Should a 5010 837 professional claim submitted in its own ST-SE envelope with other ST-SE envelope claims be treated as a discrete claim for editing purposes?For example: sending an 5010 837 professional file with 3 claims such as:
ISA
GS
ST
DETAIL SEGMENTS CLAIM 1
SE
ST
DETAIL SEGMENTS CLAIM 2
SE
ST
DETAIL SEGMENTS CLAIM 3
SE
GE
IEA
If there is an issue with one of the claims in its own ST-SE envelope, should entire file be rejected or only the ST-SE envelope in error?
We interpret your term "file" to be an interchange, and the balance of this response is based upon that interpretation.
Ultimately, any decision as to what to reject or accept is up to trading partners. However, the ASC X12 standard acknowledgment transactions (the 997 Functional Acknowledgment and the 999 Implementation Acknowledgment) are designed to be able to accept or reject an entire functional group (GS/GE) or accept or reject individual transactions within the functional group. Therefore, if an applicable standard or implementation error is found within one transaction (ST/SE) that contains a single claim, the related 997/999 can reject only that ST/SE (single claim) and accept all other ST/SEs within the same functional group.
For example, within the 999 transaction set, The AK2 segment identifies each transaction within a functional group that contains an error (and can identify transactions without errors). IK501 identifies the individual transaction's acknowledgement codes, which include values for Accepted, Rejected and Accepted But Errors Were Noted. AK9 identifies the number of transaction sets within the functional group, and the number of transaction sets accepted.
See Technical Report Type 3 005010X231 (Implementation Acknowledgment for Health Care Insurance (999))for detailed implementation information about the 999 transaction set for use with health care transactions.