PH34767: REQUEST TO CHANGE 999 REPORTING FOR RULES 59104, 06, 08

APAR status

• Closed as program error.

Error description

• Rules 59104, 59106, and 59108 enforce the following 837P, 837I
  and 837D requirement:
  
  For each COB payer, Claim Check or Remittance Date (2330B
  DTP_573) must be present When Coordination of Benefits Payer
  Paid Amount (2320 AMT_D) is used And Service Line Adjudication
  Information (2430 SVD) is not present
  
  When a claim is does not comply with these requirements, the
  following 999 Segment Level detail is generated:
  IK3*AMT*46*2320*I6~
  
  This translates to:
  The 2320 AMT segment on line 46 of the transaction set is
  non-compliant because there is an Implementation Dependent
  Segment Missing.
  
  Alternate reporting:
  IK3*DTP*0*2330B*I6~ (or IK3*DTP*46*2330B*I6~)
  CTX*SITUATIONAL TRIGGER*AMT*46*2320~
  
  This would translate to:
  The 2330B DTP segment on line 0 (or near line 46) of the
  transaction set is non-compliant because it is an Implementation
  Dependent Segment Missing. The non-compliance is the result of
  an situational requirement that applies to the 2320 AMT segment
  on line 46 of the transaction set.
  
  The existing behavior follows the general convention for 999
  reporting as implemented in the Pack for Healthcare. In the case
  of these particular rules, however, it is difficult for trading
  partners to correctly identify the actual cause of the failure
  because there is no mention of the 2330B DTP loop or segment
  identifier at all. The existing behavior for these rules does
  not adhere to the 999 convention that the 2100 IK3 reports the
  segment in error and the 2100 CTX reports the situational
  requirement that "triggered" the error.
  
  Request to change the reporting behavior for these rules so that
  the 2100 IK3 segment reports the 2330B DTP as the segment that
  is "in error" and the 2100 CTX segment reports the 2320 AMT as
  the segment that is "triggering" the error.
  

Local fix

• ITXCQ - ITX00060764
  LV / CN
  Circumvention: None
  

Problem summary

• Users affected:
  Transformation Extender Pack for Healthcare Payer HIPAA
  
  Problem Description:
  
  For per payer situational errors 59104, 59`06, and 59108, 999
  currently reports IK3*AMT*50*2320*I6, but customer would like to
   have IK3*DTP*nn*2330B*I6~
  CTX*SITUATIONAL TRIGGER*AMT*nn*2320~
  
  Platforms affected:
  ALL
  

Problem conclusion

• New rules,  59252, 59253, and 59254 were added to report the DTP
   in the IK3 and AMTD in the CTX segment in the 999.
  
  Applies to:
  Healthcare Payer 9.0.2, 10.0
  
  Fixed in the next Service Pack and releases.
  
  To obtain the fix for this APAR:
  
  To see if the next service pack or product release is available,
   check the IBM Transformation Extender Release Notes page:
  http://www.ibm.com/support/docviews.wss?uid=swg27008337
  
  If the service pack or product release is available, download it
  from Fix Central:
  http://www.ibm.com/support/fixcentral/
  
  If the service pack or product release is not available and you
  require the APAR fix immediately, request a Limited Availability
  Interim Fix (LAIF) by openung a PMR:
  http://www.ibm.com/mysupport/
  
  Prior to version 9.0.0, IBM Transformation Extender was called
  IBM WebSphere Transformation Extender.
  

Temporary fix

Comments

APAR Information

• APAR is sysrouted FROM one or more of the following:

• APAR is sysrouted TO one or more of the following:

Fix information

• Fixed component name

  TX HIPPA EDI

• Fixed component ID

  5724M6100

Applicable component levels