of the CLP segment would be identified as CLP01. The
first position in the SVC segment is occupied by a composite data structure that contains seven
component data elements, the reference designator for the second component data element
would be SVC01-02.

Delimiters

A delimiter is a character used to separate two data elements (or sub-elements) or to terminate a
segment. The delimiters are an integral part of the data. Delimiters are specified in the interchange
header segment, ISA. The ISA segment is a 105 byte fixed length record. The data element separator is
byte number 4; the component element separator is byte number 105; and the segment terminator is the
byte that immediately follows the component element separator. Once specified in the interchange
header, the delimiters are not to be used in a data element value elsewhere in the interchange as the
translator will always identify the symbol as a delimiter. Below are the delimiters to be used in ASC X12
transaction sets.
CHARACTER NAME DELIMITER

Data Element Separator * Asterisk

Sub-element Separator > Greater than sign
Segment Terminator Hex ‘0D0A’ Carriage Return Line Feed

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NHIC/CMS General Requirements

Signature Requirements

Provider Signature:
Since it is not possible for the provider to sign paper-less claims, the provider must complete enrollment
for Electronic Claims Submission. This enrollment must be completed prior to submitting claims for
payment.

NOTE: Enrollment is required for each provider number for which the provider intends to bill
electronically. Failure to complete enrollment will result in a rejection UPON TRANSMISSION.

Testing Requirements

Local program testing is the decision of each user, however, we strongly suggest production testing prior
to submitting claims for payment. Test claims will not be processed for payment.

In order to test, the Test/Production Indicator field within the ISA Segment MUST always be a “P”.
Anything other than a “P” will result in a file rejection. All test indicators are located within the provider or
claim level segments of all ASC X12 transactions.

The ASC X12 837 Batch Claims Submission transaction, CLM09 is the Test/Production Indicator
location. “00” indicates production, and “27” indicates test. For all other transactions sets the
Test/Production Indicator is located in a REF segment. To submit a test or production transaction input a
“P” for production or a “T” for test.

The response on the test batch will be returned to the submitter in the same manner as a production
batch. It is necessary to download the responses to receive test results. Refer to the response layouts in
this manual.

For assistance with testing call the NHIC Help Desk at: 512/271-9753 or 800/626-4117.

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Electronic Claims Management System (ECMS) Header

All X12 transaction sets will be translated through ECMS using the “Paper Free”translation software program. Prior to acceptance of a
transaction set, ECMS will interpret the Sender/Receiver ID located in the ISA Interchange Control Segment. This ID will indicate:
◊ The parties to the transaction
◊ The types of transactions the parties are authorized to submit
◊ The version of X12 Standards that are being used in the transaction
This information is mandatory. Without this information, ECMS will not be able to begin the translation and submit the transaction to CMS. The
information in the ISA, GS, and ST segments are also used to complete the ECMS Header used by CMS to interpret and identify the type of
transaction incoming. All transactions submitted in the X12 format need to complete these segments according to the specifications located in
the appropriate transaction set document.

ECMS Compliance Edits

Below is a list of the compliance edits that ECMS will perform on all ASC X12 transactions prior to translation. Each ASC X12 transaction will be
edited at the Interchange level (ISA/IEA), the Functional Group level (GS/GE), the Transaction Set level (ST/SE), the Data Segment level, and
the Data Element level.

Each ISA/IEA is checked Each GS/GE is checked Each ST/SE is checked Each Data Segment is Each Data Element is
to: to: to: checked to: checked to:
Ensure control numbers Ensure that the functional Ensure that the transaction Ensure that no invalid Ensure that mandatory
between the ISA and IEA group is supported by the set is supported by the segments are received for data elements are not
are the same and valid ECMS ECMS a particular transaction missing from the segment
Ensure that Sender and Ensure that the functional Ensure that for every ST Ensure that all mandatory Ensure that conditional
Receiver Ids are valid group version is supported (header) there is an SE segments are received for required data elements are
by the ECMS (trailer) segment a particular transaction not issuing from the
segments
Ensure that the X12 Ensure that for every GS Ensure that the control Ensure that loops and Ensure that data elements
version that is submitted is (header) there is a GE numbers between the ST segments do not occur with X12 codes list only
correct for that (trailer) segment and SE are the same and more than the given contain values from these
sender/receiver pair and is valid maximum for that code lists that apply within
supported by the ECMS loop/segment the business context of the
transaction

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Each ISA/IEA is checked Each GS/GE is checked Each ST/SE is checked Each Data Segment is Each Data Element is
to: to: to: checked to: checked to:
Ensure that date and time Ensure that the control Ensure that the number of Ensure that segments are Ensure that numeric data
data elements are numbers between the GS segments sent match the in the appropriate elements only contain
formatted appropriately and GE are the same and number that the ECMS sequence for a particular numeric values, and that
and do not include future valid received transaction alpha-numeric data
dates elements do not include
special characters
Ensure that data elements Ensure that the number of Ensure that the transaction Ensure that a data element
with specific data element transaction sets sent set control number is not is sent in the correct
values, contain only those match the number that the used more than once format. Date data
values. (ie: production/test ECMS received within the functional group. elements are formatted as
contains only a “P”or a CCYYMMDD with valid
“T”. Century, Years (no future
period), months (1-12),
days (1-31)
Validate sender/receiver Time data elements are
ID’s and their ability to formatted as HHMM. With
send/receive this valid hours (00-24) and
transaction/version valid minutes (0-59)

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