Encounter Claims Data Biweekly Processing Cycle
The following information details the biweekly events of encounter submission, processing, and remittance advice delivery. This schedule applies to both the:
- Professional/Institutional/Dental (X12 837) batch files
- Pharmacy (NCPDP Batch 1.2) batch files
Encounter Data File Submission
The schedule for encounter date file submission is as follows:
- To be included in the next biweekly warrant cycle, encounter data files must be submitted by 11:59 p.m. every other Wednesday. This cut-off is necessary to allow for identification of any file or data issues and resolutions prior to the delivery of the remittance advice the following week.
- Encounter data files submitted through FTP may be submitted at any time of the day and any day of the week.
Encounter Data Processing and Acknowledgement
DHS has specified processing times for the processing of encounter files. These processing times are necessary to allow for even system loads for all types of system processing:
- Encounter data files submitted at 12:00 midnight or after on the Wednesday due date will not be processed until Saturday at 12:01 a.m.
- Acknowledgement of encounter data files processed (999 for Professional/Institutional/ Dental files and N11R for Pharmacy claim files) is generated when processing is completed.
By Thursday of the week following the encounter data file submission cut-off time, a remittance advice (X12 835) is due in both the Managed Care Organization’s MN-ITS mailbox and their contracted encounter data submitter’s MN-ITS mailbox. However, the remittance advice may appear in the mailbox as early as Monday of the following week, depending on the volume of data submitted and processed. The remittance advice includes both the X12 837 and the NCPDP Batch 1.2 files.