Frequently Asked Questions (FAQ)

8)        What is a 999? How many different types of 999s will we be receiving?

Issued at the functional group level, a 999 provides information regarding the acceptance or rejection of a functional group. A claim file can generate a positive 999, a negative 999, or a partial 999. A partial 999 is issued when there are multiple transaction sets within a functional group and some of them are compliant and some are not.

The data element AK2-02 in the 999 is populated with the value from ST-02 from the input file, which is the transaction set control number. When a partial 999 is issued, only the transaction sets that were not compliant are withheld from being processed. All of the compliant transaction sets are processed and sent to the MMIS. The submitter then must resubmit all of the transaction sets that were rejected. Therefore, a whole file is rejected only when all the claims are grouped in a single rejected transaction set. The HIPAA implementation guide provides information for submitters to minimize the risk by not grouping all the claims in a single transaction set.

9)      What is an 824 and why is it generated?

An 824 is a reject report that provides information based on the business edits required by a specific state?s Medicaid program.

10)      How soon will I be able to view a 999 or 824 once I?ve submitted a file?

For both 999 and 824 files, after you submit your files, it could take anywhere from several minutes to two hours for these reports to be delivered to you.

11)      What does it mean if I receive a 999 with no segments or data elements in error?

A 999 that reports no segments or elements in error is a positive 999. When you receive a 999 that has AK3 segments, but no AK4 segment, the segments that are mentioned in the AK3 are in error, not the elements.

12)      Does a 999 apply to all of the claims in a transaction set?

Yes. All of the claims in a transaction set have to be X12N syntax compliant. If there is a compliance error on one of the claims, the entire set will not be processed.

13)      Does an 824 apply to all of the claims in a batch?

No. The 824 is a claim-level reject report. Only claims that fail due to a particular business edit will be kept from being processed. All other claims will be sent to Medicaid.

14)      How can I use the features of ACTT Now to automatically identify my 999 errors?

When viewing the raw data of a file you can click on the AK3 or AK4 segments to quickly identify the segment and elements that contain errors.

15)      I submitted claims to the Conduent EDI Solutions, Inc. and did not receive payment. What happened?

q  Check the 999 ? The file may have failed compliance check, producing a negative 999. The 999 will convey the reason for failure.

q  Check for a TA1 ? If the file is not in a recognizable format or if the Trading Partner IDs are incorrect the file will not be processed for payment.

q  Check for an 824 ? The reject notifications are generated in the event that an X12N transaction fails a payer edit. These can be found in the payer-specific section. For many states, 824 files are also generated for pre-processor rejects in the payer system. This functionality is available for some payers.

16)      What do different values in data element NM1 01 mean?

17)      What is an 835?

An 835 is the remittance advice in the X12N format.

18)      What is the general process that a file goes through from submission to adjudication?

When you submit a file, it goes to Conduent EDI Solutions, Inc.. After compliance verification, business edit checks, and necessary conversion, your claims are sent to the appropriate payer.