Originally posted by: jvanboga
How large are the files you are expecting? both in MB and claims.
Will you files contain multiple transaction sets?
What level of compliance validation are you running? We run a low level of compliance checking to get the claim data in. A compliant file with a bad claim gets rejected. Provider is notified via EOB and/or 835 and/or online use of 276/277. They can fix their claim and resend it. A non-compliant 837 is rejected and sent back to the Clearing House. If they can't pass a level 1 test there's probably higher level issues too.
Can Commerce Manager help? Yes, to a degree. Running 837 files tru our setup drops bad Transaction Sets (TS). The resulting ack we return to the TP/ClearingHouse tells them which TSs were rejected. Also, I haven't done this in a long time but depending on how the 837 is configured CM can break the file into multiple outputs (I believe its based on GS level and requires unique sender IDs in each GS02).
I get large 834 files from several companies. One company has had some problems in last 6 months with inconsistant terminators, blank N3 segments etc... To make matters worse several years ago CM lost some files during processing (only happened to files over 50mb). When that happened I put a file size check on all x12 files before they went into CM. At that time I wrote a process to break the files into smaller chunks. Recently, at our BA's request, partly because of the TP's value, I wrote a process that validates an 834 ISA loops to 1 - find the bad ISA, 2 - then validate each of its GS loop to determine which is bad, 3 - then it validate each transaction to determine which one is bad, 4 - then it validates each INS loop and writes a report with a snapshot of the bad loops and reference points. The BAs can then work the TP thru the issues and in their mind make us look good to the TP. Ugly? yes! In production? No! Automated? No! The point is though, that I/you could do the same thing with an 837.
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