EDI 997 Functional Acknowledgment for Healthcare Insurance
What is the EDI 997 Functional Acknowledgment?
The 997 Functional Acknowledgment describes the syntax-level acknowledgment of the receipt of an X12 functional group. The encoded documents are the transaction sets (grouped in functional groups) used to define transactions for electronic data interchange. It confirms to a sender that a receiver has received the EDI transactions successfully. In addition, the acknowledgment contains an acceptance or rejection notification. Trading partners may choose to supply more detailed EDI 997s that describe individual elements that contain syntax errors when rejections occur. Note that the 997 response neither indicates the trading partner agrees with the contents of the transaction nor that the transaction meets business requirements.
Note: Version 5010 of the HIPAA EDI standards established EDI 999 as the healthcare standard acknowledgment document, designed to replace the Version 4010 997 Functional Acknowledgement. However, you may encounter both the 997 and 999 in use. The HIPAA 5010 999 Implementation Acknowledgment includes additional specific validation information on syntactical quality and implementation guide conformance.
EDI 997 Functional Ack in Data Mapper
(Click to enlarge)
EDI 997 Frequently Asked Questions
While both the EDI 997 and EDI 999 provide functional acknowledgments, the EDI 999 offers more detailed validation specific to HIPAA 5010 requirements. PilotFish supports both, allowing flexibility depending on your trading partners’ preferences.
Yes, PilotFish allows you to configure the level of detail in EDI 997 responses, including specifying whether to include error detail down to the element level based on your trading partner’s needs.
PilotFish is optimized for high-volume environments, allowing real-time or batch processing of EDI 997 acknowledgments. The platform can handle large-scale EDI operations without sacrificing performance or accuracy. Read the EDI claims case study that includes examples of real-time and batch EDI workflows.
In PilotFish, monitoring mechanisms can detect when an expected EDI 997 is not received, allowing users to automate alerts or escalation workflows to ensure timely resolution of missing acknowledgments. See the eiDashboard for Reporting & Monitoring transactions.
Check out our EDI FAQ pages for more.
EDI 997 Format Example
The following example describes a 997 transaction set that is responding to a functional group that was received containing two 837 transaction sets. The first transaction set conformed fully with the X12 standard, while the second contained errors.
| ISA*00* *00* *ZZ*123456789012345 *ZZ*123456789012346*080503*1705*>*00501*000010216*0*T*:~ GS*FA*1234567890*2345678901*20080503*1705*20213*X*005010X230~ | The Interchange Control and Functional Group segments (ISA, GS, GE, and IEA) are required in the ASC X12 message. See Appendix C for additional details on these segments. |
| ST*997*2870001*005010X230~ | The ST segment indicates the beginning of the 997 transaction set, control number 2870001. |
| AK1*HC*17456*005010~ | The AK1 segment describes the functional group to which this 997 is responding. |
| AK2*837*0001~ AK5*A~ | The first Transaction Response Loop indicates that the received transaction set, control number 0001, was accepted with no errors. |
| AK2*837*0002~ AK3*CLM*22**8~ AK4*1*1028*1~ AK5*R*5~ | The second Transaction Response Loop indicates that the received transaction set, control number 0002, was rejected due to a missing CLM01 data element. |
| AK9*P*2*2*1~ SE*10*2870001~ GE*1*20213~ | The Trailer section provides a summary of the disposition of the received functional group and ends the transaction set. |
Source
Accredited Standards Committee X12. ASC X12 Standard [Table Data]. Data Interchange Standards Association, Inc., McLean, VA. ASC X12 Examples
X12, chartered by the American National Standards Institute for more than 35 years, develops and maintains EDI standards and XML schemas.