HIPAA Accelerator Guide

10.2
- 10.5.3
- 10.5.0
- 10.4.0
- 10.2.3
- 10.2.2
- 10.2.1

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Inbound/Outbound

For a partner that belongs to a provider's community or to a payer's community, some of the relations that exist between the inbound and outbound traffic are reflected in the HIPAA Accelerator through the DX console. The relations are shown on the functional group, on the transaction set and claims.

Functional group relations

This relation is captured for outbound traffic for both provider's and payer's community. To capture the relation two profile parameters are used:

Parameter	Description
999 Acknowledgment	Indicates whether a 999 acknowledgment will be returned from Partner
Timeout for ACK (seconds)	Timeout period for receiving 999 Ack. After time out period, the event status of the originate GS will be changed to Timeout.

If the first parameter (999 Acknowledgment) is set to "Enabled" the 2^nd parameter (Timeout for ACK (seconds)) will be set as the time out period.

A flag is raised (reconciliation flag) for every functional group of the outbound traffic. This flag will be reconciled when the corresponding 999 acknowledgement is received from the partner. If the Timeout period passed and no acknowledgement was received, the event status of the functional group will be changed to 'Timed Out'.

Claim level relations

The Claim life cycle is captured for both Payer and Provider communities. The life cycle can be seen when looking on the Claim level DX event history Tab.

Following is the payer's Community Claim Life Cycle:

Inbound	Outbound	Correlation	Remarks
837	277CA	V
	835	V	Only for accepted Claims

Following is the provider's Community Claim Life Cycle:

Inbound	Outbound	Correlation	Remarks
277CA	850	V
835		V	Only for accepted claims

A reconciliation flag is raised for every 837 Claim. This flag will be reconciled when the corresponding 277CA acknowledgement arrives. If the Timeout period passed and no acknowledgement was received, the event status will be changed to 'Timed Out'. A new flag will be raised for the 277CA accepted claims. It will be reconciled when the corresponding 835 claim arrives. If the Timeout period passed and no acknowledgement was received, the event status will be changed to 'Timed Out'

Note: Reconciliation between 837, 277CA and 835 occurs for inbound and outbound traffic.

For the Provider's community, a reconciliation flag will be raised for the created outbound 837 and will be reconciled when the corresponding inbound 277CA Acknowledgment is received. A new reconciliation flag will be raised for the accepted claim and will be reconciled when the inbound 835 claim is received.

For the Payer's community, a reconciliation flag will be raised for the inbound 837 and will be reconciled when the respective 277CA outbound acknowledgment is created. A new reconciliation flag will be raised for the accepted claim and will be reconciled when the outbound 835 claim is created.

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Table of Contents

HIPAA Accelerator Guide

HIPAA Accelerator Guide

Inbound/Outbound

Inbound/Outbound

Functional group relations

Claim level relations