Example 01: Positive Acknowledgment

ABC Insurance is a health care insurance company and has an Electronic Transmitter Identification Number of 111111111. ABC Insurance provides health care insurance to SmithCo, which uses an Electronic Transmitter Identification Number of A1234 for all of its EDI transmissions with ABC Insurance. The EDI contact at ABC Insurance is John Johnson, who can be reached to discuss transmission issues at (800) 555-1212, extension 1439.

ABC Insurance received a benefit enrollment (834 transaction set, version 005010X220A1) from SmithCo on 7/9/2002 at 9:02am, which contained an Interchange Control number (ISA13) of 123456789, a Functional Group Control number (GS06) of 2, and a Transaction Set Control Number (ST02) of 0001. The transaction set was subjected to the appropriate business application edits and was found it to be in compliance with the business application.

Although it is not legally mandated, it is the policy of ABC Insurance to respond to all error-free transaction sets with a positive 824 response. Therefore, a positive 824 was prepared, on 7/9/2002 at 9:32am, for return to SmithCo. The 824 transaction set’s unique transaction set identifier within ABC Insurance’s application was FFA.ABCDEF.123456. and contained a Transaction Set Control Number of 021390001.