How To Interpret 999 Rejections

Now that we've covered the basic fundamentals of the 999 Implementation Acknowledgment, we can start working on any errors contained in the 999.

Remember that we're reviewing a 999 acknowledgment in response to an 837 EDI transaction that was submitted. Once the 999 is analyzed, we should have a good idea of what the issue was in the originating 837 transaction.

Let's start with the 1st example.

Sample 999 - Accepted with Errors

The above 999 was accepted but did have errors. How do we know that? By reviewing the codes contained in the IK501 and AK901 data elements. The codes are highlighted green in the above example.

The IK501 contains an 'E' which corresponds to "Accepted But Errors Were Noted"

The AK901 contains an 'A' which corresponds to "Accepted".

That's all the IK5 and AK9 segments tell us about the issue so far. If there was additional information, the values would be different in these segments.

Now that we know there was a problem, we need to review the other segments contained in the 999 to identify the issue. The AK1 and AK2 segments are primarily used to determine which 837 transaction failed. The IK3 and IK4 segments are used to describe the incorrect data in the 837 transaction.

For this discussion, we're going to focus on the IK3 and IK4 segments.

Let's first talk about the IK3 segment.

Here are the specifications from the 5010 implementation guide on the IK3 segment.

Segment	Field	Name	Definition
IK3	01	Segment ID Code	Code defining the segment ID of the data segment in error.
IK3	02	Segment Position in Transaction Set	The numerical count position of this data segment from the start of the transaction set.
IK3	03	Loop Identifier Code	The loop ID number given on the transaction set diagram is the value for this data element in segments LS and LE.
IK3	04	Implementation Segment Syntax Error Code	Code indicating implementation error found based on the syntax editing of a segment.

Here are the data elements and the data contained in those elements.

• IK3 - IK3
• IK301 - CLM
• IK302 - 23
• IK303 - 2300
• IK304 - 8

What does this tell us? There was an error in the CLM segment contained in the 2300 Loop, at numerical position 23 with an error code of 8. The 8 stands for "Segment Has Data Element Errors"

Before jumping over to the 837 transaction to see if we have enough information to identify the problem, let's look at the IK4 segment next since it's there.

Here are the specifications from the 5010 implementation guide on the IK4 segment.

Segment	Field	Name	Definition
IK4	01	Position In Segment	Code indicating the relative position of the simple data element or composite data structure in error within a segment...
IK4	01-1	Element Position in Segment	This is used to indicate the relative position of a simple data element, or the relative position of a composite data structure...
IK4	01-2	Component Data Element Position in Composite	To identify the component data element position within the composite that is in error.
IK4	01-3	Repeating Data Element Position	To identify the specific repetition of a data element that is in error.
IK4	02	Data Element Reference Number	Reference number used to locate the data element in the Data Element Dictionary.
IK4	03	Implementation Data Element Syntax Error Code	Code indicating the implementation error found after syntax edits of a data element.
IK4	04	Copy of Bad Data Element	This is a copy of the data element in error.

Here are the data elements and the data contained in those elements.

• IK4 - IK4
• IK401 - 6
• IK402 - 1073
• IK403 - 7
• IK404 - Z

What does this tell us? There was an error at reference number 1073 and element position 6, which corresponds to the CLM06 data element. The syntax error code of 7 means "Invalid code value". The actual data that had the error was 'Z'.

We can conclude that the error occurred in the 2300 loop at data element CLM06. The value submitted was a 'Z'. The only valid values for the CLM06 data element are 'Y' and 'N'.

Before we review a 2nd example, there was another segment contained on this 999 acknowledgment that we didn't discuss, the CTX segment. In this example, the segment is telling us the patient account number of the claim in question.

Tip: Look for additional reports from the trading partner as this 999 acknowledgment was accepted for further processing.

Let's take a look at a 2nd example.

Sample 999 - Rejected with Errors

We know that this 999 rejected with errors because of the values in the IK5 and AK9 segments.

The IK501 contains an 'R' which corresponds to "Rejected"

The AK901 contains an 'R' which corresponds to "Rejected".

Let's move straight to the IK3 and IK4 segments.

Note: There are multiple IK3 and IK4 segments. In this example, they happen to be the same. This can occur when there are multiple validation rules for a single field.

Here are the data elements and the data contained in those elements.

• AK3 - IK3
• AK301 - CLM
• AK302 - 23
• AK303 - 2300
• AK304 - 8

What does this tell us? There was an error in the CLM segment contained in the 2300 Loop, at numerical position 23 with an error code of 8. The 8 stands for "Segment Has Data Element Errors".

Next, let's look at the IK4 segment.

Here are the data elements and the data contained in those elements.

• AK4 - IK4
• AK401 - 2
• AK402 - 782
• AK403 - 6
• AK404 - $206

What does this tell us? There was an error at reference number 782 and element position 2, which corresponds to the CLM02 data element. The syntax error code of 6 means "Invalid character in data element.". The actual data that had the error was '$206'.

We can conclude that the error occurred in the 2300 loop at data element CLM02. The value submitted was '$206'. You can't send the dollar sign character in this field.

Once again the CTX segment is present. In this example, the segment is telling us the patient account number of the claim in question.

Tip: This 837 transaction will need corrected and resubmitted to the trading partner, as the 999 acknowledgment was rejected for processing.

The final piece of the puzzle is matching up the 999 with the corresponding 837 transaction. Continue reading the next article where we discuss matching 999 acknowledgment with the 837 transaction.