EDI 824 Application Advice
What is an EDI 824 Application Advice?
The X12 EDI 824 transaction set specified under HIPAA 5010 establishes the format and data contents of the Application Advice Transaction Set (824) for use within the context of an Electronic Data Interchange (EDI) environment. The 824 is used as a means of communicating errors in a previous transaction. This allows the trading partner who sent the original transaction to identify, correct and resubmit that transaction. The transaction set can be used to provide the capability to report the results of an application system’s data content edits of transaction sets.
X12 EDI 824 can report the inspection results of the previously sent transaction as any of the following: Accepted, Rejected, Accepted with Changes, Partial Acceptance or Partial Rejection of any transaction set. The editing of the originating transaction sets can be reported at the functional group and transaction set level, in either coded or free-form format. The 824 is an Optional Transaction, currently not a HIPAA mandated transaction.
In healthcare applications, the optional EDI 824 transaction meets HIPAA 5010 requirements for non-claims (276, 270 and 278) transactions.
EDI 824 Application Advice in Data Mapper
(Click to enlarge)
In practice, EDI 824 is also used as an acknowledgment of EDI 837 Claims. Many state health and wellness and/or Medicaid departments may require the use of EDI 824 Application Advice as a response from the receivers of inbound X12 EDI 837 Claims transactions under set conditions. (See each state’s Department of Health applicable Companion Guide for EDI 824 Application Advice.)
Healthcare solution providers (e.g., CVS Caremark) also may require the use of EDI 824 in their trading partner acknowledgment specifications as an error reporting format for inbound EDI 837 Claims.
The EDI 275 Attachment Acknowledgment in healthcare workflows may be a 999 and/or an 824. Using the 824 acknowledgment to report the success or failure of the attachment transaction may be preferred, as the 824 can embed the HL7 report indicating that the HL7 transaction was accepted or contained an HL7 syntax error.
Errors can cause the entire Functional Group (GS/GE) or entire Transaction Set (ST/SE) to be rejected, depending on the type of error, with no further processing. Since further processing is halted, the expected X12 response transaction may never be received (e.g., an 837 would not appear on an 835 remittance advice; a 271 would not be received in response to a 270; a 277 would not be received in response to a 276).
Most, but not all, edit failures of these types will be reported using the 999 and/or 824 transactions. Generally, the 999 will report on acceptance/rejection at a high level. The 824 is used to supplement the 999 by providing very specific error information, data element by data element, allowing for easier analysis and correction.
EDI 824 Application Advice doesn’t replace the EDI 997, EDI 999 or EDI TA1 transactions. The recipient of an 824 Application Advice document may send or be required to send a 997 Functional Acknowledgement in response. The 997 indicates that the 824 was successfully received.
Note: EDI 824 should not be used in situations where a specific response document exists for a given transaction, e.g., EDI 835 Remittance Advice in response to an EDI 837 Healthcare Claim.
Transmission Explanation
| Business Scenario 1 – Positive Acknowledgement | |
| ST*824*021390001*005010X186A1~ | Beginning of an 824 transaction set, Control number = 021390001 |
| BGN*11*FFA.ABCDEF.123456*20020709*0932**123456789**WQ~ | Beginning Segment Response to transaction set reference (FFA.ABCDEF.123456) and transaction creation time (20020709 0932). Reference Identification (123456789), Action Code (WQ=Accept) |
| N1*41*ABC INSURANCE*46*111111111~ | Submitter Name (ABC INSURANCE) and Electronic Transmitter Identification Number(ETIN) (111111111) |
| PER*IC*JOHN JOHNSON*TE*8005551212*EX*1439~ | Submitter EDI Contact Information. Phone# 8005551212 ext. 1439 |
| N1*40*SMITHCO*46*A1234~ | Receiver Name (SMITHCO) and Electronic Transmitter Identification Number (ETIN) (A1234) |
| OTI*TA*TN*NA***20020709*0902*0002*0001*834*004010X095~ | Original Transaction Identification. Transaction Set Accept (TA). Transaction Reference Number(TN): NA Original Goup Date: 20020709 Original Group Time: 0902 Group Control Number: 002 Transaction Set Control Number:0001 Transaction Set Identifier Code: 834 Version / Release / Industry Identifier Code: 004010X095 |
| SE*7*021390001~ | Transaction Set Trailer with segment count (7) and Control Number (021390001). |
| Business Scenario 2 – Complete Transaction Set Reject Reporting | |
| ST*824*021390002*005010X186A1~ | Beginning of an 824 transaction set, Control number = 021390002 |
| BGN*11*FFA.ABCDEF.123456*20020709*0932**123456789**U~ | Beginning Segment Response to transaction set reference (FFA.ABCDEF.123456) and transaction creation time (20020709 0932). Reference Identification (123456789), Action Code (U=Reject) |
| N1*41*DEF INSURANCE*46*222222222~ | Submitter Name (DEF INSURANCE) and Electronic Transmitter Identification Number(ETIN) (222222222) |
| PER*IC*TOM EVANS*TE*8005551212*EX*1439~ | Submitter EDI Contact Information. Phone# 8005551212 ext. 1439 |
| N1*40*JONESCO*46*B5678~ | Receiver Name (JONESCO) and Electronic Transmitter Identification Number (ETIN) (B5678) |
| OTI*TR*TN*NA***20020709*0902*0002*0001*124*004010~ | Original Transaction Identification. Transaction Set Reject (TR). Transaction Reference Number(TN): NA Original Goup Date: 20020709 Original Group Time: 0902 Group Control Number: 002 Transaction Set Control Number:0001 Transaction Set Identifier Code: 124 Version / Release / Industry Identifier Code: 004010 |
| TED*024**VEH*36*02~ | Technical Error Description. Segment ID Code (VEH), Segment Position in Transaction Set (36) Position In Segment(02) |
| RED*NA**94**IBP*E054~ | Error or Informational Message. Insurance Business Process Application Error Code(IBP) and Code (E052) |
| SE*9*021390002~ | Transaction Set Trailer with segment count (9) and Control Number (021390002). |
| Business Scenario 3 – Partial Transaction Set Reject Reporting | |
| ST*824*0001*005010X186A1~ | Beginning of an 824 transaction set, Control number = 0001 |
| BGN*11*12345*20040831*150057**0123**RU~ | Beginning Segment Response to transaction set reference (12345) and transaction creation time (20040831 150057). Reference Identification (123456789), Action Code (RU=Return) |
| N1*41*CONSOLIDATED INSURANCE CO*46*00000~ | Submitter Name (CONSOLIDATED INSURANCE CO) and Electronic Transmitter Identification Number(ETIN) (00000) |
| PER*IC*CUSTOMER SERVICE*TE*8005551212~ | Submitter EDI Contact Information. Phone# 8005551212 |
| N1*40*PHIL GOOD, M.D.*46*TXX23~ | Receiver Name (PHIL GOOD, M.D.) and Electronic Transmitter Identification Number (ETIN) (TXX23) |
| We start by reporting at the Transaction Set level that the entire Transaction Set has been accepted by Consolidated Insurance into their “production” system. The REF02 comes from the BHT03 of the 837, which typically is the “Tape/Reel Serial Number”. For additional validation and reconciliation, the total dollar amount of all the claims in the 837 Transaction set is given in AMT02 and the count of all claims in the 837 is given in QTY02. The 837 Transaction Set submitter is identified as Phil Good. In addition, there is a Warning message attached to this Transaction Set that reports that the segment terminators were followed by new-lines. Since this is only a warning, it did not cause rejection of the 837 Transaction Set. This Transaction Set summary is important in reconciling the 824 with the 837 that it is responding to. | |
| OTI*TA*TN*NA***040812*1253*1000001*0021*837*004010X098A1~ | Original Transaction Identification. Transaction Set Accept(TA). Transaction Reference Number(TN): NA Original Goup Date: 040812 Original Group Time: 1253 Group Control Number: 1000001 Transaction Set Control Number:0021 Transaction Set Identifier Code: 837 Version / Release / Industry Identifier Code: 004010X098A1 |
| REF*F8*0123~ | Original Reference Number: 0123 |
| DTM*050*20040814~ | Date/Time Reference: Date 20040814 |
| AMT*GW*16970.33~ | Monetary Amount Information. Total Charge(GW) : 16970.33 |
| QTY*TO*5~ | Quantity Information. Total(TO): 5 |
| NM1*41*2*PHIL GOOD, M.D.*****46*TXX23~ | Submitter(41) Name (PHIL GOOD, M.D.) and Electronic Transmitter Identification Number(ETIN) (TXX23) |
| TED*024~ | Technical Error Description. |
| RED*NA**94**IBP*W050~ | Error or Informational Message. Insurance Business Process Application Error Code(IBP) and Code (E052) |
| Next comes a “Batch” level summary. Since the 837 only had one billing provider, there is only one batch reported, but if the 837 had contained several Billing Providers there would have been one batch reported for each Billing Provider loop in the 837. This batch allows the quick identification of acceptance or rejection for all the claims for that billing provider, and gives a claim count for this Billing Provider and the total dollar amount for those. | |
| OTI*BP*BT*NA***040812*1253*1000001*0021*837*004010X098A1~ | Original Transaction Identification. Batch Partial Accept/Reject(BP). Transaction Reference Number(TN): NA Original Goup Date: 040812 Original Group Time: 1253 Group Control Number: 1000001 Transaction Set Control Number:0021 Transaction Set Identifier Code: 837 Version / Release / Industry Identifier Code: 004010X098A1 |
| REF*EJ*26462967~ | Patient Account Number(EJ): 26462967 |
| AMT*GW*540~ | Monetary Amount Information. Total Charge(GW) : 540 |
| NM1*QC*1*SMITH*TED****MI*000221111A~ | Patient(QC) Name (TED SMITH) and Member Identification Number (000221111A) |
| The second claim is “Accepted with Error” and the error is noted as an invalid ZIP code. The invalid ZIP code is 10407 as reported in TED07. | |
| OTI*IE*IX*NA***040812*1253*1000001*0021*837*004010X098A1~ | Original Transaction Identification. Item Accept with Error(IE). Item Number(IX): NA Original Goup Date: 040812 Original Group Time: 1253 Group Control Number: 1000001 Transaction Set Control Number:0021 Transaction Set Identifier Code: 837 Version / Release / Industry Identifier Code: 004010X098A1 |
| REF*EJ*78945639837~ | Patient Account Number(EJ): 78945639837 |
| AMT*GW*1100.67~ | Monetary Amount Information. Total Charge(GW) : 540 |
| NM1*QC*1*BROWN*ROBERT*W**JR*MI*888553737~ | Patient(QC) Name (ROBERT W BROWN) and Member Identification Number (888553737) |
| TED*024**N4*32*3**10407~ | Technical Error Description. Segment ID Code (N4), Segment Position in Transaction Set (32), Position In Segment(3), Copy of Bad Data Element(10407) |
| RED*NA**94**IBP*E038~ | Error or Informational Message. Insurance Business Process Application Error Code(IBP) and Code (E038) |
| SE*29*0001~ | Transaction Set Trailer with segment count (29) and Control Number (0001). |
X12, chartered by the American National Standards Institute for more than 35 years, develops and maintains EDI standards and XML schemas.