|The pages that follow contain some of the documentation related to the NSMHA Consumer Information System. Many of the transactions listed herein mimic the elements contained in the respective table. The exceptions being the Batch Header, Authorization Request, Inpatient Services, and Outpatient Services; the latter three of which respectively utilize the 278, 837I, and 837P HIPAA transactions.
It is understood that, although some transactions are listed with a Status of Final, there may be modifications that are necessary as a result of testing.
- As a general rule, any date submitted, shall not be in the future.
- Unless otherwise identified, dates should be submitted in the format of 'YYYY-MM-DD'.
Before using the supplied Action Code, the NSMHA CIS verifies whether a record already exists. If a record is submitted with an Action Code of ‘A’ and there is already that record in the NSMHA CIS based on the record keys, the Action Code is changed to ‘C’. Similarly, if a record is submitted with an Action Code of ‘C’ and the NSMHA CIS does not already have that record based on the record keys, the Action Code is changed to ‘A’. If a record is submitted with an Action Code of ‘A’ and the record is not already part of the NSMHA CIS, it is processed as an ‘A’. If a record is submitted with an Action Code of ‘C’ and the NSMHA CIS already has that record record, I leave it a ‘C’. An Action Code of ‘D’ is always treated as ‘D’.
On the Consumer Demographic transaction Action Codes ‘A’ and ‘C’ are the only allowable codes. An Action Code of ‘D’ would error. Expectation being if need to delete a Consumer Demographic record, a Cascade Delete transaction would be used.
On the Cascade Merge and Authorization Request transactions, the only allowable Action Code is ‘A’.
|File Naming Conventions for Batch Files:
The requested filename is a combination of the agency RORG plus the Batch Number. The extension to use is based on the following:
At a minimum, all filenames must begin with the agency RORG and the extension must be one of the ones noted above.
- 278 Request - use '278' as the extension
- 837 Professional - use '837P' as the extension
- 837 Institutional - use '837I' as the extension
- For the 999.00 transaction batch file, use 'ERR' as the extension
- For all other non-HIPAA batch/EDI files, use 'EDI' as the extension
|Test files run through the testing system need to include all the necessary transaction for processing. For example: If you are running the 837p encounter file you will want to have an EDI that contains the RDEM and RSTAF records that correspond to the client in the 837p. Both files should be in the sftp testing/inbound folder to prevent errors. When you have tested EDI files, and the contents have processed without errors, put those transactions in one EDI file to upload with the 837p, 837i or 278 that you are wishing to process.