Software Release 5.2 September 2017 Insight User's Guide Basics 5 Password Expiration and...

TIBCO Foresight® Transaction Insight® User’s Guide Software Release 5.2 September 2017

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Transaction Insight User's Guide Contents i

Contents

1 Introduction 1

Overview ................................................................................................................ 1 About this Document .............................................................................................. 1

2 Basics 3

Logging In .............................................................................................................. 3 Password Expiration and Deactivation .................................................................. 5 Foresight Portal Platform ....................................................................................... 5 Navigating .............................................................................................................. 6 Selecting from a List............................................................................................... 8 Dates and Times .................................................................................................... 9

Validation Dates .............................................................................................. 9 Dates from EDI Data ..................................................................................... 10 Specifying Dates on Statistics Pages ............................................................ 11

Inbound and Outbound Documents ..................................................................... 13 E-Mails ................................................................................................................. 14 Internal and External Partners ............................................................................. 14 Application Documents ........................................................................................ 14

3 Statistics Pages 15

Overview of Statistics Pages ............................................................................... 15 Common Elements of Statistics Pages ................................................................ 16

Test and Production Data .............................................................................. 16 Filters ............................................................................................................. 17 Statistical Charts ............................................................................................ 20 Downloading to Excel .................................................................................... 22

Documents and Document Volumes Pages ........................................................ 24 Opening the Documents or Document Volumes Pages ................................ 25 Using the Documents and Document Volumes Pages ................................. 25 Comparing Volumes between Categories of Partners .................................. 27

Errors Page .......................................................................................................... 28 Using the Errors Page ................................................................................... 29 Viewing Documents with a Specific Error ...................................................... 31

Success Rate Page.............................................................................................. 32 Using the Success Rate Page ....................................................................... 32

Transmissions Volumes Page ............................................................................. 33 DRG Usage Page ................................................................................................ 35 ICD Usage Page .................................................................................................. 36

Transaction Insight User's Guide Contents ii

ICD Statistics Page .............................................................................................. 39

4 My Tasks 1

Overview of My Tasks Page ................................................................................ 41 My Tasks .............................................................................................................. 41

Columns on the Main My Tasks Page ........................................................... 42 Using the My Tasks Page.............................................................................. 43 Document Summary Page via My Tasks ...................................................... 47

5 Search Pages 51

Getting Access to the Search Pages ................................................................... 51 Common Elements............................................................................................... 51 Search Documents Page ..................................................................................... 53 Code Lookup Page .............................................................................................. 55 Search Transmissions Page ................................................................................ 56

Using Search Time Control ........................................................................... 58

6 Files Pages 61

Overview of Files Pages ...................................................................................... 61 Uploading Files .................................................................................................... 62 Viewing Files ........................................................................................................ 63 275 Claim Attachments Page .............................................................................. 64 277 Attachment Request Page ............................................................................ 66

7 Document Summary Page 69

Opening the Document Summary Page .............................................................. 69 Using the Document Summary Page................................................................... 70

8 Transmission Summary Page 77

Opening the Transmission Summary Page ......................................................... 77 Using the Transmission Summary Page.............................................................. 78

9 EDI Viewing Formats 81

Overview .............................................................................................................. 81 Access and Editing Information ..................................................................... 81 Tabs ............................................................................................................... 84

Form View ............................................................................................................ 85 Navigating Form View ................................................................................... 85

Paged Form View ................................................................................................. 87 Navigating Paged Form View ........................................................................ 87

Structured EDI View ............................................................................................. 93 Structured EDI View for X12 Data ................................................................. 93 Structured EDI View for EDIFACT Data ........................................................ 94 Navigating the Structured EDI View .............................................................. 95

Raw EDI View ...................................................................................................... 98 Navigating the Raw EDI View ....................................................................... 99

Transaction Insight User's Guide Contents iii

Validation Highlighter View ................................................................................ 100 Navigating the Validation Highlighter View .................................................. 100

10 My Account 101

Maintaining your Account ................................................................................... 101

11 Appendix A – Status and Priorities 103

Where Statuses Appear ..................................................................................... 103 List of Statuses ................................................................................................... 105 List of Priorities ................................................................................................... 106

12 Appendix B - Submitting 107

Submitting Overview .......................................................................................... 107 Submit Filename ................................................................................................ 109 Submit Directory ................................................................................................. 110 Submitting from My Tasks ................................................................................. 111 Submitting from a HIPAA Form or Errors Not in Form ....................................... 112

13 Appendix C - Transmission Page Data Maps 113

Overview of Transmission Page Data................................................................ 113 270 and 271 Transmission Page Map ............................................................... 115 275 Transmission Page Map ............................................................................. 117 276 Transmission Page Map ............................................................................. 118 277 Transmission Page Map ............................................................................. 120 277CA Transmission Page Map ........................................................................ 122 278 RP and RQ Transmission Page Map .......................................................... 124 820 Transmission Page Map ............................................................................. 125 834 Transmission Page Map ............................................................................. 126 835 Transmission Page Map ............................................................................. 130 837 Transmission Page Map ............................................................................. 132

837 Transmission Page Map - Alphabetical Listing .................................... 132 837 Transmission Page Map – By Loop ..................................................... 137

997 and 999 Transmission Page Map ............................................................... 138

14 Appendix D – Definitions 141

Terms used in Transaction Insight ..................................................................... 141

Transaction Insight User's Guide Contents iv

Transaction Insight User's Guide Introduction 1

1 Introduction

Overview

TIBCO Foresight® Transaction Insight® provides visibility and control over the

transaction lifecycle by providing features such as:

enterprise-wide, partner-specific, and detailed transaction reporting and alerts

advanced search and transaction matching capabilities

the ability to view, share, and correct transactions.

About this Document

This document is intended for users of the Transaction Insight® system who need to view

information about EDI processing. This includes the number and types of transactions

processed by date, error rates, and types, and success rates. This information can be filtered

in various ways and at various levels of detail.

This document provides information about topics such as:

the basics of using the Transaction Insight interface

the pages used to access data such as Search, Statistics, Error, and Success Rate

pages

error correction and submitting EDI for revalidation.

Transaction Insight User's Guide Introduction 2

Transaction Insight User's Guide Basics 3

2 Basics

Logging In

To log in to the Transaction Insight Portal:

1. Use your browser to go to the portal page specified by your Transaction Insight

administrator.

2. Type the Email address and Password assigned to you by the administrator. Your “Email”

may not actually be an e-mail address.


3. Click Remember Login if you want to save your Email and Password.

Note: This option may or may not be enabled by your administrator.

This is is specific to your machine. If you choose Remember Login,

you will skip the Account Login page when accessing Transaction

Insight, and so will anyone else using your PC. If you use another PC

to access Transaction Insight, you will have to log in.

4. Click Sign In.

You will see a page containing the Foresight Portal applications plus other applications

that were supplied by your administrators. Click Transaction Insight.

If you have no other applications, you will go directly to Transaction Insight without

seeing the portal page.

To log off, click your name and then Sign Off in the upper right corner.


Password Expiration and Deactivation

Expiration

Passwords expire periodically. After that, during login, a prompt appears for the old

password, new password, and confirmation.

Your Transaction Insight administrator sets the password expiration interval, the number

of days before you can use the same password, and the specific requirements of the

password (capital letters, lower case letters, numbers, and special characters).

Deactivation

Your username is deactivated if:

You enter three invalid passwords when trying to log in. (Note: Three attempts is the

default value; your Transaction Insight administrator may specify a different number.)

You start to change a password and then do not finish.

If your password is deactivated, contact your administrator.

Foresight Portal Platform

If you have access to more than one application, you will go to Foresight Portal Platform to

select the one you want.

Choose Transaction Insight.

Once in any portal application, you can move between them with the icons at the top right:


Navigating

The main menu at the top left lets you go to the page that you want. Rest your cursor

on one of the headings and then click the page.

This list will vary, depending on your permissions.


Each page has some typical features:

The navigation bar (or “breadcrumbs”) along the top allows you go directly to previous

levels. For best results, use this bar rather than the browser’s Back button.

Avoid using the browser’s refresh button. Instead, click on the current page on the

breadcrumbs to perform a safer refresh:

If you do not see breadcrumbs, turn off Compatibility View in your browser’s Tools

menu.


Choose either Production Data or Test Data.

Adjust the date and press View Results or Show Summary.

Click the pin to select an item.

You can sort some columns by clicking on their headings.

Use drop-down lists to filter the data.

If you make an error on a page, Transaction Insight will display a red message at the top.

A red asterisk marks the location of the error.

Selecting from a List

Transaction Insight has many drop-down lists like this one:


To find a selection that is not showing, you can:

Use the scroll bar to scroll up or down.

Click on the numbers on the bottom border to display more entries at the bottom

of the list.

Clear the top line and start typing the name or ID of the entry you are seeking.

Clear the top line and type All.

Dates and Times

Two types of dates appear in Transaction Insight:

The date when TIBCO Foresight® Instream® validated the data – see Validation Dates on

page 9.

A date from the EDI data itself – see Dates from EDI Data on page 10.

Validation Dates

Most dates in Transaction Insight are validation dates. Examples:

Statistics pages

Top Errors page

Transmission Volumes

pages

My Tasks page


Dates from EDI Data

In some places, you will see a Document Date – a date taken from the EDI data itself.

Document Summary Page

Click Errors, click on an Error Code, and click a Document ID. You will see two dates

for that document:

Transmission Date is the date and time from the detail results file created by Instream®.

Document Date is the date and time from a value within the transaction set (such as the

BHT-04 and BHT-05 for 837 documents):

The location of the document date varies by transaction. See List of Document Dates by

Transaction in ApplicationDocTables.pdf.


Specifying Dates on Statistics Pages

The Statistics pages let you specify the dates covered by the reports.

Selecting the Date Interval

Click the Day, Week, or Month button:

Day See data for up to 7 days.

Week See data for up to 7 weeks. Weeks end on Saturday.

Month See data for up to 13 months.

To update the page with the new interval, click View Results, Search, or Show

Summary.

If the data for that interval and date range will not fit on the chart, Transaction Insight

changes the interval and displays a message at the top left.

Typing a Date Range

1. Type the desired dates in the date area.

2. Click View Results, Search, or Show Summary.

If no error message appears at the top left, the page updates to show information for the

dates you selected.

If you have selected Week or Month as your interval, results show the entire week or

month, regardless of the ending day.

Example: For monthly data, ending dates of 1-15-2017 and 1-30-2017 both show data for

the entire month of January.


Selecting a Date from a Calendar

If a date is editable, you can open a calendar and pick a date rather than typing it:

1. Click the symbol at the right side of the date field.

2. Display the month by clicking the arrow to the right or left of the month.

3. Click the day.

4. Click View Results, Search, or Show Summary to update the page.


Inbound and Outbound Documents

Transaction Insight distinguishes between inbound and outbound data to make it easier for

you to find your own company’s data.

Example from Transmission Volumes page:

Example from Documents page

Inbound and Outbound are from the point of view of the Transaction Insight host:

Inbound Data sent to the host’s organization.

Outbound Data sent f rom the host’s organization.

It is not dependent on sender and receiver IDs and is not determined by reading ISA or GS

values.

Importer’s -o or -i command-line qualifiers mark data as inbound or outbound. This is

generally built in to Transaction Insight workflows. When Importer reads data from the

inbound directory, it flags it as inbound. When it reads data from the outbound directory, it

flags it as outbound.

Examples of Inbound and Outbound Data

If the Transaction Insight host is an insurance company, 837 data that it receives is inbound

data. 835 data it sends to providers is outbound data.

If the Transaction Insight host is a clearinghouse, 837 data that it receives from providers is

inbound even though the receiver ID may be an insurance company. The clearinghouse

then repackages the 837 and sends it on to an insurance company. This transmission of the

837 is now outbound.

Hospital Insurance

Company 837

Inbound

Transaction

Insight Host

(Clearinghouse)

837

Outbound

Hospital Transaction Insight Host

(Insurance

Company)

837

Inbound

835

Outbound


E-Mails

Your Transaction Insight administrator may have set up your account to get e-mails if you

are a member of a team and:

a task is assigned to you

you are the team owner and a task arrives for the team

an alert is triggered and you or your team is set up to receive it.

You can edit the frequency of your e-mails under User | My Account.

The mail will be sent to your login e-mail address. See Maintaining your Account on page

101.

Internal and External Partners

Internal partners are divisions of the Transaction Insight host.

If the host is a payer, these are its divisions or departments.

If the host is a provider, this may be its billing department, for example.

If the host is a clearinghouse, these may be the various parts of the clearinghouse service.

External partners are those who exchange EDI with the Transaction Insight host.

If the host is a payer, this may be providers, other payers, or clearinghouses.

If the host is a provider, this may be payers or clearinghouses.

If the host is a clearinghouse, this may be payers, providers, and other clearinghouses.

Application Documents

Throughout Transaction Insight, you will see references to documents. These are the

claims, coverage documents, and other application documents within a transaction set.

Examples

A file might contain two 837 transaction sets. The document level for an 837 is the claim.

Each transaction set contains 30 claims spread among several subscribers and dependents.

This file therefore contains 60 application documents.

A file contains two 850 purchase orders. The document level for an 850 is the ST segment.

This file therefore contains 2 application documents.

ApplicationDocTables.pdf describes the application documents in each transaction.

Transaction Insight User's Guide Statistics Pages 15

3 Statistics Pages

Overview of Statistics Pages

Your Transaction Insight administrator has given you access to the information that you

need, while protecting the privacy of others. You should be able to see some or all of these

statistics pages:

Information / Actions Menu Item See…

Number of claims or other

business documents

Statistics >

Documents

Documents and Document Volume

on page 24

Errors Statistics > Errors Errors Page on page 28

Document volume – number of

good, bad, and total claims or

other business documents.

Statistics > Document

Volumes

Documents and Document Volume

on page 24

Percentage of documents with no

errors.

Statistics > Success

Rate

Success Rate on page 32

Transmissions per day – number

of EDI files processed by day;

data about each file.

Statistics >

Transmission

Volumes

Transmissions on page 33

View DRG codes, counts, and

amounts for two time periods.

Statistics > DRG

Usage

DRG Usage Page on page 35

List diagnosis and procedure

codes, counts, amounts, and

research details.

Statistics > ICD

Usage

ICD Usage Page on page 36

Investigate individual ICD codes. Statistics > ICD

Statistics

ICD Statistics Page on page 39


Common Elements of Statistics Pages

Test and Production Data

On each statistics page, you can see either test or production data. Set the filter at the top

left:

Transaction Insight uses the contents of the ISA-15 (X12) or the UNB11 (EDIFACT) to

determine whether an interchange is test or production.

A systems person at the host can use Importer’s -t parameter to force EDI data to be

treated as test data, regardless of the data in the ISA-15 or the UNB11. This affects future

data being imported and is not retroactive to previously imported data.

Refreshing Data

Data on Statistics pages does not automatically refresh when a new selection is made in the

Test/Production Data drop-down. To update the data you must click the appropriate

button to refresh the data.

Examples

On the Documents page: You are looking at Test Data and decide to switch to Production

Data. You must select Production Data from the drop-down and click View Results on the

page.

On the Errors page: You are looking at Production Data and decide to switch to Test Data.

You must select Test Data from the drop-down and click Search on the page.


Filters

All statistics, tasks, and search pages have filters, which let you adjust the display to include

only the data that you want to see.

To use filters:

1. Display the filters (see Displaying Filters below).

2. Select values for some or all filters.

3. Click View Results, Search, or Show Summary to update the page.

Documents that match all filter values selected will be included in the display.

Note: Data on Statistics pages does not automatically refresh when a new filter value

selection is made, including selection of internal and external partners. To update the data

after making a new selection, you must click View Results, Search, or Show Summary to

update the page.

Displaying Filters

On the My Tasks page, the filters are at the top and cannot be hidden.

On the Statistics pages, the filters are just below the graph.

To display or hide the filters areas, click Collapse and Expand to the far right, or click on

the line just above it.

Displaying Data for Individual Partners

When filters are expanded, you will see filters for internal partners and external partners.

You may have more filters that have been set up by your Transaction Insight administrator:

Most pages with filters let you select an individual external and internal partner for the

report.


The drop-down list will show all partners that you are allowed to see. Notice All Partners

at the top of each list. If IDs have been set up for your partners, you can use the buttons

above the list to sort the partners by ID rather than by name. Erase the contents of the top

line and type the first character of the name or ID to locate it faster.

To be included in the resulting display, a document must match your selections for Internal

Partners AND External Partners.

For an overview of internal and external partners, see Internal and External Partners on

page 14.

Displaying Data for a Group of Partners

Your Transaction Insight administrator may have set up filters that let you see data for a

pre-defined group of external partners such as all hospitals, all partners in a certain state or

region, etc.

For example, you might want to see success rates for all partners in your Midwestern

region. Perhaps you have different HIPAA education programs in various regions and want

to know which are most effective. Your administrator can set up filters to isolate data from

certain groups of partners so that you can get targeted reporting.

On any statistics page, if you have External Partners set to All Partners selected for

External Partners, then external filters set up by the Transaction Insight administrator will

appear below it.

Select values from any or all Filters. After you press View Results, Search, or Show

Summary, the page updates to show data for partners that match all filter values that you

selected.


Displaying Documents based on Values in the Data

Transaction Filters apply to specific transactions or messages. They let you see reports that

include only documents with certain values in the data such as certain diagnosis codes or

facility codes. If they exist, they show up after you select a specific transaction set or

message.

For example, your administrator may have set up:

A BHT-06 filter that lets you use a drop-down list to choose whether an 837I transaction is

Chargeable or not.

A Subscriber State filter that lets you choose a state from a drop-down list and see all claims

from that state.

An ICD-9 filter that lets you type in a diagnosis code and see only documents that contain

that diagnosis code.

Transaction filters appear on Statistics and Search pages once you have selected a particular

transaction set or message. After you press View Results, the page updates to show data

for documents that contain the values that you selected.

You can use the Compare By column to select a transaction filter.

You can also click on a transaction in the Partner Rankings column to select a filter for

this transaction type.

In comparison, on Search pages you can select multiple filters and they appear once you’ve

specified a standard and transaction or message:


Statistical Charts

Statistical charts include tooltips, data highlighting, and data hiding in line charts.

Tooltips

Place your cursor on a data point and a tooltip appears.

Data Highlighting

Click a data grouping on the left to highlight the information on the statistics chart.


Data Hiding

When a data group on the left of a statistics chart is grayed out, the data is hidden.

Click one or more data groups to display the data on the statistics chart.


Saving a View

On statistic pages, you can save all filter value settings with the exception of transaction

filters, for future use by yourself and/or others in your group.

Saving a view

1. Select values for the filters inside the area that you can collapse and expand.

2. Under Views, click Create:

3. Type a name for your view and click Save:

You can select this view from any statistics page. Your logon name is appended to the view

name to indicate who created it.

Sharing your saved view with others

You can share views that you create with others in your group or who have your role.

1. Select a view that you created.

2. Click Share Filter Views.

(If Share Filter Views is not available, go to User | My Account and select the FILTER

VIEWS tab.)


3. Select a group or role.

You can share with those with the same roles or groups as yours.

4. Under the Share column, select all views that you want to share with them.

5. Click Save.

6. You can repeat steps 3-5 for other groups or roles in the list, if you’d like.

When others share their views with you

To use their views

If someone else shared a view with you, it will show up in the Views list. You can select it

to use the same filter settings that they had when they created the view.

To delete their views from your list

You are in charge of what appears in your view list. You can delete a view created by you or

by others by selecting it and clicking Delete.

This affects your list only. Others who have this view will be unaffected.

Downloading to Excel

Statistics pages let you download their reports to Excel. Click the link at the bottom left:

It will then suggest a unique filename with a date-time stamp.

The steps you take after this will depend on which browser you are using. Typically, you

will have a Save button or link where you can select a download directory and change the

filename. Check your desktop and your download directory if you are not offered a means

to select a directory.


Documents and Document Volumes Pages

The Documents and Document Volumes pages are identical, except the Document

Volumes page has extra rows to show the good and bad document count as well as the total

document count.

On these pages, you can:

See the number of documents processed for each transaction type.

See the number of documents of a specific transaction type for each external partner, in

order of volume.

Choose date ranges for a report.

Filter a report in various ways.

Data includes volumes of documents sent to or from all partners that you are authorized to

see.


Opening the Documents or Document Volumes Pages

Under Statistics, click Documents or Document Volumes on the left.

Using the Documents and Document Volumes Pages

The Documents and Document Volumes pages show the number of documents of each

type that were been processed during a timeframe of your choice.

You can customize the display in these ways:

To do this … Do this … Number (see

graphic below)

Change date

interval

Choose Day, Week, or Month.

Click View Results.

1

Change date

range

Type the desired date in the Start Date and End Date

areas to the right of the graph, or use the pop-up

calendar.

Click View Results.

See Specifying Dates on Statistics Pages on page

11.

2

See volumes for

one partner

Use internal or external partner filters (expand the

filters area). The report shows document volumes for

that partner by transaction and version.

See Displaying Data for Individual Partners on

page 17.

3



graphic below)

See volumes for

multiple partners

Select from the partner filters or group filters (expand

the filters area).

See Displaying Data for a Group of Partners on

page 18.

4

Show volumes for

documents that

contain a specific

value

Select from the Transaction Filters.

See Displaying Documents based on Values in the

Data on page 19.

Sort the rows

differently

Click on the column head that is to control the sort.

When you rest your mouse cursor on a sortable

column heading, it turns into a hand:

5

See volumes for

one type of

document

Click the pushpin button in its first column. 6

Compare volumes

for individual

external partners

Click a document in the Partner Rankings column.

You will see volumes for all partners to whom you

have access; note the filter settings.

7

Compare volumes

for categories of

external partners

Use that document’s Compare By column to choose a

category.

See Comparing Volumes between Categories of

Partners on page 27.

8


Comparing Volumes between Categories of Partners

This feature is useful if you have access to multiple partners.

The Transaction Insight administrator may have set up categories of partners. If so, you can

compare document volume within a category. You might compare the volumes among

states, clearinghouses, providers, or any other category set up by your administrator.

On the main Documents, Errors, Document Volumes, or Success Rate page, use the arrow

in the Compare By column to select a category.

Example

You are choosing the category State for 5050 850 Inbound documents:

After selecting, you see the volumes for each state. We assume that State is a partner filter

set up by your administrator. This example has two divisions: New Jersey and Maryland.

You can change category with the drop-down list above the chart.

Categories offer the same divisions as Partner Filters and Transaction Filters, but they

compare divisions rather than filter out data for just one division.


Errors Page

Click Errors on the main menu to understand reasons for document rejection. On the

Errors pages, you can:

See errors in the order of frequency.

Specify message wording type: EDI, Non-Technical, UB92, HCFA 1500, or Dental.

Filter for:

− dates

− standard\version\transaction sets or messages

− individual partner

− groups of partners

− values within documents

− a particular error type

− a particular error number.

For each error number, see which application documents contained the error.

Compare categories of partners for each error code.

See summary information about an application document that has an error.

View an application document in a web form.

Your administrator may have set up e-mail alerts to be sent to specific users or teams when

documents contain errors.


Using the Errors Page

The Errors page shows the top 10 errors in documents processed during a date range.

To do this … Do this … Number

(see graphic

below)

Filter the data to include

certain partners or certain

documents

Use the filters (expand the filters area).

See Filters on page 17.

Change the date range Type the other dates in the From Date and To Date

fields below the graph, or select from the pop-up

calendar.

Click Search.


11.

Change the type of wording

used in error descriptions

Select from among the Description Types below the

list of errors. 1

See which documents

contain a specific error

Click the error number in the Error Code column, or

the pushpin next to it.

Scroll down to see the list of transmissions at the

bottom of the page.

2

Compare categories of

partners for each error

code

Select the category in the Compare By column. 3

See other pages of errors Click on another page number at the bottom right. 4

Sort the rows differently On the errors list, click on the Error Code or Number

of Errors column headings.

Choose Number of Error Instances or Number of

Documents affected by this Error.

On the transmissions list for a specific error code,

click on any heading.

5

Select number of errors or

number of documents

What determines the ranking – the number of error

instances or the number of documents containing

errors?

6


To do this … Do this … Number

(see graphic

below)

Filter error type of severity Note: Your administrator can include or hide this field

using the setting IsTop10ErrorTypeSearchOn in the

Web.config file.

To select only one error type and/or one severity,

click this link at the right side of the page:

7


Viewing Documents with a Specific Error

To find out which transmissions contain a specific error and then view the error in a form:

1. Locate the error on the main Errors page. You may have to click on another page number

at the bottom right to find it.

2. Click on the error number in the Error Code column, or use the pushpin next to it.

3. View the transmissions at the bottom of the page.

1 Transmission Column

If a transmission contains multiple application documents (see

ApplicationDocTables.pdf) with errors, each will be listed on a separate line.

2 Document ID Column

This contains a unique ID that Transaction Insight assigns to each application document.

Clicking on a Document ID number displays:

A document summary (see Using the Document Summary Page on page 70).

A link that lets you view the data in a form.


Success Rate Page

Click Success Rate on the main menu to see the percentage of error-free documents for

each document type or partner during a timeframe of your choice.

This gives you metrics to evaluate success rates by payer, lets you see trends over time, and

lets you see which errors are causing the rates.

On the Success Rate pages, you can:

Compare success rates for each transaction with daily, weekly, or monthly time intervals

Filter for dates, individual partner, groups of partners, or values within documents

For each transaction type, compare the success rates of partners

For each partner category, compare success rates.

Using the Success Rate Page

The Success Rate page shows the success rate by document type during a timeframe of

your choice.


graphic

below)


certain partners or certain

documents

Use the filters below the chart. Display them with

Expand.


Change the date range Type the desired dates, or select them from the drop-

down calendar.

Click View Results.


11.

1

Sort the rows differently Click on the Type column heading or on one of the

time interval column headings.

On the partner rankings list, click on any heading.

2

See the top 10 errors for a

time interval, transaction

type, and direction

Click any success rate number. This takes you to the

Error page for that interval.

See Errors on page 28.

3


Main Success Rate Page

Transmissions Volumes Page

Click Transmission Volumes on the main menu to see:

Number of transmissions for each day

Number of good, bad, and total application documents (see ApplicationDocTables.pdf.)

Summary numbers for Monetary Amount.

A link to the Transmission Search page.

You can filter with the fields across the top or in the expandable filters area just below them

(see Displaying Filters on page 17).


graphic below)

Filter the data to

include certain

partners or certain

transmissions

Use the filters along the top.

Use Click to Expand Partner Filters at the top right to

display or hide partner and transaction filters.

When finished setting filters, click Show Summary to

update the page.


1

Sort the rows

differently

Click on the column heading that is to be used for

sorting. Click it again to sort in the opposite direction.

2

Find a specific

transmission

Use the Link To column. 3

See more dates Click on a page number at the bottom right.


Main Transmissions Page

Column headings are:

Date

Date and time that Transaction Insight started processing the documents.

Bytes

Total size of transmissions for that date.

Transmissions

Number of transmissions.

Good Docs

Number of application documents with no errors.

Bad Docs

Number of application documents with errors.

All Docs

Total number of application documents.

Monetary Amounts

Monetary amounts in good, bad, and all docs. See ApplicationDocTables.pdf for the

source of the amount.

Link To

Links to the Transmission Search page for this date.


DRG Usage Page

This page allows you to compare 837 DRG codes for two time periods.

It appears if you are using the Transaction Insight Healthcare Edition and your

administrator has chosen the following under Settings | General settings:

Product Mode of Healthcare

Page Settings of Display DRG Usage

The page shows each DRG code that appeared in the data, the number of application

documents in which appeared, and the dollar amounts in those application documents.

If you see this message, contact your Transaction Insight administrator:

*The DRG transaction filters have not been defined.

When you first open the page, adjust the dates for the two time periods and click View

Results for each.

To do this … Do this …

See data. Press View Results for each DRG period.

On this page, you need to press View Results to display results. This is

different than the other Statistics pages.


certain partners or

certain documents.

Use the filters. Expand the filters area by clicking Expand at the far right.




Change the date range. Type the other dates in the Start Date and End Date fields, or select

from the pop-up calendar.

Click View Results.

See Specifying Dates on Statistics Pages on page 11.

Information on the page includes:

DRG Code A DRG code that appeared in the data.

Count Number of documents containing the code.

Amount Dollar amount of the claim. See ApplicationDocTables.pdf for the

source of Amount.

ICD Usage Page

If you own TIBCO Foresight® ICD-10 Conversion Adapter, this page shows diagnosis

and procedure codes found in the data selected, how many documents contained each

code, and the total amount for the claims containing them. You can then research further

by individual code.

This page appears if you are using the Transaction Insight Healthcare Edition and the

administrator has chosen the following under Settings | General Settings:


Page Settings of Display ICD Usage

When you first open the page, click View Results.

Example

You can then investigate further, all the way down to viewing a particular document in a

form, by clicking on a code and then on a document.



See data. Press View Results.

On this page, you need to press View Results to display results.

This is different than the other Statistics pages.

Filter the data to include certain

partners or certain documents.

Use the filters. Expand the filters area by clicking Expand at the

far right.


Change the date range. Type the other dates in the Start Date and End Date fields

below the graph, or select from the pop-up calendar.

Click View Results.


See an overview of the codes,

number of documents

containing the codes, and

amount.

Set the filters and click View Results.

See a corresponding code. Click the code.

Then look below for the corresponding code.

See details about a code as

it appears in each document

After clicking the original code, click the Expand button below:



See the corresponding VIPS

data for a document

Use the Click for Details link in the VIPS Details column for the

document:

This shows the actual raw data string that was used to match the

code.

Go to the Document Summary

page for a document

Click Document ID for that document:

See data in a form. After clicking Link to Document, use the Click here to View

the document link on the Document Summary page.


Code An ICD code.


Amount Dollar amount of the claim. See ApplicationDocTables.pdf for the

source of Amount.

Effective Date Document date. See Document Date in ApplicationDocTables.pdf

for the source of this data.

Age Patient’s age from the DMG segment.

Gender Patient’s gender from the DMG segment.


ICD Statistics Page

If you own Foresight® ICD-10 Conversion Adapter, the ICD Statistics page lets you

investigate a particular ICD code or particular partner’s use of ICD codes.

This page appears if you are using the Transaction Insight Healthcare Edition and your

administrator has chosen the following under Settings | General settings:


Page Settings of Display ICD Statistics.

When you first open the page, make selections in all three of these fields and click View

Results.

The bottom of the page will show the corresponding code, how many documents

contained it, and when it was imported.


See data. Fill out the three fields in the ICD Code Selection area and click

View Results. The corresponding information appears below.

If the Codes radio button is selected, you see the corresponding

code below.

If the Partners radio button is selected, you see the partners who

send data with that code.

Filter the data to include certain

partners or certain documents.

Expand the filters area by clicking Expand at the far right, and

use the filters.


Change the date range. Type the other dates in the Start Date and End Date fields, or

select from the pop-up calendar. Click View Results.




See more information about a

code or partner.

Click the arrow in the first column:

If the Codes radio button is selected, you will see which partners

used the code and how many times.

If the Partners radio button is selected, you will see each partner

and how many times they used the code.


Code An ICD-9 or ICD-10 code.


Partner A Transaction Insight partner as defined by your administrator.

Transaction Insight User's Guide My Tasks Page 41

4 My Tasks Page

Overview of My Tasks Page

If you are responsible for handling application documents that have errors, your

Transaction Insight administrator may give you access to the My Tasks page:

My Tasks

On the main My Tasks page, you can:

View a list of documents containing errors

Sort the list by any column heading

Search for a transmission or document

Assign tasks to team members

Change status or priority of tasks

Unlock documents

Validate changed documents

Create an external EDI file of corrected data

Filter the list of tasks.


Columns on the Main My Tasks Page

Document ID

Internal document ID assigned by Transaction Insight.

Date

Date the transmission was processed by Instream®.

Transmission

Name of the transmission.

Submitter ID

The submitter identifier. To see the source of this value, see

ApplicationDocTables.pdf.

Sender

The transmission’s sender as identified by criteria set up by the administrator.

Receiver

The transmission’s receiver as identified by criteria set up by the administrator.

Amount

The dollar amount for 277, 820, 835, and 837 documents. To see the source of this

value, see ApplicationDocTables.pdf.

Standard

The standards organization.

Version

The data’s version

Type

Transaction or message type and direction.

Status

Status setting (see List of Statuses on page 105).

Priority

Priority setting (High, Normal, and any custom priorities).

Assigned To

Team member assigned to handle the document.

Owner

The team owner.

Locked By

Team member who is currently editing the document, or who last edited it.


Using the My Tasks Page

The My Tasks page shows a list of documents that contain errors. Depending on

permissions set by the Transaction Insight administrator, you can use the page in these

ways:


graphic below)

Show task for

another team

Select the team at the top right. All teams to which you

belong will be on the drop-down list.

1

Filter by contents

of Transmission,

Document, or

Amount columns

Under Search In, choose a column. In the field to the

right, type a transmission name, document number, or

amount.

Press Apply Filters.

Example: To find all transmissions starting with

Hillsdale837, choose Transmission/Document, type

Hillsdale837* and press Apply Filters. The search may

be case sensitive. Note the wildcard * at the end.

2

Filter the list Select from the filters at the top and press Apply Filters.

The page updates to show only documents that match

the values that you selected. By default, you see only

documents assigned to you that are not closed.

3

Sort the list Click on a column heading. To sort in the opposite

direction, click again.

4

Assign tasks to

team members

Select checkboxes for all tasks to be assigned.

Under Possible Actions, choose Assign.

Choose the team member in the field that appears after

selected items to.

Click Assign.

The name will appear in the Assigned To column for the

selected tasks.

5



graphic below)

Change status To set status to reflect the current progress of one or

more tasks:

Select checkboxes for all tasks to be affected.

Under Possible Actions, choose Change Status.

Choose the status in the field that appears after of

selected items to.

Click Change Status.

The Status column updates for the selected tasks.

See List of Statuses on page 105.

5

Change priority Select checkboxes for all tasks to be affected.

Under Possible Actions, choose Change Priority.

Choose the priority in the field that appears after of

selected items to.

Click Change Priority.

The Priority column updates for the selected tasks.

5 and 6

Unlock a locked

document (see

Locked by

column)

A document is locked when someone is editing it. It can

be left in a locked state if a team member improperly

exits a form (closing the browser while editing a form,

without clicking Save or Cancel, for example).

To unlock:

Check with other team members to be sure that no one

is currently editing the data in a form.

Select checkboxes for tasks that are to be unlocked.

Under Possible Actions, choose Unlock.

Click Unlock.

5 and 6



graphic below)

Validate a

document

After correcting data, you can validate directly from the

form, or you can validate one or more documents here.

Select checkboxes for tasks that are to be validated.

Under Possible Actions, choose Validate.

Click Validate.

Look in the Status column to see if it passed. Results

can be:

Failed Systems error. Have your administrator

check the event log.

Invalid Data is still invalid.

Valid Data is valid. You can now Submit (see

below).

Validating Data has not finished validating. Refresh

the page occasionally until it changes to

another status.


5 and 6

Create a new EDI

file for processing

by non-

Transaction

Insight systems

After correcting and validating data, you can re-assemble

full EDI files and place them in a directory designated by

your Web.config file.

For details, see Submitting Overview on page 107.

5 and 6

Display

application

document details

Click its link in the Document ID column. 7


Document Summary Page via My Tasks

From the main My Tasks page, click a link in the Document column.

This opens the Document Summary page. The top part is the same as the document

summary under the Errors and Search pages (see Using the Document Summary Page

on page 70).

The bottom allows you to take these actions:


graphic below)

Edit the data in a form Click Edit the document to change the data in a

form.

1

See the data in a form Click View the document to see the data in a

form.

2

Take action on the form Use the Form Actions area to perform the

following actions:

Save – save changes you’ve made on the

document.

Validate – send the updated document to

Instream for re-validation.

Submit – reassemble a new, corrected EDI file in

a designated directory (see Submitting from My

Tasks on page 111.)

Force Through – save the document to an

external directory even though it has uncorrected

type 7 and 8 errors (see

TI_Reference_Manual.pdf for more information

on Force Through processing.)

Restore to Original – delete all changes you’ve

made and restore the original document.

Cancel – cancel the operation in progress and exit

with no changes to the form since the last Save.

This also releases your “lock” on the document,

enabling editing by other users.

Export to XML – export and save the document as

XML format.

Export to PDF – export and save the document as

PDF format.

3

Perform a task Use the Task Actions area to assign, change

status, or change priority of the task

Click Update.

4



graphic below)

Purge the form TIPurge is a program delivered with Transaction

Insight that provides the ability to remove targeted

data from the Transaction Insight database. Once

purged, it cannot be restored. Do not confuse

this with an archiving program.

Use the checkbox in this section to indicate if the

document should be purged. Select Update to

complete the process.

Refer to TIPurge.pdf for more information.

5

Add and view comments The last few comments appear at the bottom, just

above the Comment box. Click another page

number below the list of comments to see more

comments.

To add a comment, click the Comments tab, type

it in the Comment box at the bottom and click Add

Comment.

6

See a history of all

events for this document

Click the History tab at the bottom.

To read a comment, click on it.

To display all comments, click Show all

comments.

To read details about data that has been

changed, click Show Details about fields

changed in the document.

If this document was changed and the changes

affected other documents, the History tab will

contain links to their summary pages. This can

happen if you corrected an error above the claim

level, for example.

7

Transaction Insight User's Guide Search Pages 51

5 Search Pages

Getting Access to the Search Pages

Your Transaction Insight administrator may have given you access to the Search

Documents, Code Lookup, and Search Transmissions pages:

Common Elements

The search pages share some common elements.

Fields

Field Description

Test/Production Data Set by the ISA15 or Importer’s t parameter.

Standard/Version/TransactionSet Specify the standard, version, and transaction set you are

searching for.

Date Range Make as small as possible.


Field Description

Document Extended Fields Set up by your administrator. Select a field, operator, and

value. Operators are listed below.

See ApplicationDocTables.pdf.

Transaction Filters Vary by transaction. Set up by your administrator.

Select a Standard and Transaction Set before you can

filter by Transaction Filter.

Then select the field, operator, and value. Operators are

listed below.

Partner Filters Select as many as you can to narrow the search results.

Operators

Operator Description

= Equal to

> Greater than

Numeric data

>= Equal to or greater than

Numeric data

< Less than

Numeric data

<= Less than or equal to

Numeric data

like Can use the * wildcard

Examples:

A* any value starting with A

*A* Any value containing A

*A any value ending in A

Note: A wildcard at the beginning of a search term is called a leading wildcard.

Leading wildcard searches (e.g., *testsearch) can cause slow response times

and for this reason, your Transaction Insight administrator may opt to restrict

their use.


Search Documents Page

This page lets you find documents that match criteria that you select.

Filter so that it does not return too many documents. There is a limit of 100.


To conduct a search:

1. Choose Search | Documents on the top menu.

2. Select as many filter values as you can.

3. Adjust the date range to be small (maximum 31 days).

External Identifier Search

Your Search Documents page may have a tab like this, which lets you search for

Transaction Insight documents with an ID code that your company has assigned it:

If so, choose the field and type a value to see one or more documents with that ID.

This is customized for your company. Contact your administrator for details.


Code Lookup Page

This page is available in Transaction Insight Healthcare Edition only. It lets you check

an external code’s validity based on:

TIBCO Foresight-distributed external code sets

modifications you have made to TIBCO Foresight-distributed code sets

your own code sets.

Due to licensing restrictions, Transaction Insight cannot display the entire list of

valid external codes. Refer to ExtendingCodeTables.pdf for information on code

tables.

1. Select a code table.

A code table that has been disabled in a user table will have the word “Disabled” after

its name in the list.

A code table that has been modified in a user table will have “User Table” after its

name.

2. Type a possible code.

3. Click View Results.

The results include:

ID The code.

Start Date The date when the code became effective, if the

code has a date range.

End Date The date when the code stopped being effective, if

the code has a date range.

Flag Default Code has not been modified by the user

Customer modified Code has been added or changed

State (Zip code list only) The state where the zip code is located.


Search Transmissions Page

This page lets you find entire files, not just application documents, that match selected

criteria.

Filter so that it does not return too many files. There is a limit of 100.

To conduct a search:

1. Choose Search | Transmissions on the top menu.

2. Select as many filter values as you can.

3. Adjust the date range to be as small as possible (maximum 31 days).

This page is very similar to the Search Documents Page (see page 51). It returns a list

of files that match the search criteria:


To see information about a file, click the link in the File Name column. You will go to

the Transmission Summary page.

To see information about a document in the file, click the arrow to display a file’s

documents, and then click the link in the Document ID column. You will go to its

Document Summary page.

Hover over each column heading and click to sort as desired.


Using Search Time Control

The Transmission Search page has a control called Search Time.

The default for this setting is specified by the Transaction Insight administrator and it

appears as the first (top) search time selection on the Time Range control drop down

menu. The Transaction Insight administrator can also control your use of the Start

Date/Time and End Date/Time fields by enabling/disabling your default access to the

associated controls.

You can select a different time by accessing the Search Time drop down menu.

Additional information about search time ranges:

The "Today Only" option is defined as from 00:00 to the current time.

The system always rounds up to the nearest 5-minute increment. This ensures that the

End Time mincludes the most recent transmissions.

Example: If the default is "Last 6 Hours" and the current time is 13:32, the Start Time

will be 7:35 and the End Time will be 13:35.


Access to Start Date/Time and End Date/Time Controls

A default has also been set by the Transaction Insight Administrator that impacts your

ability to access the Start Date/Time and End Date/Time fields. You may find fields are

disabled when you initially access the Transmission Search Page.

To re-enable the Start Date and End Date controls:

1. Choose "Select Custom Date Range" from the drop down menu on the Transmission

Search Page.

2. Note that the Start Date/Time and End Date/Time fields are now enabled. Select a

custom date and time range using the Start Date/Time and End Date/Time controls.

3. Select additional filter values as desired.

4. Click the Search button.

Additional information about search time ranges:

If the Start Date/Time and End Date/Time fields are enabled, the time interval

specified is retained; it is not automatically re-adjust if time passes between searches.

Example: You select "Set Custom Date Range" and request data for the current date

from 10:05 to 12:05 and click Search. You return to the same search 30 minutes later

and click Search again. The selected time range remains 10:05 to 12:05.

If the Start Date/Time and End Date/Time fields are disabled, the time interval

you've specified is automatically re-adjusted if time passes between searches.

Example: You select "Last Hour" at 10:15 and click Search. You return to the

search 10 minutes later and click Search agin.

The system automatically re-adjusts the time for the selected time range ("Last

Hour"), returning data from the last hour beginning at the current time, now 10:25.

This ensures you are always receiving data for the true last hour.

Transaction Insight User's Guide Files Pages 61

6 Files Pages

Overview of Files Pages

Your Transaction Insight administrator may have given you access to capabilities using

the Files pages:

Additionally, your administrator may have set up locations for you to upload or view

files on the Transaction Insight server.

Information / Actions Menu See…

Upload EDI and other files for processing Upload Uploading Files on page 62

View files in a designated directory on the

server

View Viewing Files on page 63


If you are using the Transaction Insight Healthcare Edition, your administrator may

have given you permission to use the 275 Attachments and 277 Attachments Requests

pages.

Information / Actions Menu See…

Upload an attachment and create a

corresponding DDE file, which can be used as

input to the TIBCO Foresight® Translator

Claims Attachment Adapter tool.

275

Attachments

275 Claim Attachments

Page on page 64

Create a new attachment request. 277

Attachments

Request

277 Attachment Request

on page 66

Uploading Files

Your administrator may have set up a directory on the Transaction Insight server where

you can upload EDI data and/or other files. Before uploading files, find out the purpose

and requirements from your administrator.

To do this, click Files | Upload on the top menu.

To upload:

1 Type the path and name of the file to upload, or use the Browse button.

2 Select the destination if you are offered a choice. Consult your administrator if you do

not know which destination to choose.

3 Click Upload.


Viewing Files

Your administrator may have set up a location for you to view files generated by

Transaction Insight. Choose Files |View from the top menu to see files stored there.

If you have access to multiple viewing directories, pick the one that you want from the

drop-down list at the top left.

Otherwise, the contents of the directory will appear.

You can:

Open a file by clicking its filename.

Delete a file by clicking X in the Delete column.

See other pages of files by clicking a page number at the bottom. List more pages by

clicking […].


275 Claim Attachments Page

Note: This page is available on Transaction Insight Healthcare Edition and appears if

you have been given permission from your administrator.

The 275 Claim Attachment Upload form allows you upload an attachment and create a

corresponding DDE file, which can be used as input to the TIBCO Foresight®

Translator Claims Attachment Adapter tool.

Content of the 275 Claim Attachments Page is configured by your administrator. The

example shown here illustrates the most commonly used fields.

When you access the 275 Claim Attachments Page for the first time, all fields are blank.

After you’ve submitted a 275 Claim Attachments Page once, the form is pre-populated

with the values you used previously.

Required fields are marked with a blue asterisk.


Uploading an Attachment

To upload:

1 Use the Browse button to navigate to the path and name of the file.

2 Click Upload.

Errors are noted in red as shown here:

Completing the Upload

During the 275 upload process, complete (at a minimum) all required fields in the 275

Attachment Details section.

Click Save Attachment to complete the 275 Claim Attachment Upload or Cancel

to clear the page and start over.

Errors on the page are noted in red as shown here:


277 Attachment Request Page

Note: This page is available on Transaction Insight Healthcare Edition and appears if

you have been given permission from your administrator.

The 277 Attachment Request Page allows you to request additional information for a

health care claim by creating a 277 Health Care Claim Request for Additional

Information.

Content of the 277 Attachments Request Page is configured by your administrator and

the page can become lengthy. The example shown here illustrates a partial screen with

some of the most commonly used fields. Note that some fields may be pre-populated by

your administrator. Required fields are marked with a blue asterisk.

Note: Accessing this page via Files|277 Attachment Request results in a blank

document. To create a 277 Attachment Request based on a specific 837, create the

request by accessing the transaction with Document Search and clicking Generate

Attachment Request at the bottom of the Document View page. Accessing the form

in this way causes the 277 Attachment Request to be pre-populated with information

from the 837.

To display or hide sections, click Collapse and Expand to the far right.


Submitting the 277 Attachment Request

Before submitting the 277 Attachment Request, complete (at a minimum) all required

fields in the 275 Attachment Details section.

Click Submit Request to save and submit the 277 Attachment Request.

Errors on the page are noted in red as shown here:

Transaction Insight User's Guide Document Summary Page 69

7 Document Summary Page

Opening the Document Summary Page

To see details about a particular document:

From the main Errors page, click on the error number to display the documents at the

bottom of the page. On the bottom of the page, click the number in the Document ID

column.

From the main Search Documents page, click on the Document Submitter ID.

From the Search Transmissions page, click on the arrow in the first column, next to

the Date column, and then click the Doc #.

From My Tasks, click on a link in the Document ID column.


Using the Document Summary Page

The Document Summary page initially displays in a compact format with much of the

data collapsed. To expand an area for full viewing, click Expand.


Document Summary Information Section

This section provides a summary of information about the document.

Doc Summary for: n. where n is the submitter ID

For documents with no submitter ID, this is NONE.

(See ApplicationDocTables.pdf for information on Submitter IDs.)

Example:

Document Summary for: 26463774

Transmission information

Provides information about the file and document.

(See Terms used in Transaction Insight on page 141.)

Example:

Document View Link

Click this link to view the document.

Example:


Instream Error Summary Section

The Instream Error Summary section provides information about the settings used

when the document was validated:

Version - Instream version used to validate the document.

APF File - Profile used to validate the document.

Error Files - Instream error files used during validation.

Guideline - Guideline used to validate this document.

Code Table - (Transaction Insight Healthcare Edition only) Table containing HIPAA

external codes.

TPA Table - File containing trading partner automation settings (if used).

Document Errors - a summary of errors found in the document.

For HIPAA documents, this section lists Instream errors at the main level of the

application document. For a claim, this would be an error in the data for the claim

as a whole.

For other data types, this lists all errors.

Loopn Errors (HIPAA data only)

This section lists Instream errors at each loop level. By referring to the list of

HIPAA loop numbers in ApplicationDocTables.pdf, you can see where this is.

There may be other external systems listed below Instream with similar information.

Example:


External Notes Section

Your administrator may add notes to documents that are already in Transaction Insight.

You can see these notes on the Document Summary page.

Example:

Related Documents Section

Related documents are those that have been identified by the TIMatcher program as

being related to the document. For example:

an 835 might show as related to 837P claims

a corrected document that has been imported back into Transaction Insight may show

as related to the original.

Matching is an advanced activity set up by your administrator. See TIMatcher.pdf for

details.

Transaction Filters Section

This section displays the document’s transaction filter names and values if configured to

do so. Information designated as confidential by your Transaction Insight host is

blocked unless you have permission to see it.

Transaction Filters appear under the Statistics and Search pages and can be used to filter

based on specific information in the data.

See Filters_for_FPP.pdf for configuration information.

A transaction filter with zero or one filter value(s) appears as a single line. In this

example, the transaction filters:

Provider Accept AssignN Code, which has a value of A, appears one time in the

document

Release of Info Code, which has no filter value assigned, appears one time in the

document.


If a filter has multiple filter values you can click the arrow to the left of the filter name to

expand the information. For the selected filter you see a breakdown of each filter value

and the number of occurences within the doucment.

Use the page controls at the bottom left of the expanded box to scroll through the

results.

Extended Fields Section

This displays the document’s extended field values.

An extended field is one that your Transaction Insight host may choose to import for

this transaction set. You can see them on the Search pages:

And on the Document Summary page:

Information designated as confidential by your Transaction Insight host is blocked

unless you have permission to view it.


External Identifiers Section

This displays the document’s external identifier(s).

An external identifier is a unique ID for this document. It lets you use the Search

Document page’s External Identifier Search tab to find a specific document by its ID.

See External_Identifiers.pdf for details.

Purge

TIPurge is a Java program delivered with Transaction Insight that provides the ability to

remove targeted data from the Transaction Insight database. Once purged, it cannot

be restored. Do not confuse this with an archiving program. Refer to TIPurge.pdf for

more information.

Your administrator may allow you to purge documents. If so, use the checkbox in this

section to indicate if the document should or should not be purged. Select Update to

complete the process.

If the Do not purge checkbox is… …and the document is targeted by TIPurge…

checked the document is retained

unchecked the document is purged

Note: If the Transaction Insight administrator chooses to drop the database partition

containing this document, the Do not purge flag is no longer honored. Dropping a

partition is unrelated to TIPurge.

AMA Copyright

Transaction Insight Healthcare Edition customers will see a notice indicating that CPT

codes referenced in Transaction Insight are copyrighted by the American Medical

Association.


Other Information

If you arrived at this page through My Tasks, you will also have these options.

Button or link to edit the document

If this is active, you can use it to edit the document data in

various ways: HIPAA form, Errors Not In Form, or Raw EDI.

To be viewable, EDI data (not just a validation results file)

must have been processed by Transaction Insight.

Task actions See and change settings. See Columns on the Main My

Tasks Page on page 42.

Comments Add and view comments.

History See a history of all events for this document.

Prev Record

Next Record

If the file contained multiple application documents, you can

navigate to the others and they will open in the same view

that you are currently using.

Transaction Insight User's Guide Transmission Summary Page 77

8 Transmission Summary Page

Opening the Transmission Summary Page

To see details about an entire transmission:

1. Choose Search | Transmissions on the top menu.

2. Set the filters and click Search to find a transmission.

3. Click on its File Name:


Using the Transmission Summary Page


1 Transmission Summary for: filename

2 Transmission Information

Transmission Name Name of file containing this document.

Other information See Terms used in Transaction Insight on page 113.

3 Counts/Totals for the contents of the transmission.

4 Instream

Instream Version Version for the validation Instream.

Report File Name The validation detail results file.

Report File Path Location of the detail results file when it was imported.

5 Import

Importer Version Version for the importer that handled this file.

Importer Start Date

Importer End Date

Date and time when the file started importing.

Is Complete Importer has finished processing the transmission.

Machine Name The unique name of the Importer that processed this

file. This can be the machine name or a name assigned

by the Importer -n parameter or the name setting in

Importer.ini.

6 Purge

Purge Status NULL Hasn’t had anything done to it.

Q Queued to be purged in the next run

P Purging this transmission right now

F Transmission main data purged, but not completely

finalized

X Transmission purge completely done

Do Not Erase TIBCO Foresight® Test Asset Management Suite

(TAMS) only. The transmission has been marked as

Do Not Erase, which means it will not be purged.

7 Original File Original File Date See Terms used in Transaction Insight on page 113.

Original File Name See Terms used in Transaction Insight on page 113.

Original File Path See Terms used in Transaction Insight on page 113.

Original File Size See Terms used in Transaction Insight on page 113.

Transaction Insight User's Guide EDI Viewing Formats 81

9 EDI Viewing Formats

Overview

Documents can be viewed from the Document Summary page and/or edited from the

My Tasks page.

Access and Editing Information

Access varies depending on the type of data, X12 or EDIFACT.

X12 data:

is available when data and validation detail results are submitted to Transaction

Insight

is viewed through Transaction Insight

shows warnings and/or errors (modifications)

is editable in certain views when accessed via the My Tasks page.

EDIFACT data:

is available when data and validation detail results are submitted to both

Transaction Insight and TIBCO Foresight® Archive and Retrieval System

is viewed through Foresight® Archive and Retrieval System

does not show warnings and/or errors

is not editable.


This table breaks the information down further.

View Available

for

Accessed Through Errors/

Warnings Shown?

Editable via

My Tasks?

Form X12 Transaction

Insight

Errors – Yes

Warnings – Yes, if

enabled by the

Transaction

Insight

Administrator.

Yes

Paged Form X12 Transaction

Insight

Errors – Yes

Warnings – Yes, if

enabled by the

Transaction

Insight

Administrator.

Note: Warnings are

shown in the Form

Details Area only;

they do not appear

in the Tree View

Control.

Yes

Structured EDI/

Errors Not in Form

X12

Transaction

Insight

Yes

Yes

EDIFACT Foresight Archive and

Retrieval System

No No

Raw EDI X12

Transaction

Insight

No

No

EDIFACT Transaction

Insight, using data

retrieved from

Foresight Archive and

Retrieval System

No No

Validation

Highlighter

EDIFACT Foresight Archive and

Retrieval System

Yes No


Accessing a Document via the Document Summary Page

The Document Summary page provides a link to view the EDI contained within a

document. This is a static view of the EDI; no editing is available from the Document

Summary page. To edit the information (X12 only) see Accessing a Document via the

My Tasks Page on page 83.

For X12 data, the link says “Click here to View the document.”

For EDIFACT data, the link says “Click here to View the document in Archive.”

Accessing a Document via the My Tasks Page

The My Tasks page provides buttons to edit or view the EDI for a document (X12

only).


Tabs

When viewing EDI, up to four viewing formats are provided. Use the tabs to select

different views.

The available tabs and tab labels differ depending on the type of transaction being

viewed, however the tab view order remains the same (from left to right):

1. Form or Paged Form View

2. Structured EDI/Errors not in Form ( does not appear with Paged Form View)

3. Raw EDI

4. Validation Highlighter

X12 Example (Form View)

X12 Example (Paged Form View)

EDIFACT Example

Structured EDI View Raw EDI Validation Highlighter


Form View

Form View presents the EDI in an easy-to-read format based on the appearance of a

manual (paper) transaction, such as a healthcare claim form.

You can access Form View if:

data is X12

a form exists for the transaction type; for example, transaction types 835 and

837D have forms, while transaction types 850 and 212 do not

data and validation detail results were submitted to Transaction Insight

your Transaction Insight administrator has assigned you appropriate

permissions including access control levels to fields.

Example:

Navigating Form View

You can edit the form if you are accessing it through the My Tasks page and have

clicked Edit the Document. See My Tasks Page on page 41.

If accessed directly from the Document Summary page, the form is static. You can,

however, view and obtain additional information about errors or warnings on the form

by hovering over the error ( ) or warning ( ) icon beside the flagged field.

Note: By default, the Form View displays errors, but does not display warnings. Contact

your Transaction Insight administrator to enable the display of warnings.


Paged Form View

Paged Form View presents X12 EDI in a human-readable format based on the structure

of the EDI. It provides specialized controls such as paging, searching, and filtering that

allow for faster access to data in the case of very large documents.

Availability of Paged Form View is specified on a per-transaction type basis. For

example, your system may specify that all 850 transactions will appear in Paged Form

view.

This view is always available for both data with errors (“bad” X12 EDI) and with no

errors (“good” X12 EDI).

You can access Paged Form View for X12 data if:


your administrator has assigned you appropriate permissions including partner

group, roles, and access control to fields

your administrator has set up this transaction type to use this view.

Example:

Navigating Paged Form View

Paged Form View consists of the Form Details area and three specialized controls used

for navigating, filtering, and searching.


Tree View Control (page 88)

Form Details Area (page 89)

Tree View Filter (page 91)

Search Control (page 91)

Tree View Control

The Tree View control is located to the left of the Form Details area and is used to

navigate the data. The Tree View is initially opened to the document-level loop (in this

case, the ST loop).

Move through the data by:

selecting any of the nodes that are visible for the page

clicking on the page links or typing a specific page number in the textbox and

clicking the Go button.


Warning/Error Information

The Tree View displays icons for any loop that has errors ( ) or changes ( ). You

can view and obtain additional information about errors or changes on the form.

Note: Warnings ( ) (if enabled) do not appear in the Tree View. They appear in the

Form Details Area only.

Hover the cursor over the icon to display a tooltip with a count of the errors or

changes.

Click on the icon to highlight the error or change in the Form Details area:

Form Details Area

The Form Details area is populated based on the selection in the Tree View. In this

example, the ST loop is selected in the Tree View so the Form Details is populated with

the segments under the ST loop.


To display or hide sections, click Collapse and Expand to the far right.

Editing Data

You can edit the Form Details Area if you are accessing the form through the My Tasks

page and have clicked Edit the Document. See My Tasks Page on page 41.

If accessed directly from the Document Summary page, the form is static; it cannot be

edited.

Errors, Warnings, and Change Information

For information about errors, warnings (if enabled), or changes in the Form Details area,

hover the cursor over the error ( ), warning ( ), or Change icon ( ).

Example:

Note: By default, the Paged Form View displays errors, but does not display warnings.

Contact your Transaction Insight administrator to enable the display of warnings.


Tree View Filter

The Tree View Filter is located at the top left of the page, above the Tree View Control.

It is used to restrict what is displayed in the Tree View Control and the Form Details

area.

Use the drop-down menu to specify:

All – Display all loops (default)

Errors Only – Display only:

loops with at least one error in the Tree View

elements with errors in the Form Details area.

Changes Only – Display only:

loops with at least one change in the Tree View

elements with changes in the Form Details area.

Errors and Changes – Display only:

loops with at least one error or change in the Tree View

elements with errors or changes in the Form Details area.

Note: The ISA and GS loops (or any loop above the document level) are always

displayed regardless of the presence of errors or changes. This ensures the root of the

Tree View is always visible on the page.

Search Control

The Search control is located on the top right of the page, above the Form Details area.

It allows you to search the data for a particular string.

Note: If you don’t see the search box, you may need to scroll the screen to the right.

Enter a search string and click the search icon. Note that the search control is case

insensitive.


Search result entries are displayed in two parts:

A blue link to the loop that contains the data. When the link is selected, the

Tree View displays and selects the page that contains that loop and the Form

Details area is populated with the loop’s data.

The loop of data with the matching text highlighted in yellow.

If multiple pages of results are returned, use the page controls at the bottom of the box

to scroll through the results.

To display or hide the search results, click the arrow to the right of the search icon.


Structured EDI View

Structured EDI View presents the EDI in a human-readable format based on the

structure of the EDI. Structured EDI View differs between X12 and EDIFACT data.

See Structured EDI View for X12 Data on page 93

See Structured EDI View for EDIFACT Data on page 94.

This view is also referred to as Errors Not in Form.

Structured EDI View for X12 Data

Structured EDI View presents X12 EDI in a human-readable format based on the

structure of the EDI.

This view is always available for data with errors (“bad” X12 EDI). To access Structured

EDI View for X12 data with no errors (“good” X12 EDI), your Transaction Insight

administrator must set TurnOnAllErrorsNotInForm to True in the Transaction Insight

Web.config file.

You can access Structured EDI View for X12 data if:


errors were found or the data was imported with Importer’s savegooddata

option

your administrator has assigned you appropriate permissions including partner

group, roles, and access control to fields.

Example:


Structured EDI View for EDIFACT Data

Structured EDI View presents EDIFACT EDI in a human-readable format based on

the structure of the EDI.

The structured EDI view for EDIFACT data does not display warnings or errors. To

see errors you must use the Validation Highlighter View. See Validation Highlighter

View on page 100.

You can access Structured EDI View for EDIFACT data if:

data is EDIFACT

data and validation detail results were submitted to Transaction Insight and

Foresight Archive and Retrieval System

the Archiver_UI_Importer workflow is running


permissions.


Example:

The Structured EDI View for EDIFACT is accessed through the Foresight Archive and

Retrieval System database. To return to the Transaction Insight application, click the

Transaction Insight icon at the top right of the screen:

Navigating the Structured EDI View

The Structured EDI View will show either a complete display of the document’s data, or

just the fields leading down to an error (X12 only). This is a configuration option set by

your Transaction Insight administrator.


Collapsible Sections

This view has expandable/collapsible sections:

Editable for X12 Data

You can edit the data if:

the data is X12

you are accessing it through the My Tasks page and have clicked Edit the

Document. See My Tasks Page on page 41.

If accessed directly from the Document Summary page, the data is static.

Error/Warning Information

For X12 data, you can view and obtain additional information about errors on the form

by hovering over the warning ( ) or error ( ) icon beside the flagged field.

Note: By default, the Structured EDI View displays errors, but does not display

warnings. Contact your Transaction Insight administrator to enable the display of

warnings.


Large Documents

If your document is very large, you may see a message that the file was too large to

display:

To remedy this situation, the Transaction Insight administrator can adjust either of these

Web.config file settings:

TurnOnAllErrorsNotInForm – set this to false

DocumentFileSize – increase (this may increase the likelihood of slow page loads or

timeouts).


Raw EDI View

Raw EDI View presents the raw electronic data with no additional formatting.

Warnings and errors are not shown in this view. To view warnings and/or errors:

for X12, use the Form View (page 85), Paged Form View (page 87), or

Structured EDI View for X12 Data (page 93)

for EDIFACT, use the Validation Highlighter View (page 100).

You can access the Raw EDI View if:


EDIFACT, data, and detail file are also in Foresight Archive and Retrieval

System

errors were found or the data was imported with Importer’s savegooddata

option


permissions.

Example:

Note: Your Transaction Insight administrator will set the maximum file size for Raw

EDI View using the DocumentFileSize entry in the web.config file. A file exceeding the

limit will result in a message indicating the file is too large and can’t be displayed.


Navigating the Raw EDI View

This page shows EDI as reconstituted from the Transaction Insight or Foresight

Archive and Retrieval System database.

If the amount of X12 data is too large to display on the page, some may be eliminated

when viewing from the Transaction Insight database. To access the entire file in its

original form, use the Foresight Archive and Retrieval System.

Selecting the EDI

To select the Raw EDI for copying or printing, click the Select EDI Text button.

Returning to Transaction Insight (EDIFACT)

The Raw EDI View for EDIFACT is accessed through the Foresight Archive and

Retrieval System database. To return to the Transaction Insight application, click the

Transaction Insight icon at the top right of the screen:


Validation Highlighter View

Validation Highlighter View allows you to see warnings and errors in EDIFACT data.

You can access the Validation Highlighter View if:

data is EDIFACT

data and validation detail results were submitted to both Transaction Insight and the

Foresight Archive and Retrieval System

errors were found or the data was imported with Importer’s savegooddata option

the Archiver_UI_Importer workflow is running

your administrator has assigned you appropriate permissions.

Example:

Navigating the Validation Highlighter View

Validation Highlighter View presents the EDIFACT data with warnings highlighted in

yellow and errors highlighted in red.

Click on the warning/error to obtain information about how the segment should be

used.

For more information about Validation Highlighter, refer to

ValidationHighlighter.pdf.

Transaction Insight User's Guide My Account 101

10 My Account

Maintaining your Account

You can use User | My Account at the top menu to reset your password, view team

permissions, and share your own filter views:

1. Click My Account.

2. Make changes as needed.

3. Click Save Changes.

Transaction Insight User's Guide My Account 102

Team Permissions

The Team Permissions tab displays your teams and roles.

Filter Views

If you have saved filter views on one of the statistics pages, you can use the Filter

Views tabs to share these saved views with others with the same roles or partner

groups.

This example shares the Hillsdale Market Team 1 view with other users who have the

Administrators role:

Transaction Insight User's Guide Appendix A – Status and Priorities 103

11 Appendix A – Status and

Priorities

Where Statuses Appear

Statuses refer to the current state of a task. You can see a document’s status in these

locations:

My Tasks main page:

Document Summary page (from Tasks main page, click on a number in the

Documents column):


Errors Not In Form or HIPAA form (from Tasks main page, click on a number in the

Documents column, then click Edit the Document):

You may see other statuses that have been set up by your Transaction Insight

administrator.


List of Statuses

These are default Transaction Insight statuses. Your administrator can add others under

Common Administration’s Admin | Settings | STATUSES/PRIORITIES.

Status Meaning

Closed Set by a team member who has been given Change Status to Closed

permission by your administrator.

Deleted When using Force Through for Delete/Return, this document has been

flagged as deleted.

Deleting When using Force Through for Delete/Return, this document is currently

in the process of been flagged as deleted.

Failed The Validate, Submit, or Force Through process failed to complete. This

is likely to be a system error. Have your administrator check the event

log.

Forced The Force Through process successfully created an EDI file in the

directory specified by the ForceDirectory setting in Web.config.

Forcing The Force Through process is currently running.

Invalid The Validate found errors in the EDI. Correct the additional errors on the

form, save, and validate again.

Modified The document has been changed and saved but not validated.

New The original setting for a task.

Returned When using Force Through for Delete/Return, this document has been

flagged as returned.

Returning When using Force Through for Delete/Return, this document is currently

in the process of been flagged as returned.

Submitted The Submit successfully created an EDI file in the directory specified by

the Web.config file SubmitDirectory setting.

Submitting The Submit process is currently running.

Valid The Validate found no errors in the EDI. You may now Submit.

Validating The Validate is currently running or waiting to run.


List of Priorities

These are default Transaction Insight priorities. Your administrator can add others

under Common Administration’s Admin | Settings | STATUSES/PRIORITIES.

Priority Meaning

high A priority that can be set for a task under Possible Actions on the My

Tasks page. It is intended to alert team members to address this task

quickly.

normal The default priority.

Transaction Insight User's Guide Appendix B - Submitting 107

12 Appendix B - Submitting

Submitting Overview

After correcting and validating data, you can Submit. This reassembles a new, corrected

EDI file in a designated directory.

You can submit under My Tasks from:

the My Tasks page

a HIPAA form

an Errors Not in Form page.

Main steps:

1. Correct errors.

2. Save.

3. Validate and get a status of Valid.

4. Submit.

You can see the status at the bottom of the form or on the main My Tasks page.


Submitting Detaches 837 HIPAA Documents

Submitting permanently detaches an 837 document from others in the same file. You

cannot re-attach a document once it has been submitted.

For example, a submitter has three claims:

1. You correct claim 1, Save, Validate, and Submit it. That claim is no longer connected to

claim 2 or 3.

2. You correct data above the submitter level on claim 2. When you Save, Transaction

Insight gives you the choice of propagating that correction to claim 3.

3. The change will not affect claim 1, since it has already been submitted and is therefore

no longer attached to the other two claims.

Submitting 834 HIPAA Audit Documents

Submitting an 834 audit document will submit all other documents within the same

transaction set. This preserves the audit transaction intact, as is necessary for an audit.


Submit Filename

Examples in this section assume an original filename of MYFILE.EDI.

Data submitted Filename created by Submit

Transaction Insight

entire transaction

(ST-SE)

TI_TransmissionFileName.ext_TransmissionID_STID.txt

Example:

TI_MYFILE.EDI_12345_222.txt

An audit 834 will submit the entire transaction (ST-SE).

Document TI_TransmissionFileName.ext_ SubmitterID_DocID.txt

Example:

TI_MYFILE.EDI_CLM111_111.txt

Foresight® Test Asset Management Suite (TAMS)

User specifies

filename and

extension

Filename_guid.ext

Example - User types MYFILENEW.EDI when submitting:

MYFILENEW_ 6f1301df-959f-44c8-be42-d0b24c9354a5.EDI

User specified

filename, no

extension

Filename_guid.txt

Example - User types MYFILENEW when submitting:

MYFILENEW_ 6f1301df-959f-44c8-be42-d0b24c9354a5.txt

User does not

specify filename

TransmissionFileName_guid.OriginalExt

Example - User does not type a filename when submitting:

MYFILE_ 6f1301df-959f-44c8-be42-d0b24c9354a5.EDI


Where:

Transmiss ionFileName The transmission’s original filename; for

multiple documents, the top selected

document in the task list.

Transmiss ionID Unique number identifying the imported

file. For Transaction Insight internal use

and not visible in the user interface.

Submit terID Data from file; See

ApplicationDocTables.pdf. This is the

SubmitterID from the file as it was

imported. If you change the SubmitterID

data in the form (the CLM01, for

example), and then submit, this new value

will not be used in the filename.

STID Unique number identifying the

application document. For Transaction

Insight internal use. Not visible in the user

interface.

DocID Unique document ID. See Document ID

Column on page 31.

guid Unique randomly-generated number for

this specific submit action. If the filename

already contains a guid , due to a previous

submission, it is replaced with a new one.

Characters that are invalid for a Windows file name are replaced with a dash.

Submit Directory

Submitted files are created in a directory that your Transaction Insight administrator

specified in the Web.config file:

<add key="SubmitDirectory" value="c:\NewEDI" />

From that directory, your company would typically have an external application program

process it.


Submitting from My Tasks

From My Tasks, you can select multiple documents and then submit them all:

1. Select checkboxes for tasks that have a status of Valid and are to be submitted. You can

click the Status heading to sort by status.

2. Under Possible Actions, choose Submit.

3. Click Submit. Refresh the page to see the new status. If the status is now Submitted,

you have generated the external files (see List of Statuses on page 105).

When Multiple Documents are Selected

Your Transaction Insight administrator decides what happens when you have multiple

documents selected and then choose Submit:

Default behavior Selected tasks that have the same Transmission file and ST Number are

placed together in one file with enveloping handled as follows:

Each document is in its own transaction set (ST-SE). This is true even

if two documents (two claims for example) shared an ST in the original

transmission.

The ISA/IEA and GS/GE are shared.

Control numbers are the same as they were in the original file. This

means that ST control numbers are duplicated for documents that

originally shared an ST.

The counts in the SE, GE, and IEA will be adjusted.

The filename created will be based on the first selected document in

the list. Sorting the list may cause a different document name to be

used.

Option to create

separate

documents

To have each selected document go to a separate file, your administrator

can put this in Web.config:

<add key=”SubmitOneFilePerDocument” value=”true” />


Submitting from a HIPAA Form or Errors Not in Form

When you submit from a HIPAA form or Errors Not in Form, you will get one

application document in its own file. The control numbers will match those in the

original file. Therefore, if you submit two or more documents from the same transaction

set, they will have the same control numbers. The counts in the SE, GE, and IEA are

adjusted.

After correcting errors:

1. Save corrections and validate.

2. Check the status to be sure it is Valid. You can do this at the bottom of the form or on

the main My Tasks page.

3. Click Submit.

4. Refresh the page and check the status to be sure it is Submitted. This means the new

file has been created.

Transaction Insight User's Guide Appendix D – Definitions 113

13 Appendix C - Transmission

Page Data Maps

Overview of Transmission Page Data

This appendix describes the source of information that appears on the Transmission

page.

This information is different for each transaction. In addition, Transaction Insight

administrators can configure the information on this page.


Please refer to the following charts for specifics.

270 and 271 map ....................................................................................... Page 115

276 map ...................................................................................................... Page 118

277 map ......................................................................................................

278 map ...................................................................................................... Page 124

820 map ...................................................................................................... Page 125

834 map ...................................................................................................... Page 126

835 map ...................................................................................................... Page 130

837 map ...................................................................................................... Page 132

You can also see fields for an 837 in the document 837_ExtendedFields.pdf .


270 and 271 Transmission Page Map


Fields that Display by Default

Field on Transmission Page Location of Data in EDI

Amount Dollar amount of the claim. See ApplicationDocTables.pdf for

the source of Amount.

Assigned From My Tasks page

Document Date BHT04 + BHT05

Number of Errors Count of errors with a severity greater than 2

Original File Date Date supplied by the -m Instream command line parameter

Original File Name Name supplied by the -m Instream command line parameter

Receiver Criteria set up by Transaction Insight administrator

Sender Criteria set up by Transaction Insight administrator

Status From My Tasks page


Submitter Identifier 2100D - NM109 if available

Otherwise 2100C - NM109 if available

Otherwise 2100D- NM103 if available

Fields that you can add with Choose Fields Link


Dependent Entity ID Code 2100D -NM101

Dependent Entity Type Qual 2100D - NM102

Dependent ID Code 2100D - NM109

Dependent ID Code Qual 2100D - NM108

Dependent Name First 2100D - NM104

Dependent Name Last 2100D - NM103

Dependent Name Middle 2100D - NM105

Dependent Name Suffix 2100D - NM107

Info Receiver Entity Id Code 2100B - NM101

Info Receiver Entity Type Qual 2100B - NM102

Info Receiver Id Code 2100B - NM109



Info Receiver Id Code Qual 2100B - NM108

Info Receiver Name First 2100B - NM104

Info Receiver Name Last 2100B - NM103

Info Receiver Name Middle 2100B - NM105

Info Receiver Name Suffix 2100B - NM107

Info Source Entity Id Code 2100A - NM101

Info Source Entity Type Qual 2100A - NM102

Info Source Id Code 2100A - NM109

Info Source Id Code Qual 2100A - NM108

Info Source Name First 2100A - NM104

Info Source Name Last 2100A - NM103

Info Source Name Middle 2100A - NM105

Info Source Name Suffix 2100A - NM107

Provider Code 2100D/2100C - PRV01

Provider Ref Id 2100D/2100C - PRV03

Provider Ref Id Qual 2100D/2100C - PRV02

Subscriber Entity Id Code 2100C - NM101

Subscriber Entity Type Qual 2100C - NM102

Subscriber Id Code 2100C - NM109

Subscriber Id Code Qual 2100C - NM108

Subscriber Name First 2100C - NM104

Subscriber Name Last 2100C - NM103

Subscriber Name Middle 2100C - NM105

Subscriber Name Suffix 2100C - NM107


275 Transmission Page Map




Amount n/a


Document Date BGN03

Time is not taken from data








Submitter Identifier TRN02



No fields available






Amount n/a


Document Date BHT04

Time is not meaningful since the corresponding time element is not

used by HIPAA








Submitter Identifier 2200E - TRN02 if available

Otherwise 2200D - TRN02



Claim Service Date 2200E - DTP03 if available

Otherwise 2200D - DTP03

Dependent Entity Id Code 2100E - NM101

Dependent Entity Type Qual 2100E - NM102

Dependent Id Code 2100E - NM109

Dependent Id Code Qual 2100E - NM108

Dependent Name First 2100E - NM104

Dependent Name Last 2100E - NM103

Dependent Name Middle 2100E - NM105

Dependent Name Prefix 2100E - NM106

Dependent Name Suffix 2100E - NM107



Payer Claim Id Num 2200E - REF02 if available

/2200D - REF02

Payer Entity Id Code 2100A - NM101

Payer Entity Type Qual 2100A - NM102

Payer Id Code 2100A - NM109

Payer Id Code Qual 2100A - NM108

Payer Name Last 2100A - NM103

Provider Entity Id Code 2100C - NM101

Provider Entity Type Qual 2100C - NM102

Provider Id Code 2100C - NM109

Provider Id Code Qual 2100C - NM108

Provider Name First 2100C - NM104

Provider Name Last 2100C - NM103

Provider Name Middle 2100C - NM105

Provider Name Prefix 2100C - NM106

Provider Name Suffix 2100C - NM107

Subscriber Entity Id Code 2100D - NM101

Subscriber Entity Type Qual 2100D - NM102

Subscriber Id Code 2100D - NM109

Subscriber Id Code Qual 2100D - NM108

Subscriber Name First 2100D - NM104

Subscriber Name Last 2100D - NM103

Subscriber Name Middle 2100D - NM105

Subscriber Name Prefix 2100D - NM106

Subscriber Name Suffix 2100D - NM107






Amount 2200E - STC04 - Line Item Charge Amount (Dependent)

2200D - STC04 - Line Item Charge Amount (Subscriber)


Document Date BHT04

Time is not meaningful since the corresponding time element is not

used by HIPAA







Submitter Identifier 2200E - TRN02 if available

Otherwise 2200D - TRN02

277 fields that you can add with Choose Fields Link


Claim Service Date 2200E - DTP03 if available

Otherwise 2200D - DTP03

Dependent Entity Id Code 2100E - NM101

Dependent Entity Type Qual 2100E - NM102

Dependent Id Code 2100E - NM109

Dependent Id Code Qual 2100E - NM108

Dependent Name First 2100E - NM104

Dependent Name Last 2100E - NM103

Dependent Name Middle 2100E - NM105

Dependent Name Prefix 2100E - NM106

Dependent Name Suffix 2100E - NM107



Payer Claim Id Num 2200E - REF02 if available

Otherwise 2200D - REF02

Payer Entity Id Code 2100A - NM101

Payer Entity Type Qual 2100A - NM102

Payer Id Code 2100A - NM109

Payer Id Code Qual 2100A - NM108

Payer Name Last 2100A - NM103

Provider Entity Id Code 2100C - NM101

Provider Entity Type Qual 2100C - NM102

Provider Id Code 2100C - NM109

Provider Id Code Qual 2100C - NM108

Provider Name First 2100C - NM104

Provider Name Last 2100C - NM103

Provider Name Middle 2100C - NM105

Provider Name Prefix 2100C - NM106

Provider Name Suffix 2100C - NM107

Subscriber Entity Id Code 2100D - NM101

Subscriber Entity Type Qual 2100D - NM102

Subscriber Id Code 2100D - NM109

Subscriber Id Code Qual 2100D - NM108

Subscriber Name First 2100D - NM104

Subscriber Name Last 2100D - NM103

Subscriber Name Middle 2100D - NM105

Subscriber Name Prefix 2100D - NM106

Subscriber Name Suffix 2100D - NM107


277CA Transmission Page Map




Amount 2200D - STC04 - Line Item Charge Amount (Subscriber)


Document Date 2200D - DTP03 - Claim Level Service Date if available

Otherwise BHT04 - Transaction Set Date + BHT05 - Transaction

Set Time







Submitter Identifier 2200D - TRN02

277CA fields that you can add with Choose Fields Link


Billing Provider Entity Type

Qual

2100C - NM102

Billing Provider Id Code 2100C - NM109

Billing Provider Id Code

Qual

2100C - NM108

Billing Provider Name First 2100C - NM104

Billing Provider Name Last 2100C - NM103

Claim Status Tracking Num 2200D - TRN02

Clearinghouse Claim Id 2200D - REF02 where REF01 = D9

Info Receiver App Trace

Num

2200B - TRN02

Info Receiver Entity Type

Qual

2100B - NM102

Info Receiver Id Code 2100B - NM109

Info Receiver Name First 2100B - NM104



Info Receiver Name Last 2100B - NM103

Info Source Entity Id Code 2100A - NM101

Info Source Id Code 2100A - NM109

Info Source Id Code Qual 2100A - NM108

Info Source Name Last 2100A - NM103

Institutional Bill Type Id 2200D - REF02 where REF01 = BLT

Patient Id Code 2100D - NM109

Patient Id Code Qual 2100D - NM108

Patient Name First 2100D - NM104

Patient Name Last 2100D - NM103

Payer Claim Control Num 2200D - REF02 where REF01 = 1K

Service Provider Trace Id 2200C - TRN02

Transmission Receipt

Control Id

2200A - TRN02


278 RP and RQ Transmission Page Map

278 RP and RQ Transmission Page Map



Amount n/a










Submitter Identifier 2010E - NM109 if available

Otherwise 2100E - NM103


278RQ ONLY. Not available in 278RP


Requestor Name Entity Id Code 2010B - NM101

Requestor Name Entity Type

Qual

2010B - NM102

Requestor Name First 2010B - NM104

Requestor Name ID Code 2010B - NM109

Requestor Name Id Code Qual 2010B - NM108

Requestor Name Last 2010B - NM103

Requestor Name Middle 2010B - NM103

Req NM1 Name Suffix 2010B - NM107






Amount RMR04


Document Date BPR16








Submitter Identifier 2300B - RMR02 if available

Otherwise 2300A – RMR02



No fields available






Amount n/a


Document Date BGN03 + BGN04








Submitter Identifier 2000 - Subscriber Number REF02



Beginning Segment Action

Code

BGN08

Beginning Segment Cross

Reference Identification

BGN06

Beginning Segment Date BGN03

Beginning Segment Reference

Identification

BGN02

Beginning Segment Time BGN04

Beginning Segment Time

Code

BGN05

Beginning Segment

Transaction Set Purpose Code

BGN01

COB Effective Date Time

Period

File Effective Date DTP03


Period Format Qualifier





Qualifier


COB Eligibility Date Time

Period

2320 - DTP03 if available

Otherwise 2300 - DTP03






Qualifier



Disability Type Code 2200 - DSB01

Incorrect Member

Demographics Date Time

Period

2100B - DMG02

Incorrect Member

Demographics Date Time


2100B - DMG01

Incorrect Member

Demographics Gender Code

2100B - DMG03

Incorrect Member Name Entity

Identifier Code

2100B - NM101

Incorrect Member Name Entity

Type Qualifier

2100B - NM102

Incorrect Member Name First 2100B - NM104

Incorrect Member Name

Identification Code

2100B - NM109


Identification Code Qualifier

2100B - NM108

Incorrect Member Name Last

or Organization

2100B - NM103


Middle

2100B - NM105

Incorrect Member Name Prefix 2100B - NM106

Incorrect Member Name Suffix 2100B - NM107

Medical Code Value 2200 - DSB08

Member Benefit Status Code 2000 - INS05

Member COBRA Qualifying

Event Code

2000 - INS07



Member Communications

Contact Function Code

2100A - PER01


Number 1

2100A - PER04


Number 2

2100A - PER06


Number 3

2100A - PER08


Number Qualifier 1

2100A - PER03


Number Qualifier 2

2100A - PER05


Number Qualifier 3

2100A - PER07

Member Date Time Period 2000 - INS12

Member Date Time Period

Format Qualifier

2000 - INS11

Member Demographics

Citizenship Status Code

2100A - DMG06

Member Demographics Date

Time Period

2100A - DMG02

Member Demographics Date

Time Period Format Qualifier

2100A - DMG01

Member Demographics

Gender Code

2100A - DMG03

Member Demographics Marital

Status Code

2100A - DMG04

Member Demographics Race

or Ethnicity Code

2100A - DMG05

Member Employment Status

Code

2000 - INS08

Member First Name 2100A - NM104

Member Handicapped (Y)

Status

2000 - INS10

Member Individual

Relationship Code

2000 - INS02

Member Last Name 2100A - NM103



Member Level Date Time

Period

2000 - DTP03



2000 - DTP02


Qualifier

2000 - DTP01

Member Maintenance Reason

Code

2000 - INS04

Member Maintenance Type

Code

2000 - INS03

Member Medicare Plan Code 2000 - INS06

Member Number 2000 - INS17

Member Policy Number


2000 - Member Policy Number REF02

Member Policy Number


Qualifier

2000 – Member Policy Number REF01

Member Residence City Name 2100A - N401

Member Residence Country

Code

2100A - N404

Member Residence Location

Identifier

2100A - N406

Member Residence Location

Qualifier

2100A - N405

Member Residence Postal

Code

2100A - N403

Member Residence State or

Province Code

2100A - N402

Member Residence Street

Address 1

2100A - N301

Member Residence Street

Address 2

2100A - N302

Member Student Status Code 2000 - INS09

Member Subscriber (Y) or

Dependent (N) Status

2000 - INS01

Payer Identification Code 1000B - N104

Payer Name 1000B - N102



Product/Service ID Qualifier 2200 - DSB07

Sponsor Identification Code 1000A - N104

Sponsor Name 1000A - N102

Subscriber Number 2000 - Subscriber Number REF02

TPA/Broker Identification Code 1000C - N104

TPA/Broker Name 1000C - N102

Transaction Set Policy

Number Reference

Identification

Transaction Set Policy Number REF02

Transaction Set Policy

Number Reference

Identification Qualifier

Transaction Set Policy Number REF01





Amount BPR02 - Monetary Amount


Document Date GS04 - Date + GS05 - Time







Submitter Identifier ST level REF02 – Receiver Identification (optional segment – if

value does not exist, NONE will display)



Charge Amount Not mapped – will display as null



Check Number TRN02

Claim Number REF02 – Receiver Identification (optional segment)

Amount835 BPR02

Error Type Do not use with new imports.

Insured Name ID Code 2100 - NM109 where NM101 = IL

Issue Date BPR16

Paid Amount Not mapped – will display as null.

Payee Additional Identifier 1000B - REF02

Payee Additional Identifier

Qualifier

1000B - REF01

Payee Name 1000B - N102

Payee Qualifier Not mapped – will display as null.

Payee Tax ID 1000B - N104

Payment Date BPR16

Receiver Identifier REF02 – Receiver Identification (optional segment)

Responsibility Amount Not mapped – will display as null.

Service Provider ID Code 2100 - NM109 where NM101 = 82



837 Transmission Page Map - Alphabetical Listing




Amount CLM02










Submitter Identifier 2000C - CLM01 if available

Otherwise 2000B – CLM01



AttendingPhysician2ndID 837I only

2310A - REF02

AttendingPhysician2ndIDQual 837I only

2310A - REF01

AttendingPhysicianIDCode 837I only

2310A - NM109

AttendingPhysicianIDCodeQual 837I only

2310A - NM108

Beginning Service Date 2400 - DTP03 where DTP02 contains “RD8”

Billing / Pay-To Provider

Specialty Code 2000A - PRV01




Specialty REF ID 2000A - PRV03


Specialty REF ID Qualifier

2000A - PRV03

Billing Provider Secondary ID 2010AA - REF02

(first instance)

Billing Provider Second ID

Qualifier

2010AA - REF01

(first instance)

BillingProviderSecondIDRefID 2010AA - REF02

(second instance)

BillingProviderSecondIDRefID

Qual

2010AA - REF01

(second instance)

Billing Provider ID 2010AA - NM109

Billing Provider ID Qualifier 2010AA - NM108

Claim Charge Amount Subscriber or Patient 2300 - CLM02

Claim Date Of Service Subscriber or Patient 2300 - Statement Dates DTP03

Claim Frequency Type Code Patient - CLM0503 if available

Otherwise Subscriber - CLM0503"

ClaimSuppInfoIDCode Patient - 2400 PWK06 if available

Otherwise Subscriber 2400 PWK06

Clearinghouse Claim ID Subscriber or Patient 2300 - Claim Identification Number For

Clearinghouses and Other Transmission Intermediaries REF02

ClearinghouseClaimNumRefID Subscriber 2300 - REF02 where REF01 = D9

Dependent 2nd

ID Identifier 2010CA - REF02

Dependent 2nd

ID Qualifier 2010CA - REF01

Dependent Date of Birth 2010CA - DMG02

Dependent Identifier 2010CA - NM109

Dependent Identifier Qualifier 2010CA - NM108

Dependent Name First 2010CA - NM104

Dependent Name Last 2010CA - NM103

Dependent Name Middle 2010CA - NM105

Dependent Name Suffix 2010CA - NM107



Ending Service Date 2400 - DTP03 where DTP02 contains “RD8”

Operating Physician Entity Type 837I only

2310B - NM102

Operating Physician Name First 837I only

2310B - NM104

Operating Physician Name Last 837I only

2310B - NM103

Operating Physician Name

Middle

837I only

2310B - NM105

Operating Physician Name

Suffix

837I only

2310B - NM107

Operating Physician Secondary

ID

837I only

2310B - REF02

Operating Physician Secondary

ID Qualifier

837I only

2310B - REF01

OperatingPhysicianIDCode 837I only

2310B - NM109

OperatingPhysicianIDCodeQual 837I only

2310B - NM108

Original Reference Number 2300 > Original Reference Number REF02

Patient Account Number CLM01

Pay To Provider City 2010AB - N401

Pay To Provider Country Code 2010AB - N404

Pay To Provider Entity Type 2010AB - NM102

Pay To Provider Mailing

Address 1

2010AB - N301

Pay To Provider Mailing

Address 2

2010AB - N302

Pay To Provider Name First 2010AB - NM104

Pay To Provider Name Last 2010AB - NM103

Pay To Provider Name Middle 2010AB - NM105

Pay To Provider Name Suffix 2010AB - NM107

Pay To Provider State 2010AB - N402



Pay To Provider Zip 2010AB - N403

Pay To Provider Secondary ID 2010AB - REF02

(first instance)

PaytoProvider2ndIDRefID 2010AB - REF02

(second instance)

Pay To Provider Secondary ID

Qualifier

2010AB - REF01

(first instance)

PaytoProvider2ndIDRefIDQual 2010AB - REF01

(second instance)

PaytoProviderID 2010AB - NM109

PaytoProviderIDQual 2010AB - NM108

Provider City 2010AA - N401

Provider Contact 1 Email 2010AA - PER04/06/08 when PER03/05/07 = EM

Provider Contact 1 FAX 2010AA - PER04/06/08 when PER03/05/07 = FX

Provider Contact 1 Name 2010AA - PER02

Provider Contact 1 Phone 2010AA - PER04/06/08 when PER03/05/07 = TE

Provider Contact 2 Email 2010AA - PER04/06/08 when PER03/05/07 = EM

Provider Contact 2 FAX 2010AA - PER04/06/08 when PER03/05/07 = FX

Provider Contact 2 Name 2010AA - PER02

Provider Contact 2 Phone 2010AA - PER04/06/08 when PER03/05/07 = TE

Provider Country Code 2010AA - N404

Provider Entity Type 2010AA - NM102

Provider Identifier 2010AA - NM109

Provider Identifier Qualifier 2010AA - NM108

Provider Mailing Address 1 2010AA - N301

Provider Mailing Address 2 2010AA - N302

Provider Name First 2010AA - NM104

Provider Name Last 2010AA - NM103

Provider Name Middle 2010AA - NM105

Provider Name Suffix 2010AA - NM107



Provider State 2010AA - N402

Provider Zip 2010AA - N403

Receiver Identifier 1000B - NM109

Receiver Identifier Qualifier 1000B - NM108

Receiver Name Last 1000B - NM103

Rendering Provider Name Last 837D and 837P

2310B - NM103

Rendering Provider Secondary

ID

837D and 837P

2310B - REF02

Rendering Provider Secondary

ID Qualifier

837D and 837P

2310B - REF01

Rendering Provider Specialty

Code

837D and 837P

2310B - PRV01


Ref ID

837D and 837P

2310B - PRV03


Ref ID Qualifier

837D and 837P

2310B - PRV02

RenderingProvider2ndID 837D and 837P

2310B - REF02

RenderingProvider2ndIDQual 837D and 837P

2310B - REF01



SubmitterIdentifier837I

SubmitterIdentifier837D

Submitteridentifier837P

1000A - NM109

Submitter Contact 1 Email 1000A - PER04/06/08 when PER03/05/07 = EM

Submitter Contact 1 FAX 1000A - PER04/06/08 when PER03/05/07 = FX

Submitter Contact 1 Name 1000A - PER02

Submitter Contact 1 Phone 1000A - PER04/06/08 when PER03/05/07 = TE

Submitter Contact 2 Email 1000A - PER04/06/08 when PER03/05/07 = EM

Submitter Contact 2 FAX 1000A - PER04/06/08 when PER03/05/07 = FX

Submitter Contact 2 Name 1000A - PER02

Submitter Contact 2 Phone 1000A - PER04/06/08 when PER03/05/07 = TE

Submitter Identifier Qualifier 1000A - NM108

Submitter Name First 1000A - NM104

Submitter Name Last 1000A - NM103

Submitter Name Middle 1000A - NM105

Subscriber 2nd

ID Identifier 2010BA - REF02

Subscriber 2nd

ID Qualifier 2010BA - REF01

Subscriber Date of Birth 2010BA - DMG02

Subscriber Identifier 2010BA - NM109

Subscriber Identifier Qualifier 2010BA - NM108

Subscriber Name First 2010BA - NM104

Subscriber Name Last 2010BA - NM103

Subscriber Name Middle 2010BA - NM105

Subscriber Name Suffix 2010BA - NM107

Transaction Date BHT04 + BHT05

837 Transmission Page Map – By Loop

Please see 837_ExtendedFields.pdf.






Amount

Assigned

Document Date GS04+GS05








Submitter Identifier AK102



Functional Group Acknowledge

Code

AK901

Functional Group Syntax Error

Code #1

AK905


Code #2

AK906


Code #3

AK907


Code #4

AK908


Code #5

AK909

Functional Identifier Code AK101

Group Control Number AK102

GS Receiver GS03

GS Sender GS02



Num Accepted Transaction

Sets

AK904

Num Received Transaction

Sets

AK903

Num Transaction Sets Included AK902


14 Appendix D – Definitions

Terms used in Transaction Insight

Term Meaning

Amount

A dollar amount from the data. Varies by transaction set. For the source of this

information, see ApplicationDocTables.pdf.

Application Document The business section of a transaction or message, such as a claim in an 837 or a

transaction set for an 850. See ApplicationDocTables.pdf.

Assigned Team member assigned to deal with the erroneous document.

Bad Document Document with at least one error with severity greater than 2.

Document Date

Date from the EDI data itself. This varies by transaction. See


Document ID A unique ID that Transaction Insight assigns to each application document.

Dollar Amount A dollar amount from the data. Varies by transaction set. For the source of this

information, see ApplicationDocTables.pdf.

Number of Errors Number of errors with severity greater than 2.

Original File Date

Value supplied by the -m Instream command line parameter or by using

useinputfileasoriginal=1 in Importer.ini.

Original File Name

Value supplied by the -m Instream command line parameter or by using


Original File Path Value supplied by the -m Instream command line parameter or by using


Original File Size Value supplied by the -m Instream command line parameter or by using


Receiver

Partner receiving the data, as identified by criteria set up by the Transaction Insight

administrator.


Term Meaning

Sender Partner sending the data, as identified by criteria set up by the Transaction Insight

administrator.

Status

Status assigned to the application document if it has errors. See Overview of My

Tasks Page on page 41 and List of Statuses on page 105.

Submitter ID

This value comes from the EDI. It varies by transaction set. See


Transmission Date Date and time when document was validated.

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