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5010 Testing Companion Guide

5010 X12 Encounter TPL and MCO Paid Date Syntax Testing

Syntax and content testing for 5010 837 encounter claim transactions for the TPL and MCO Paid Date data is required prior to submitting production claims on 3/1/2014. These files cannot be submitted by SFTP but through the MN–ITS Test Region website.

The following batch transaction types may be submitted for testing through the MN–ITS Test Region website under the Submit Transactions option – select Transaction Type: X12/Pharmacy1.2

  • 837 Health Care Claim: Professional
  • 837 Health Care Claim: Institutional
  • 837 Health Care Claim: Dental

The following transactions are currently available for End-to-End Testing. You must have completed the above syntax testing and received an accepted 999 prior to receiving an 835E.

  • TA1 Interchange Acknowledgment
  • 999 Implementation Acknowledgement for Health Care Insurance
  • 837 Health Care Claim: Professional
  • 837 Health Care Claim: Institutional
  • 837 Health Care Claim: Dental
  • 835E Health Care Claim Payment/Advice

Submitting a claim for adjudication includes receiving a test 835E Remittance Advice in return. 835Es are generated roughly two times a week. Once you have received an accepted 999 within two or three working days an 835E should be in your test inbox in MN–ITS.

General rules for batch submission

X12 batch files

  • Please submit batch transactions with an ISA15 Interchange Usage Indicator value of a "P"
  • The ISA11 must contain a valid character, MHCP recommends "[" (left bracket)
  • Currently MHCP cannot accept "|" (pipe) in either the ISA or body of the file - your file will not receive a 999 or TA1 if you use a pipe
  • The same segment terminator at the end of ISA16 must be at the end of your file, no extra characters otherwise the file will not receive a 999 or TA1
  • Do not submit batches larger than 50 claims per transaction set and limit transaction sets to 5
  • Submit an e-mail to the EDQ mailbox just prior to submitting your test file. The EDQ unit will forward your e-mail to the ECommerce unit, who will verify your file successfully processed
  • Our MN–ITS Test Region is normally available between 8:00 a.m. – Noon and 1:00 p.m. - 4:00 p.m. Monday – Friday. If you cannot get through during these times – please contact the Provider Call Center. Have the name of your test file ready.
  • After submitting your 5010 test transactions check the 999, TA1 or Production Failed folders for results.
  • Some responses are contingent upon mainframe availability. During a test cycle – mainframe is unavailable and therefore your response will indicate this.
  • An e-mail will be sent from the ECommerce unit stating your files have passed the syntax testing. If you have any questions regarding the remark codes that are on your test 835E, please send and e-mail to the EDQ unit indicating you have a question on your TEST 835E. Remember this is also our test region. You may see non true denial edits post in the test region that would NOT show in production

File naming standards

  • Do not use "." (period) as a separator in your file name other than to indicate the extension of your file, use "_" (underscore) for your separator
  • Your filename must contain an extension of either “.txt” or “.dat

General testing inquiries

For questions and issues with 5010 testing, please contact the MHCP Provider Call Center and indicate you are testing 5010 Encounter TPL Data files. Describe your issue and have the name of your test data file available.

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