Chapter 5 Connectivity and Communications This chapter provides information to establish an electronic communications session with Anthem and to submit and receive files. Important: Do not send duplicate files to Anthem. If you are concerned that we did not receive a file, check your activity log or contact an Anthem EDI Specialist (800-991-7259 or 804-354-4470) to research the issue. If you transmit a claim submission file more than once to the Enterprise EDI Gateway (Gateway), inappropriate processing may occur, possibly causing duplicate payment notifications to providers and members. Repeated occurrences of duplicate claim transmissions may result in termination of submission privileges. If you have questions or concerns about connectivity and communications, contact your Anthem EDI Specialist at one of the following numbers: Richmond: (804) 354-4470 Toll Free: (800) 991-7259 Fax: (804) 354-2529 This chapter includes the following sections: Section Title Page 5.1 Communications Protocols 5-2 5.2 File Transfer Protocol (FTP) 5-3 5.3 Submitting Transactions to Anthem 5-14 5.4 Receiving Files from Anthem 5-17 CG Release 6.0 (November 2009) Part I: 5-1 Anthem, Virginia
5.1 Communication Protocols Trading partners are responsible for the purchase of communication protocol packages and access support for the Enterprise EDI Gateway (Gateway) connection. The Gateway is our delivery system for all ANSI ASC X12N transactions. It receives, identifies, and forwards incoming transactions to appropriate processing systems. Furthermore, the Gateway sends the outgoing 835 Payment Advice and reports (Reject Report, 997 Functional Acknowledgment, and 864 Text Messages containing the TA1 Interchange Acknowledgment, Level 2 Status Report,, Level 3 Adjudicated Claims Response, and Alert Messages) to trading partners. 5.1.1 Requirements to Submit to the Enterprise EDI Gateway (Gateway) In order to transfer a transaction file electronically to the Gateway, you need to be able to perform the following: Create an electronic file in the required format. Pre-edit all required fields for content and format before the transferring files. Resubmit unreadable data. Correct and resubmit electronic transactions that fail our frontend edits. Communicate with the Gateway using the File Transfer Protocol (FTP) described in Section 5.2, or Zmodem described in separate document (refer to website under Chapter 5). Communicate with the Gateway through the Internet using a HTTP/S web page with an assigned user ID and password. See separate document (refer to website under Chapter 5). Note: This functionality is not available for all transactions. CG Release 6.0 (November 2009) Part I: 5-2 Anthem, Virginia
5.2 File Transfer Protocol (FTP) The File Transfer Protocol (FTP) allows you to send and receive files through the Gateway. The FTP utility is built into Windows 95, 98, 2000, NT, and XP operating systems. Using the Windows Dial-up Networking feature, you can make a PPP connection to the Gateway and transfer files using simple FTP commands. You may send and receive files in the same session or in separate sessions depending upon your operational needs. You may use FTP on operating systems other than Windows. However, your technical staff will need to provide support required for non-windows systems. Our Anthem EDI Specialists will work with you to ensure that your File Transmission Environment is appropriate. The following sections explain how to use FTP to communicate with the Gateway: 5.2.1 Setting Up Your FTP Connection 5.2.2 Connecting to Anthem through the PPP Network 5.2.3 Initiating an FTP Work Session 5.2.4 Sending Claim (837) or Inquiry (270, 276, 278) Files 5.2.5 Receiving Report Files 5.2.6 Receiving the 835 Payment Advice 5.2.7 Activity Log 5.2.8 Ending Your FTP Work Session PPP (Point to Point Protocol) is the most common method to connect to the internet and corporate networks via dial-up networking. 5.2.1 Setting Up Your FTP Connection Anthem EDI Specialist Richmond: (804) 354-4470 Toll Free: (800) 991-7259 Fax: (804) 354-2529 FTP setup instructions differ between versions of Microsoft Windows. Below are instructions for Windows 95 or 98. Instructions for Windows 2000, NT, or XP begin on the next page. Note: All entries are case sensitive. Some require lowercase and others require UPPER case. For example, when connecting to the Enterprise EDI Gateway, type your Trading Partner ID in lowercase (e.g. tnv000). Whereas, when initiating an FTP work session, type your Trading Partner ID in UPPERCASE (e.g. TNV000). Please use the case (upper or lower) indicated in the instructions. In Windows 95 or 98 The process below may vary, depending on your system setup and the technical upgrades installed. If the instructions do not flow with your setup and you need help, call an Anthem EDI Specialist. 1. To access the Dial-Up Networking menu: Click: Start Select: Programs, then Accessories Click: Dial-Up Networking The Dial-Up Networking menu will display. 2. Double click Make a new connection. The New Connection Dialog box will display. 3. Type: (A name for your connection) Recommendation: Anthem VA Gateway 4. Select: (Your system s modem) CG Release 6.0 (November 2009) Part I: 5-3 Anthem, Virginia
(Continued) 5.2.1 Setting Up Your FTP Connection Anthem EDI Specialist Richmond: (804) 354-4470 Toll Free: (800) 991-7259 Fax: (804) 354-2529 5. Click: Configure, then General Verify the port, volume, and speed. 6. Select: Configure, then Connection Verify: Data bits: 8; Parity: None; Stop bits: 1 7. Select: Configure, then Options Click OK Verify that (Bring up Terminal Window after dialing) is selected. (Required for FTP to work.) 8. Type: (Area code and phone number) Ask your Anthem EDI Specialist for the phone number. Ask your office technical specialist for dialing conventions. For example, you may need 9 to reach an outside line, or you may need 1 for long distance. Note: The country should be USA. Click: Next 9. Click: Finish The new connection will display in your Dial-Up Networking menu. In Windows 2000, NT or XP The process below may vary, depending on your system setup and the technical upgrades installed. If the instructions do not flow with your setup and you need help, call your Anthem EDI Specialist. 1. Access the New Connection Wizard. If your Start menu does not include Settings: Click: Start Select: All Programs, then Accessories, then Communications Click: New Connection Wizard The New Connection Wizard will display. If your Start menu does include Settings : a. Click: Start Select: Settings, and Network Connections b. When you place your cursor on Network Connections: If a list displays that includes New Connection Wizard: Click: New Connection Wizard The New Connection Wizard will display. Go to Step 2. If the list with New Connection Wizard does not display: Click: Network Connections In the Network Connections window: Click: Create a New Connection (under Network Tasks) The New Connection Wizard will display. CG Release 6.0 (November 2009) Part I: 5-4 Anthem, Virginia
(Continued) 5.2.1 Setting up your FTP Connection Anthem EDI Specialist Richmond: (804) 354-4470 Toll Free: (800) 991-7259 Fax: (804) 354-2529 2. Use the New Connection Wizard to create the connection: a. Click: Next b. The Select your Connection Type window will display. Selections on this window vary amongst systems. Select: Either Connect to the Internet or Dial up to private network (depending on your system display) Click: Next c. If the Getting Ready window does not display, go to Step d. If it does display: 1. Select: Set up my connection manually Click Next 2. Click: Connect using a dial-up modem Click: Next 3. In the Connection Name window: Type: (A name for your connection) Recommendation: Type Anthem VA Gateway to identify the connection. Click: Next d. Type: 8006340116 (Area code and phone number) Ask your office technical specialist for dialing conventions. For example, you may need 9 to reach an outside line, or you may need 1 for long distance. Click: Next e. In the Connection Availability window, we recommend: Select: Anyone s use Click: Next The Internet Account Information window will display. f. Deselect any selected item in the Internet Account Information window and leave all fields blank. Click: Next g. If the Connection Name window displays: Type: (The connection name) Recommendation: Anthem VA Gateway Click: Next h. On the Completing the New Connection Wizard window: Click: Finish The connection is now created. CG Release 6.0 (November 2009) Part I: 5-5 Anthem, Virginia
(Continued) 5.2.1 Setting up your FTP Connection Anthem EDI Specialist Richmond: (804) 354-4470 Toll Free: (800) 991-7259 Fax: (804) 354-2529 3. On the dial-up connection window shown below on the left: Click: Properties On some systems, Properties/General displays your modem. If so, you may want to click Configure and verify the speed, Enable hardware flow is selected, and Show terminal window is not selected. We suggest that you discuss this step with your technical support personnel. On the window shown below on the right, select Security. Connect Anthem VA Gateway Anthem VA Gateway Properties In Security, verify that the following are selected: Typical Show terminal window (Required) 4. Click: OK The dial-up connection window (shown on the left in Step 3) will display. CG Release 6.0 (November 2009) Part I: 5-6 Anthem, Virginia
5.2.2 Connecting to Anthem through the PPP (Point to Point) Network Anthem EDI Specialist Richmond: (804) 354-4470 Toll Free: (800) 991-7259 Fax: (804) 354-2529 Perform the following steps to connect with the Enterprise EDI Gateway. 1. If the dial-up connection window is not displaying: Click: Start Select: All Programs, then Accessories, then Communications Click: Network Connections The Network Connection window will display. On the Network Connection window: Click: (Your connection) The dial-up connection window will display. Connect Anthem VA Gateway 2. On the dial-up connection window: Click: Dial Your modem will dial the number for the connection. After connecting, the After Dial Terminal window will display. CG Release 6.0 (November 2009) Part I: 5-7 Anthem, Virginia
(Continued) 5.2.2 Connecting to Anthem through the PPP (Point to Point) Network Anthem EDI Specialist Richmond: (804) 354-4470 Toll Free: (800) 991-7259 Fax: (804) 354-2529 3. At the Login prompt: Type: (Your Trading Partner ID provided by the Anthem EDI Specialist) Note: Use lowercase letters. Example: tnv000 The response may take a minute or more. 4. When the password prompt appears: Type: (Your password) The Anthem EDI Specialist provides your initial password. If a prompt appears to change your password, follow the instructions to do so. Note: Your password expires every 45 days. When necessary, you will be prompted to change it. After Dial Terminal Atx Version 5 Copyrights by IBM and by others 1982, 2005.C Login: tnv000 Tnv000 s Password 3004-610 You are required to change your password. Please choose a new one. Tnv000 s New password: Enter the new password again:? Done Cancel 5. After successfully logging in, the following display appears on the After Dial Terminal window. As the Anthem Gateway activates, a repeating series of characters displays at the bottom of the window. After Dial Terminal? Hours of operations: CLOSED ON HOLIDAYS 6:00am 5:00PM (EDT), Monday through Friday E-mail our EDI Centers Edihelp.va@anthem.com ~ŷ}#a!}!}!} }4}!}$}%Ü}"}&} } } } }%}&U- ;T~~ŷ}#A!}!}!} }4}!}$}%Ü}"}&} } } } }%}&U- ;T~~ŷ}#A!}!}!} }4}!}$}%Ü}"}&} } } } }%}&U- ;T~~ŷ}#A!}!}!} }4}!}$}%Ü}"}&} } } } }%}&U- ;T~ Done Cancel 6. Immediately after seeing the repeating series of characters: Click: Done If you wait too long to click Done, your session will terminate. When connected, a small icon appears next to your system clock. CG Release 6.0 (November 2009) Part I: 5-8 Anthem, Virginia
5.2.3 Initiating an FTP Work Session After connecting to the Gateway by clicking Done, initiate your FTP work session by performing the following procedure. 1. Click: Start Click: Run The Run window will display. 2. In the Run window: Type: CMD Press: OK A window with the DOS command prompt will display. Note: The steps below, require typing lowercase letters. 3. Change to the directory where your transmission file is located. In the instructions below, replace the instructions in parentheses with your EDI Directory path. Do not include the parentheses. Type: cd\(path to the directory where your EDI files are stored) 4. Type: ftp (then the IP address provided by your Anthem EDI Specialist) A user prompt will display. 5. Type: (Your Trading Partner ID provided by the Anthem EDI Specialist) Note: Use lowercase letters. E.g. tnv000 A password prompt will display. 6. Type: (Your password) The FTP prompt will display. 7. Type: binary Note: Always perform this step. C:\ C:\WINDOWS\System32\cmd.exe ftp 30.34.127.236 C:\>ftp 30.34.127.236 Connected to 30.34.127.236. 220 vaathmr062 FTP server (Version wu-2.6.2(2) Wed Sep 8 14:24:16 EST 2004) ready. User (30.34.127.236: (none)): tnv000 331 Password required for tnv000 Password: 230 User tnv000 logged in. Access restrictions apply. ftp> binary 200 Type set to I. ftp> CG Release 6.0 (November 2009) Part I: 5-9 Anthem, Virginia
(Continued) 5.2.3 Initiating an FTP Work Session 8. The MOTD (Message of the Day) shown below will display. Anthem uses this screen to send important information. Note: If you have new reports or payments, YOU HAVE PAYMENTS or YOU HAVE REPORTS will display at the bottom of the MOTD. C:\ C:\WINDOWS\System32\cmd.exe ftp 30.34.127.236 WELCOME to the Anthem Virginia Gateway For assistance with your electronic transactions please contact the Anthem EDI Helpdesk 1-800-991-7259 Anthem EDI = Press OPTION 2, then OPTION 2 again Hours of operations: CLOSED ON HOLIDAYS 8:00AM - 5:00PM (EDT), Monday through Friday E-mail our EDI Call Centers edihelp.va@anthem.com YOU HAVE PAYMENTS YOU HAVE REPORTS Sample MOTD (Message of the Day) 5.2.4 Sending Claim (837) or Inquiry (270, 276, or 278) Files After you initiate your work session, use the following procedures to send files. 1. Initiate the FTP Work Session (See Section 5.2.3) 2. To access the directory that contains your transmission files: Type: cd claimsin Note: After cd, there is one space. A message will display indicating the command was successful. 3. To transfer your transmission file: Type: put (then the filename) Note: After put, there is one space. A message displays indicating the file uploaded. 4. Next, return to the initial directory: Type: cd.. Note: After cd, there is one space. C:\ C:\WINDOWS\System32\cmd.exe ftp 30.34.127.236 C:\>ftp 30.34.127.236 Connected to 30.34.127.236. 220 vaathmr062 FTP server (Version wu-2.6.2(2) Wed Sep 8 14:24:16 EST 2004) ready. User (30.34.127.236: (none)): tnv000 331 Password required for tnv000 Password: 230 User tnv000 logged in. Access restrictions apply. ftp> binary 200 Type set to I. ftp> cd claimsin 250 CWD command successful. ftp> put xxxxxxx File upload was successful. ftp> cd.. CG Release 6.0 (November 2009) Part I: 5-10 Anthem, Virginia
5.2.5 Receiving Report Files Reject Report TA1 Interchange Acknowledgment 997 Level 2 Status Report Level 3 Adjudicated Claims Report Each day, use the following procedure to receive your reports. 1. If you are not already in the FTP work session, initiate the FTP Work Session (See Section 5.2.3). 2. To access the directory that contains your Reports: Type: cd reports Note: After cd, there is one space. After typing cd reports and pressing [Enter], the screen will clear of everything except the ftp prompt. C:\ C:\WINDOWS\System32\cmd.exe ftp 30.34.127.236 C:\>ftp 30.34.127.236 Connected to 30.34.127.236. 220 vaathmr062 FTP server (Version wu-2.6.2(2) Wed Sep 8 14:24:16 EST 2004) ready. User (30.34.127.236: (none)): tnv000 331 Password required for tnv000 Password: 230 User tnv000 logged in. Access restrictions apply. ftp> binary 200 Type set to I. ftp> cd reports 3. To receive your report files: Type: mget Note: After mget there is one space. C:\ C:\WINDOWS\System32\cmd.exe ftp 30.34.127.236 ftp> mget 4. The system identifies reports from the reports folder and displays each filename with a question mark (?). To retrieve each report: Type: y After a successful transfer, report files automatically delete from your reports directory. 5. Next, return to the initial directory: Type: cd.. Note: After cd, there is one space. CG Release 6.0 (November 2009) Part I: 5-11 Anthem, Virginia
5.2.6 Receiving the 835 Payment Advice 835 Payment Advice Anthem produces your 835 Payment Advice (remittance) once a week. Each week, use the following procedure to receive your 835 Payment Advice. 1. To access the directory that contains your 835 Payment Advice: Type: cd payments Note: After cd, there is one space. 2. To receive your report files: Type: mget Note: After mget there is one space. 3. As each report filename appears with a question mark (?): Type: y 4. After a successful transfer, remittance files automatically delete from your reports directory. 5. Return to the initial directory: Type: cd.. Note: After cd, there is one space. CG Release 6.0 (November 2009) Part I: 5-12 Anthem, Virginia
5.2.7 Activity Log 5.2.8 Ending Your FTP Session The Activity Log shows your transmission history and can be a helpful troubleshooting tool. On occasion, your Anthem EDI Specialist may request that you review your transmission history by accessing your Activity Log. To ensure your most current activity is included, wait about thirty minutes after transmitting before accessing your Activity Log. Note: Your entries are case sensitive. Please use lowercase as indicated below. Use the following procedure to access your Activity Log: 1. To access the directory that contains your Activity Log: Type: cd userlog Note: After cd, there is one space. 2. To receive your Activity Log: Type: AL(mmdd) (mm is the month and dd is the day. Example: AL0402 requests the Activity Log for April 2) Note: Type AL in UPPERCASE. Your Activity Log will display. 3. Return to the initial directory: Type: cd.. Note: After cd, there is one space. Perform the following procedure to end your FTP session: 1. Type: quit 2. To disconnect from the PPP connection: Note: You must disconnect, or you will remain connected to the network and your claims will not transfer to Anthem until your connection either times out or you disconnect. 3. Right click the small icon that represents your connection. Click: Disconnect CG Release 6.0 (November 2009) Part I: 5-13 Anthem, Virginia
5.3 Submitting Transactions to Anthem This section provides basic information about submitting transactions to Anthem. For specific steps to send transactions, see Section 5.2.4, Sending Claim (837) or Inquiry (270, 276, or 278) Files. The ANSI ASC X12N Implementation Guides (IGs) provide instructions on how to prepare files so that they comply with standards. The Companion Documents in Part II of this Companion Guide provide specific information regarding Anthem Blue Cross and Blue Shield (Anthem) transaction processing. Use the Companion Documents, in conjunction with the IGs. After you prepare and name a file and set up the envelope and control segments, you may compress (or ZIP) it, and send it to Anthem. Important: Do not send a file more than one time to Anthem. If you are concerned that we did not receive your claims submission file, contact an Anthem EDI Specialist (800-991- 7259 or 804-354-4470). The Anthem EDI Specialist will research the situation and contact you by telephone and then by either email or fax to explain what you need to do. If you transmit a claim submission file more than once to the Gateway, inappropriate processing may occur, possibly causing duplicate payment notifications to providers and members. Repeated occurrences of duplicate claim transmissions may result in termination of submission privileges. You may submit claims to the Gateway twenty-four hours a day, seven days a week. During a typical business week, you can anticipate receiving reports and acknowledgments according to the timeframes in the chart below. For the following report(s) and acknowledgment(s): Reject Report TA1 Interchange Acknowledgment 997 Functional Acknowledgment Level 2 Status Report Level 3 Adjudicated Claims Response Timeframes for Reports and Acknowledgments (We may exceed the timeframes below.) When we receive a transaction by: 5:00 PM Eastern Time, You can expect the response or acknowledgment: within two to three hours after we receive the transmission. by 6:00 PM Eastern Time the next business day. If a holiday schedule necessitates a delivery time change, we send an Alert Message to communicate the change. CG Release 6.0 (November 2009) Part I: 5-14 Anthem, Virginia
5.3.1 Preparing Transaction Files 5.3.2 File Naming Conventions The ANSI ASC X12N Implementation Guides provide instructions to prepare the transaction files so that they comply with standards. The Companion Documents in Part II of this Companion Guide provide specific information to prepare the transaction files for Anthem. Trading partners must adhere to instructions and requirements in both the Implementation Guides and the Companion Documents in Part II. In general, to prepare a transaction to send to Anthem, you must perform the following procedures: 1. Prepare the file as indicated in the IG and the appropriate Companion Document. Prepare the envelope and control segments as explained in the IG and in each Companion Document. Envelope control segments include: Interchange Control Header (ISA) Interchange Control Trailer (IEA) Functional Group Header (GS) Functional Group Trailer (GE) 2. Name and send the file as explained in the remaining sections of this chapter. Name the files you send to Anthem according to the following guidelines: Construct a unique name for each file you create. Do not insert spaces. The Enterprise EDI Gateway (Gateway) will not admit filenames with spaces. Do not include a prefix that matches prefixes Anthem uses in files we send to you. For example, avoid the prefixes FA (Functional Acknowledgment) and TX (834 Text Message). 5.3.3 File Compression Data compression is useful in EDI communications because it enables devices to transmit the same amount of data in fewer bits so that the transmission requires less time. Data files can compress to a small fraction of the normal size thus allowing faster transmission. After preparing and naming the electronic files and setting up the envelope and control segments, you may compress (or zip) the files in the transmission. A compressed transmission may contain one or more files. The Gateway uses a data compression format that generates ZIP files (.zip extension). If you transmit compressed files to Anthem use a file compression utility that is compatible with PKZIP, version 2.04g or higher by PKWARE. Currently, Anthem only processes files compressed with a PKZIP compatible utility. Note: We recommend, but do not require, data compression. CG Release 6.0 (November 2009) Part I: 5-15 Anthem, Virginia
5.3.4 For Concerns about Claim Receipt, Call the EDI Specialist Anthem EDI Specialist Richmond: (804) 354-4470 Toll Free: (800) 991-7259 Fax: (804) 354-2529 5.3.5 Production Status Information Richmond (804) 354-4470 Toll Free (800) 991-7259 5.3.6 Resubmitting 837 Transactions That Fail Compliance To avoid unnecessary and inappropriate processing, do not send files more than once. If you are concerned that we did not receive your transactions, contact your EDI Specialist. (Refer to Chapter 6, Contact Information.) Your EDI Specialist will research the situation and contact you by telephone to explain what you need to do. If a trading partner transmits transactions more than once to the Enterprise EDI Gateway (Gateway), unnecessary and inappropriate processing may occur, possibly causing duplicate responses and/or payment notifications to providers and members. Repeated occurrences of inappropriate duplicate transmissions may result in termination of submission privileges. If you are concerned about the delivery of inbound transactions to Anthem or outbound transactions from Anthem, call the EDI Help Desk at (804) 354-4470 or (800) 991-7259. When you receive a 997 Functional Acknowledgment indicating errors in the transaction, the transaction was not processed. Please review the functional group for accuracy. If corrections are required, make them and resubmit according to the instructions below. Resubmitting Transactions that Fail Compliance 1. Review and correct the transaction. 2. Resubmit the transaction. Be sure that the Group Control Number in the Functional Group Header (GS06) and Trailer (GE02) are: different from the original value and unique within one year, and identical to each other. 5.3.7 Hours of Operation For the following report(s) and acknowledgment(s): Reject Report TA1 Interchange Acknowledgment 997 Functional Acknowledgment Level 2 Status Report Level 3 Adjudicated Claims Response You may submit claims to the Gateway twenty-four hours a day, seven days a week. During a typical business week, you can anticipate receiving reports and acknowledgments according to the timeframes in the chart below. If a holiday schedule necessitates a delivery time change, we send an Alert Message. Timeframes for Reports and Acknowledgments (We may exceed the timeframes below.) When we receive a transaction by: 5:00 PM Eastern Time, You can expect the response or acknowledgment: within two to three hours after we receive the transmission. by 6:00 PM Eastern Time the next business day. CG Release 6.0 (November 2009) Part I: 5-16 Anthem, Virginia
5.4 Receiving Files from Anthem This section provides information about receiving files from Anthem. Topics in this section include report timeframes and naming conventions. For procedures to receive electronic files from Anthem, see Sections 5.2.5, Receiving Report Files, and 5.2.6, Receiving Remittance Files. 5.4.1 Timeframes for Reports and Acknowledgments During a typical business week, you can anticipate receiving reports and acknowledgments according to the timeframes in the chart below. If a holiday schedule necessitates a delivery time change, we send an Alert Message to communicate the change. For the following report(s) and acknowledgment(s): Reject Report TA1 Interchange Acknowledgment 997 Functional Acknowledgment Level 2 Status Report Level 3 Adjudicated Claims Response Timeframes for Reports and Acknowledgments (We may exceed the timeframes below.) When we receive a transaction by: 5:00 PM Eastern Time, You can expect the response or acknowledgment: within two to three hours after we receive the transmission. by 6:00 PM Eastern Time the next business day. 5.4.2 Naming Conventions The chart on the next page explains the naming conventions for files that we send to trading partners (outbound files). In the column labeled Naming Conventions, each file type has two rows of information: The first row shows the naming convention for the file type. The second row provides a key to explain the characters within each naming convention. Some DOS-based communication protocols alter filenames. Contact your EDI Representative to discuss whether your communication protocol will alter the filenames. Default outbound naming schemes have long filenames. If your system will not accept long filenames, notify the EDI Help Desk so that we can set up your account for short (DOS) filenames (eight characters plus a three-digit extension). CG Release 6.0 (November 2009) Part I: 5-17 Anthem, Virginia
Naming Conventions Files from Anthem to Trading Partners Designation # Definition Naming Convention Not Applicable Reject Report Format: RJ{RunID} Example: RJ100057 RJ Reject Report 997 Functional Acknowledgment Format: FA{RunID}.### Example: FA0215104533001.837 FA Functional Acknowledgment ### Numeric transaction designation defined by HIPAA. These numbers reference the acknowledged transaction. 864 Text Message Transaction Format: TX{RunID}.837 Level 2 Status Report Example: TX0215105037002.837 TX Text Message 837 Numeric transaction designated by HIPAA. 864 Text Message Transaction Format: TXMMDDhhmmssnn.864 Reports and acknowledgments sent within Example: TX0215105027002.864 the 864 Text Message Transactions have the same naming convention. TX Text Message Level 3 Adjudicated Claims Response 864 Numeric transaction File Alert Message Note: The 864 data elements BMG02 (Description) and MIT02 (Description) provide the name of the specific report or acknowledgment. 864 Text Message Transaction Format: TAMMDDhhmmssnn.864 TA1 Interchange Acknowledgment Example: TA021510502701.864 TA Interchange Acknowledgment 864 Numeric transaction TA1 TA 1 Interchange Acknowledgment Format: IAHSMMDDhhmmssnn.270 Example: IAHS021510502701.270 IA Interchange Acknowledgment HS Functional Identifier Code 270 Numeric transaction as designated by HIPAA 835 Payment Advice Format: HP{RunID}.835 Example: HP0902161545977202.835 835 Numeric transaction designated by HIPAA 271 Eligibility Response Format: HB{RunID}.271 Example: HB07021001035475961.271 271 Numeric transaction designated by HIPAA 277 Claim Status Response Format: HN{RunID}.277 Example: HN07021001035475961.277 277 Numeric transaction designated by HIPAA 278 Services Review Response Format: HI{RunID}.278 Example: HI07021001035475961.278 278 Numeric transaction designated by HIPAA CG Release 6.0 (November 2009) Part I: 5-18 Anthem, Virginia