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EDI 997 Format Example

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 (which are grouped in functional groups) used in defining transactions for electronic data interchange. It confirms to a sender that a receiver has received the EDI transactions successfully. 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 Transaction Example in Data Mapper

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.

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