Understanding the 997 and the Negative TA1

The TA1 and 997 are HIPAA transactions that are sent to the submitter as an acknowledgement (positive
or negative) for their submission.

TA1 Acknowledgement
The purpose of the TA1 Acknowledgement is to report the status of the interchange envelope for the
transaction submitted by the partner. These acknowledgements can either be positive or negative
depending on the envelopes being accepted or rejected. A negative acknowledgement occurs when the
envelopes are set up incorrectly or the information in the envelope does not match the information that is
contained within the Alaska Medicaid Gateway system. At this time, Alaska Medicaid will be returning
only negative TA1s.

Example of a Negative TA1

What follows is an example of an 837 envelope for professional test claim file.

ISA*00* *00* *ZZ*0001553*ZZ*AKMEDICAID

FHSC*011022*1248*U*00401*000000905*0*P*>~
GS*HC*0001553*AKMEDICAID FHSC*20011022*1254*12345*X*004010X098A1~ ST*837*~
………
………
………
………
SE*47*0002~
GE*1*12345~
IEA*1*000000905~

Example of a TA1 Response

The example above receives a negative TA1 as illustrated below.

ISA1*00* *00* *ZZ2*AKMEDICAID FHSC3*ZZ4*00011115*

6
*041019*1411*U*00401*000009937 *0*T*>~
TA17*0000009058*0110229*125410*R11*02012~
IEA*0*000009937~

Number Element Name Instructions

1 ISA Interchange Control Header The ISA is a fixed length record with fixed
length elements.
2 ISA05 Interchange ID (Sender) This element contains a value of "ZZ,"
Qualifier mutually defined.

Version 1.0 1 November 30, 2004

 Understanding the 997 and Negative TA1

Number Element Name Instructions

3 ISA06 Interchange Sender ID This element contains an identifier
representing the program sending the file.
The value will be "AKMEDICAID FHSC,"
Alaska Medicaid.
4 ISA07 Interchange ID (Receiver) This element contains a value of "ZZ,"
Qualifier mutually defined.
5 ISA08 Interchange Receiver ID This element contains the submitter ID
number assigned by Alaska Medicaid.
6 ISA13 Interchange Control Number This element contains a distinct tracking
number for this file.
7 TA1 Interchange A TA1 will only be sent to identify
Acknowledgment interchange level errors.
8 TA101 Interchange Control Number This element contains the value from ISA13
for the interchange on which it is reporting.
9 TA102 Interchange Date This element contains the date from ISA09
for the interchange on which it is reporting.
10 TA103 Interchange Time This element contains the time from the
ISA10 for the interchange on which it is
reporting.
11 TA104 Interchange This element contains the status of the
Acknowledgment Code interchange. The only value that Alaska
Medicaid will return is "R," ISA or IEA
Interchange had critical errors and the
exchange was not accepted. Correct errors
and resend.
12 TA105 Interchange Note Code This is an explanatory code that describes
the reason for the rejection, in this example
020 - Invalid Test Indicator Value
The codes and descriptions are:
0. No error
1. The Interchange Control Number in the
Header and Trailer Do Not Match.
2. This Standard as Noted in the Control
Standards Identifier is Not Supported.
3. This Version of the Controls is Not
Supported
4. The Segment Terminator is Invalid
5. Invalid Interchange ID Qualifier for
Sender
6. Invalid Interchange Sender ID
7. Invalid Interchange ID Qualifier for
Receiver

Version 1.0 2 November 30, 2004

 Understanding the 997 and Negative TA1

Number Element Name Instructions

8. Invalid Interchange Receiver ID
9. Unknown Interchange Receiver ID
10. Invalid Authorization Information
Qualifier Value
11. Invalid Authorization Information
Value
12. Invalid Security Information Qualifier
Value
13. Invalid Security Information Value
14. Invalid Interchange Date Value
15. Invalid Interchange Time Value
16. Invalid Interchange Standards Identifier
Value
17. Invalid Interchange Version ID Value
18. Invalid Interchange Control Number
Value
19. Invalid Acknowledgment Requested
Value
20. Invalid Test Indicator Value
21. Invalid Number of Included Groups
Value
22. Invalid Control Structure
23. Improper (Premature) End-of-File
(Transmission)
24. Invalid Interchange Content (e.g.,
Invalid GS Segment)
25. Duplicate Interchange Control Number
26. Invalid Data Element Separator
27. Invalid Component Element Separator
28. Invalid Delivery Date in Deferred
Delivery Request
29. Invalid Delivery Time in Deferred
Delivery Request
30. Invalid Delivery Time Code in Deferred
Delivery Request
31. Invalid Grade of Service Code
In the example, since this transaction was a test file, the submitter should have sent in the ISA15 a “T”
instead of a “P”, which indicates it is a production file. Since this field did contain a match for the value
anticipated, a negative TA1 was generated.

Version 1.0 3 November 30, 2004

 Understanding the 997 and Negative TA1

997 Response
The next level of response (acknowledgement) is the 997. The purpose of the 997 transaction is to
acknowledge the receipt of and status pertaining to each segment in an EDI transaction. One 997 is
generated for every functional group received in the transmission. If the submitter’s file has three
functional groups, then three 997’s are sent back to the submitter. The acknowledgement can be either
positive or negative.
If the functional group in a submission is HIPAA compliant, then the submitter will receive a positive 997
indicating acceptance for processing. It will not reflect if the claims will be paid or denied. It is simply a
notification of successful receipt. However, if the transaction has HIPAA errors, then the entire batch is
rejected and an error(s) is conveyed via AK3 and AK4 segments of the 997 transaction. (Alaska defines a
batch as all data in an ST-SE envelope.).
Whenever a transmission is rejected, there will be associated AK3 and AK4 segments that will further
explain the reason why the batch was rejected.
For Alaska Medicaid processing, a 997 (TA1 also) is sent back to the submitter’s directory on the FTP
server. To access the acknowledgement, a submitter would have to log back into the FTP server and
check the outbound folder.
It is the responsibility of the submitter to read their 997 and confirm that the transaction was accepted or
rejected. If a transaction is rejected due to HIPAA errors, corrections can be made and the transaction can
be resubmitted. If the negative 997s are not reviewed and if the claims are not corrected and resubmitted,
then the claims associated with this transaction will not be processed by Alaska Medicaid and thereby will
not be considered for payment.

Example of a 997
To interpret this example, the superscript numbers provided cross reference the legend that is listed
below.

ISA*001* 2
*00*3 4
*ZZ5*AKMEDICAID FHSC6*ZZ7*30008
(Submitter ID) *040206 *1948 *U *0040112*00000004813*014*P15*>~
9 10 11

GS*FA16*AKMEDICAID FHSC17*300018*2004020619*194820*4021*X22*004010X098A123~
ST*99724*001525~
AK126*HC27*40715000128~
AK229*83730*51666010931~
AK541*A42~ ACCEPTED
AK2*837*516600110~
AK5*A~ ACCEPTED
AK2*837*516600111~
AK5*A~ ACCEPTED
AK2*837*516600112~
AK5*A~ ACCEPTED
AK2*837*516600113~
AK332*SBR33*206934*230035*836~
AK3*SBR*2069*2300*8~
AK3*SV1*3516*2400*8~
AK437*338*35539*340*DA~
AK3*NM1*3711*2310B*8~
AK4*9*67*6*909090909~
AK541*R42*543~ REJECTED with reasons

Version 1.0 4 November 30, 2004

 Understanding the 997 and Negative TA1

AK2*837*516600114~
AK5*A~ ACCEPTED
AK944*P45*546*547*448~ Count of Claims
SE*5249*001550~
GE*151*1452~
IEA*153*00000001554~

997 Legend
Number Element Name Instructions
Interchange Control Header (ISA)
1 ISA01 Authorization Information This code will always be ‘00’ to indicate no
Qualifier authorization information is present.
2 ISA02 Authorization Information Since there is no authorization information
present as indicated by the ‘00’ this element is
left blank.
3 ISA03 Security Information This code will always be ‘00’ to indicate no
Qualifier authorization information is present.
4 ISA04 Security Information Since there is no authorization information
present as indicated by the ‘00’ this element is
left blank.
5 ISA05 Interchange ID (Sender) This element will usually be “ZZ,” which
Qualifier represents mutually defined.
6 ISA06 Interchange Sender ID The following value will be sent for this
element: “AKMEDICAID FHSC”, which
represents Alaska Medicaid.
7 ISA07 Interchange ID (Receiver) This element will usually be “ZZ,” which
Qualifier represents mutually defined.
8 ISA08 Interchange Receiver ID This element will contain the submitter ID
assigned by Alaska Medicaid.
9 ISA09 Interchange Date This is the date that the interchange was
created in YYDDMM format.
10 ISA10 Interchange Time This is the time that the interchange was
created in the HHMM format.
11 ISA11 Interchange Control This value will always be a “U”.
Standards Identifier
12 ISA12 Interchange Control This value will be “00401” until any further
Version Number update by ASC X12 Procedure Review Board.
13 ISA13 Interchange Control This element contains a distinct tracking
Number number for this file.

Version 1.0 5 November 30, 2004

 Understanding the 997 and Negative TA1

Number Element Name Instructions

14 ISA14 Acknowledgment This is used to request the receipt of an
Requested interchange acknowledgment (TA1). Alaska
Medicaid will have a “0” in this element,
which means no acknowledgment is requested.
15 ISA15 Usage Indicator This identifies if the transaction is for
Production Data (P) or Test Data (T).
Functional Group Header (GS)
16 GS01 Functional Identifier For the 997, the functional group ID is FA (for
Functional Acknowledgement).
17 GS02 Application Sender’s Code This element contains the same value as
ISA06 (#6).
18 GS03 Application Receiver’s The value is the same value as ISA08 (#8).
Code
19 GS04 Functional Group Creation In YYDDMM format
Date
20 GS05 Function Group Creation In HHMM format
Date
21 GS06 Group Control Number This number is assigned by the sender and
must match the associated Functional Group
Trailer in GE02 (#52).
22 GS07 Responsible Agency Code This value will always be “X”.
23 GS08 Version/Release/Industry This is the code indicating the version, release,
Identifier Code sub-release, and industry identifier of the EDI
standard being used. For example, if the 997
was reporting on the 837 professional group
the value would be “004010X098A1”.
Transaction Set (ST)
24 ST01 Transaction Set Identifier This code will always be 997 for Functional
Code Acknowledgments.
25 ST02 Transaction Set Control This number must match the associated
Number Transaction Set Trailer in SE02 (#40).
26 AK1 The AK1 is used to respond to the functional group header and to start the
acknowledgement for a functional group.
27 Functional Identifier Code The number is the functional ID found in the
GS01 segment in the functional group on the
file submitted to Alaska Medicaid. For a
health care claim this ID will be HC.

Version 1.0 6 November 30, 2004

 Understanding the 997 and Negative TA1

Number Element Name Instructions

28 AK102 Group Control Number This is the functional group control number
found in the GS segment in the functional
group being acknowledged on the file
submitted to Alaska Medicaid.
29 AK2 The AK2 is used to start the acknowledgement of a transaction set within the
received functional group.
30 Transaction Set Identifier This is the transaction set ID found in the ST
Code segment (ST01) in the transaction set being
acknowledged on the file submitted to Alaska
Medicaid. For a health care claim, this code
will be 837.
31 AK202 Transaction Set Control This is the transaction set control number
Number found in the ST segment in the transaction set
being acknowledged on the file submitted to
Alaska Medicaid.
32 AK3 Data Segment Note: This is used to report errors in a data segment and
identify the location of the data segment.
33 AK301 Segment ID Code This contains the identification of the data
segment in error (e.g., “NM1” or “SV1”) that
was received by Alaska Medicaid.
34 AK302 Segment Position in This is the numerical count of this data
Transaction Set segment from the start of the transaction set.
(e.g. the ST loop).
35 AK303 Loop Identifier Code This identifies the loop within which the error
occurred on the file submitted to Alaska
Medicaid.
36 AK304 Segment Syntax Error This element contains the error noted for the
Code segment. The codes and descriptions are:
1. Unrecognized segment ID
2. Unexpected segment – example error
3. Mandatory segment missing
4. Loop occurs over maximum times
5. Segment exceeds maximum use
6. Segment not in defined transaction set
7. Segment not in proper sequence
8. Segment has data element errors –
example error
37 AK4 Data Element Note: This is used to report errors in a data element or
composite data structure and identify the location of the data element.

Version 1.0 7 November 30, 2004

 Understanding the 997 and Negative TA1

Number Element Name Instructions

38 AK401-1 Element Position in This is used to indicate the relative position of
Segment the data element or composite data structure in
error. If CLM03 was in error, the value would
be “3.”
39 AK401-2 Component Data Element This identifies the component data element
Position in Composite position within the composite data structure (if
applicable).
40 AK403 Data Element Syntax Error This element contains the code indicating the
Code type of error found. The values and
descriptions are:
1. Mandatory data element missing –
Example Error
2. Conditionally required data element
missing
3. Too many data elements - Example
Error
4. Data element too short
5. Data element too long
6. Invalid character in data element
7. Invalid code value
8. Invalid date
9. Invalid time
10. Exclusion condition violated
AK404 Copy of Bad Data Element This element contains a copy of the data in
error. It is not sent if bad data will affect
usage/validity of this 997 (i.e., make the 997
noncompliant).
41 AK5 Transaction Set Response Trailer. This segment is used to acknowledge
acceptance or rejection and report errors in a transaction set.
42 AK501 Transaction Set This is a code indicating acceptance or
Acknowledgment Code rejection condition based on the syntax editing
of the transaction set. The values and
descriptions used are:
ƒ “A” Accepted
ƒ “R” Rejected with explanation

Version 1.0 8 November 30, 2004

 Understanding the 997 and Negative TA1

Number Element Name Instructions

43 AK502 Transaction Set Syntax This codes indicating error found based on the
Error Code syntax editing of a transaction set. The values
and description used are:
1. Transaction set not supported
2. Transaction set trailer missing
3. Transaction set control number in header
and trailer do not match
4. Number of included segments does not
match actual count
5. One or more segments in error –
Example Error
6. Missing or invalid transaction set
identifier
7. Missing or invalid transaction set control
number
8. Authentication key name unknown
9. Encryption key name unknown
10. Requested service (authentication or
encrypted) not available
11. Unknown security recipient
12. Incorrect message length (encryption only)
13. Message authentication code failed
15. Unknown security originator
16. Syntax error in decrypted text
17. Security not supported
23. Transaction set control number not unique
within the functional group
24. S3E security end segment missing for S3S
security segment
25. S3S security segment missing for S3E
security end segment
26. S4E security end segment missing for S4S
security segment
27. S4S Security start segment missing for
S4E security end segment
44 AK9 Functional Group Response Trailer. This is to acknowledge acceptance or
rejection of a functional group and report the number of included
transaction sets from the original trailer.

Version 1.0 9 November 30, 2004

 Understanding the 997 and Negative TA1

Number Element Name Instructions

45 AK901 Acknowledgement Code This is a code indicating acceptance or
rejection condition based on the syntax editing
of the function group. The values and
descriptions used are:
ƒ “A” Accepted
ƒ “R” Rejected with explanation
ƒ “P” Partially accepted (at least one
rejected)
46 AK902 Number of Transaction This is the total number of transaction sets
Sets Included included in the functional group.
47 AK903 Number of Received This is the total number of transaction sets
Transaction Sets received in the original file sent to Alaska
Medicaid.
48 AK904 Number of Accepted This is the number of accepted transaction sets
Transaction Sets in a functional group.
Transaction Set Trailer (SE)
49 SE01 Number of Included This is the total number of segments in a
Segments transaction set including ST and SE segments.
50 SE02 Transaction Set Control This number must match what the sender put
Number in ST02 (#25).
Functional Group Trailer (GE)
51 GE01 Number of Transaction This is a count of the number of Transaction
Sets Included Sets (ST/SE loops) within the functional
groups or interchange.
52 GE02 Group Control Number This number must match what the sender put
in GS06 (#21).
Interchange Control Trailer (IEA)
53 IEA01 Number of Included This is a count of the number of Functional
Functional Groups Groups (GS/GE loops) within the interchange.
54 IEA02 Interchange Control This number must match what the sender put
Number in ISA13 (#13).

Version 1.0 10 November 30, 2004

 Understanding the 997 and Negative TA1

Multiple Batches – Partial Acceptance

If the functional group has multiple batches, then only those batches having HIPAA errors are rejected.
Remaining batches are accepted for processing. In this case, reading the 997, the submitter will realize
that the transmission has been partially accepted due the AK9-01 (Functional group acknowledge code) =
"P" suggesting "Partial acceptance".
Partial acceptance informs the submitter that at least one batch was rejected. One AK2 (Transaction set
response header) and AK5 (Transaction set response trailer) segment is generated for each incoming
batch. With the help of information provided in the 997, the submitter can make the required corrections
to the batches that were rejected and resubmit them for processing.

Multiple Batch – Partial Acceptance Example

An example of this situation is as follows: If an incoming transmission has 10 batches, then the 997 will
have 10 AK2 segments and 10 AK5 segments. AK2-02 (Transaction set control number) represents the
unique number that identifies the particular batch. AK5-01 (Transaction set acknowledgment code)
conveys the acceptance or rejection of the batch. So, if a particular batch is rejected, then AK5-01 = "R"
and AK2-02 will inform the submitter which batch has been rejected.
The example below lists the portion of the 997 describing the status for multiple batches.
AK2*837*000170 (batch number) ~
AK5*A (status A=Acceptance)~
AK2*837*000171~
AK5*A~
AK2*837*000172~
AK5*R~
AK9*P*3*3*2~
SE*348*0162~
GE*1*162~
IEA*1*000000164~
To summarize the above example batch numbers 000170 and 000171 were accepted but batch number
000172 was rejected. As a result, AK9-01 = "P" informs the submitter that transmission was accepted
partially.

Version 1.0 11 November 30, 2004