Download Q - AlphaCM · months and it’s most current status. c. Current Client Dump – this is a...

-Provider Portal Download Q

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Updated: March 8, 2019

Download Q

File Types in the Download Queue

1. DUMP FILES – Everyone receives dump files. These are data files to use as a reference

when researching and documenting claims status (File is updated every morning at 8AM).

a. Current Auth Dump – this is a data file of all authorizations created w/in the last 6

months.

b. Current Claims Dump – this is a data file that lists all submitted claims for the last 6

months and it’s most current status.

c. Current Client Dump – this is a data file that is holds information for any client that a

provider has entered an enrollment, CUR, SAR, or claim for in the last 6 months.

d. Current Portal Users Dump – this is a data file of all your current users who have a

user account to the AlphaMCS portal.

e. SAR Data Dump – this is a data file that contains SARs in the following statuses:

'Denied', 'Denied for Admin', 'Unable to Process', and 'Reduced’

2. RESPONSE FILES – these are the files you receive as a response to the 837 you submitted.

Once the 837 has been submitted, 3 response files will be generated and dropped into the

Provider’s Download Q. This usually occurs within 15 minutes after sending the file. You

will only receive these files if you are configured as EDI Certified and you do not use a

Clearing House. These files are cleared out after 90 days.

a. 999 file – Errors in the 837 and only shows claims with errors.

b. 277 file – this is the acknowledgement file to the 837 you submitted via the Upload

Q. This will show all claims submitted. This is not useful when researching

rejections. This file simply notifies the submitter if the 837 was accepted or not.


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3. 824 file – this also displays errors in the 837 submitted but will show all claims. If the

claims submitted have errors, an error message will be listed. SUBMITTER REPORTS – these

reports are similar in the response files except these are much easier to read.

a. Submitter Report – Shows all claims and its disposition. This also will display billing

details and a transmission summary.

b. Velocedi Report – this report is similar in the submitter report. However in this

report, claims are broken out by loop.

4. 835 FILES – If you are setup to receive 835 files from you MCO, then you can access them

here. You will only receive the 835 if you are EDI certified and do not use a Clearing House.

However if you do use a clearing house, you can submit a request to your MCO to send a

copy of the 835 to your download queue.

Accessing the Download Queue

To access the AlphaMCS Provider Portal Download Queue, hover

over the left menu bar and click on Download Q.

If you are a provider who is EDI Certified, but do not use a clearing

house, your download queue will contain Response Files, Submitter

Reports, Provider Dump files and 835s

If you do use a clearing house, you can request to receive a copy of

your 835s that are sent to your vendor.


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Sample Download Q

Description of Download Q Files


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Provider Configurations Your Provider Profile configuration at your MCO(s) will determine what files you will see in your

Download Queue. There are 3 distinct setups:

1. Not EDI Certified and do not use a clearing house: this means you submit claims solely

through the AlphaMCS provider portal (CMS1500s/UB04s). In your download queue you

will only see the 4 provider dump files (a set for each MCO). You will not receive response

files, submitter reports or 835s to your download queue.

2. EDI Certified and bill through a Clearing House: If your agency is configured this way, then

this means that you submit claims electronically via 837 and you receive 835s and response

files. However, since you go through a clearing house, they receive all of these files since

they manage this part of your business for you.

**If you go through a clearing house, you can submit a request to your MCO stating you

would like to receive a copy of the 835 your clearinghouse receives.

3. EDI Certified and do not use a Clearing House: This means that your agency submits

claims electronically, but do it all “in-house” and create your own 837s that are submitted

via the Transactional Upload Q. In this configuration, you will receive all four file types

mentioned above.


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How do I identify if I am EDI Certified?

You can easily identify your current provider configuration by accessing the Provider Maintenance

module…

clicking on the provider line to expand the record…


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Various Transmission Types Visualized The below image visualizes the 3 different provider configurations when sending and receiving

files.


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Opening Provider Dump Files in MS Excel

It’s slightly different depending on what browser you use but the options are the same. You will

be given the option Open, Save or Save As.

It is suggested to choose Save As and save it where you can easily access it. Opening it as is will

open the dump file in a NotePad or EditPad that will display jumbled information where it is

basically illegible.

Therefore, you will want to open it in Excel so you can format the file in the appropriate columns.

There are a few ways to do this but the below explains one method.

After you have saved the file to your local machine or network drive, launch your MS Excel

program.

With Excel program opened, you will now want to Choose File > Open which will open your

Windows Explorer to navigate to the file you wish to open.

First, you will want to change the file type from ALL Excel Files to ALL Files so you will see the .txt

file you recently downloaded and saved.

Once you find the dump file you saved, open the file.

When the file attempts to open, you will be presented with 3 steps in a dialog box asking you how

you would want to separate columns and read the file

1. The first option asks if this document is Fixed or Delimited, you will need to click Delimited

then choose Next.


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2. The 2nd screen is asking how the columns are split in the file, we use the pipe character ‘|’

This is not an option by default so you will have to choose “Other” and manually type in the

pipe symbol in the available type field. Choose Next

3. The 3rd and last step asks you how you would like the numbers in the dump file formated.

The default selection of General is what we need, so leave as is and choose finish.

Now the document should be nicely displayed in MS Excel for you. Now you can use Excel

to freeze panes, add filters, sort by, pivot tables etc.

Reading Response Files

To review the response files, first open your Provider Download Q as described above. Locate the

name of the response file in the “Download Q” interface associated with the date of the 837

submitted when researching status or seeking response. The file names will match the name of

the 837 by create date and indicate the type of response file by including one of the following as

part of the description: 277, 824, or 999.

• Verify the 999 first.

o If the 999 rejects then there are problems with format. The 824 will also indicate in the BGN

segment that is has been rejected (U=Reject and WQ=Accept). Begin working the format

errors first.

o 999 – Accept = at least one claim in the file was accepted.

o 999 – Reject = no claims in the file were accepted.

o

• HOWEVER, just because the 999 accepts, does not mean there are NO content errors, which

are contained within the 824. Verify the 824 and search for TED segments (errors or

warnings).

o If there are NO TED segments in the 824, there are NO errors or warnings.


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Verify Response File – 999

ISA*00* *00* *ZZ*43071 *ZZ*######

*130409*1315*^*00501*000024865*0*P*:~TA1*040908143*130409*0814*A*000~GS*FA*4307

1*#####*20130409*1315*24865*X*005010X231A1~ST*999*0001*005010X231A1~AK1*HC*94

0908143*005010X222A1~AK2*837*040908143*005010X222A1~IK5*A~AK9*A*1*1*1~SE*6*000

1~GE*1*24865~IEA*1*000024865~

# = MCO Provider #

ST*999 = 999 - Acknowledgement

AK9*A = Accepted/Approved File

Finding the Error in a 999

In the “rejected” response file (*ST*999 – AK9*R), search for *IK3 segment (reference below). Map

the error back to the 837 file associated with the error by referencing the segment and line #

associated with IK3.


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Implementation Segment Syntax Error Codes

CODE DEFINITION

1 Unrecognized segment ID

2 Unexpected segment

3 Required Segment Missing

4 Loop Occurs Over Maximum Times

5 Segment Exceeds Maximum Use

6 Segment Not in Defined Transaction Set

7 Segment Not in Proper Sequence

8 Segment Has Data Element Errors

I4 Implementation “Not Used” Segment Present

I5 Implementation One or More Segments in Error

I6 Implementation Dependent Segment Missing

I7 Implementation Loop Occurs Under Minimum Times

I8 Implementation Segment Below Minimum Use

I9 Implementation Dependent “Not Used” Segment Present

Verify Response File – 824

ISA*00* *00* *ZZ*43071 *ZZ*#####

*130320*1200*^*00501*000020497*0*P*:~GS*AG*43071*#####*20130320*120006*20497*X*005010X186~ST*824*00

01*005010X186~BGN*11*20497.1*20130320*120006**320114456**WQ~N1*41*Faciledi*46*00000~N1*40*NAME*46*

#####~OTI*TE*TN*320114456***20130320*1144*1*320114456*837*005010X222A1~REF*F8*320114456~DTM*050*201

30320~AMT*YU*181.4~QTY*90*1~NM1*41*2*NAME*****46*#####~OTI*BE*BT*1***20130320*1144*1*320114456*83

7*005010X222A1~REF*EI*/////////~AMT*YU*181.4~QTY*90*1~NM1*85*2*THE NAME OF THE

PROVIDER*****XX*@@@@@@@@@@~OTI*IE*IX*1056899***20130320*1144*1*+++++++++*837*005010X222A1~REF

*EJ*1056899~DTM*472*20130212~AMT*GW*181.4~NM1*QC*1*LASTNAME*FIRSTNAME*MIDDLE***MI*MEDICAID#~TE

D*024**NM1*21*9**DNC00~RED*NA**94**ABS*P2045042~TED*024**NM1*21*9**DNC00~RED*NA**94**ABS*P2045

044~TED*024**NM1*21*9**DNC00~RED*NA**94**ABS*P2045047~TED*024**NM1*21*9**DNC00~RED*NA**94**ABS*

P2045048~SE*29*0001~GE*1*20497~IEA*1*000020497

ST*824 = Response file 824 Application Reporting

TED = ERROR or Information Message Location

• The main purpose of the 824 is to show content errors. However, as indicated in slide 4, the

824 may also indicate acceptance and/or rejection as the 999.

• The 824 will also indicate in the BGN segment that is has been rejected (U=Reject and

WQ=Accept). IF the 999 rejects, the 824 will reject. However, an 824 may accept, but still

contain content errors.


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• There are two types of content errors.

o Content error may cause the claim to reject and NOT process.

OR

o Content error may create a warning, but the claim will process.

• An example of an 824 content error, would be a cross referencing problem.

Finding the Error in an 824

IF TED* segments found in the 824, research the errors and map them back to the

submitted 837 to identify the errors. To identify the error, reference these instructions.


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Content Error Examples

Example 1: The error referenced below will pass. However, this is a warning. The error

recommends changing DNC00 to the correct value, which in this case is 43071. Please note that

although the file may pass content, this does not ensure approval and the claim could still deny.

TED*024**NM1*129*9**DNC00~ = Error on the 129th NM1 Line related to DNC00

Example 2: The error below created the OTI reference which rejected the file. This claim will

need to be corrected and resubmitted to receive payment.

TED*024**REF*136*1**1D~ = Error on the 136th REF Line related to ID

OTI – Original Transaction Identification

Application Acknowledgement Code (0TI01)


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Date post:	11-Mar-2020
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