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EDI 824 Format Example

EDI 824 Application Advice

What is the EDI 824 Transaction Set?

The 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 an Optional Transaction, currently not a HIPAA mandated transaction. 

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.

In healthcare applications, the optional EDI 824 transaction meets HIPAA 5010 requirements for non-claims (EDI 276, EDI 270 and EDI 278) transactions. However, in practice, EDI 824 is used as an acknowledgment to EDI 837 Claims as well. A long list of 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 also may require the use of EDI 824 in their trading partner acknowledgment specifications as an error reporting format for inbound EDI 837 Claims. CVS Caremark is such an example.

HIPAA X12 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 (i.e. an 837 would not appear on an 835 or paper 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 this type will be reported using the 999 and/or 824 transaction(s). 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 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. 

A Human Readable version of the 824 (called the Business Rejection Report or BRR) may also be produced. The BRR is also known as the 824 Text Report.  This report helps to facilitate the immediate correction of sent transactions. And, in the case of 837, the re-billing of claims rejected during HIPAA validation is sped up.

Note: EDI 824 Application Advice should not be used in place of a transaction set designed as a specific response to another transaction set (e.g., EDI 835 Remittance Advice in response to an EDI 837 Healthcare Claim).

PilotFish’s eiConsole for X12 EDI can be configured to automatically generate an 824 Application Advice for HIPAA transactions. Your EDI 824 Application Advice may also be manually configured by the same process as any other X12 interchange, group and transaction set.

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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