How To Interpret 997 Rejections

Now that we've covered the basic fundamentals of the 997 Functional Acknowledgment, we can start working on any errors contained in the 997.

Remember that we're reviewing a 997 acknowledgment in response to an 837 EDI transaction that was submitted. Once the 997 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 997 - Accepted with Errors

  • ISA*00*          *00*          *ZZ*RECEIVERID     *ZZ*SENDERID       *181006*0529*U*00401*000000011*0*P*:~
  • GS*FA*RECEIVERCODE*SENDERCODE*20181006*0529*22*X*004010~
  • ST*997*0001~
  • AK1*HC*734591~
  • AK2*837*734591001~
  • AK3*CLM*25*2300*8~
  • AK4*6*1073*7*Z~
  • AK5*E*5~
  • AK9*A*1*1*1~
  • SE*8*0001~
  • GE*1*22~
  • IEA*1*000000011~

The above 997 was accepted but did have errors. How do we know that? By reviewing the codes contained in the AK501 and AK901 data elements. The codes are highlighted green in the above example.

The AK501 contains an 'E' which corresponds to "Accepted But Errors Were Noted"

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

That's all the AK5 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 997 to identify the issue. The AK1 and AK2 segments are primarily used to determine which 837 transaction failed. The AK3 and AK4 segments are used to describe the incorrect data in the 837 transaction.

For this discussion, we're going to focus on the AK3 and AK4 segments. Let's first talk about the AK3 segment.

  • AK3*CLM*25*2300*8~

Here are the specifications from the 4010 implementation guide on the AK3 segment.

AK3 - Data Segment Note

SegmentFieldNameDefinition
AK301Segment ID CodeCode defining the segment ID of the data segment in error.
AK302Segment Position in Transaction SetThe numerical count position of this data segment from the start of the transaction set.
AK303Loop Identifier CodeThe loop ID number given on the transaction set diagram is the value for this data element in segments LS and LE.
AK304Segment Syntax Error CodeCode indicating error found based on the syntax editing of a segment.

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

  • AK3 - AK3
  • AK301 - CLM
  • AK302 - 25
  • 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 25 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 AK4 segment next since it's there.

  • AK4*6*1073*7*Z~

Here are the specifications from the 4010 implementation guide on the AK4 segment.

AK4 - Data Element Note

SegmentFieldNameDefinition
AK401Position In SegmentCode indicating the relative position of a simple data element, or the relative position of a composite data structure...
AK401-1Element Position in SegmentThis is used to indicate the relative position of a simple data element, or the relative position of a composite data structure...
AK401-2Component Data Element Position in CompositeTo identify the component data element position within the composite that is in error.
AK402Data Element Reference NumberReference number used to locate the data element in the Data Element Dictionary.
AK403Data Element Syntax Error CodeCode indicating the error found after syntax edits of a data element.
AK404Copy of Bad Data ElementThis is a copy of the data element in error.

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

  • AK4 - AK4
  • AK401 - 6
  • AK402 - 1073
  • AK403 - 7
  • AK404 - 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'.

Tip: Look for additional reports from the trading partner as this 997 acknowledgment was accepted for further processing.

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

Sample 997 - Rejected with Errors

  • ISA*00*          *00*          *ZZ*RECEIVERID     *ZZ*SENDERID       *181006*0529*U*00401*000000011*0*P*:~
  • GS*FA*RECEIVERCODE*SENDERCODE*20181006*0529*22*X*004010~
  • ST*997*0001~
  • AK1*HC*734591~
  • AK2*837*734591001~
  • AK3*CLM*25*2300*8~
  • AK4*2*782*6*$206~
  • AK5*R*5~
  • AK9*R*1*1*0~
  • SE*8*0001~
  • GE*1*22~
  • IEA*1*000000011~

We know that this 997 rejected with errors because of the values in the AK5 and AK9 segments.

The AK501 contains an 'R' which corresponds to "Rejected"

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

Let's move straight to the AK3 and AK4 segments.

  • AK3*CLM*25*2300*8~

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

  • AK3 - AK3
  • AK301 - CLM
  • AK302 - 25
  • 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 25 with an error code of 8. The 8 stands for "Segment Has Data Element Errors".

Next, let's look at the AK4 segment.

  • AK4*2*782*6*$206~

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

  • AK4 - AK4
  • 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.

Tip: This 837 transaction will need corrected and resubmitted to the trading partner, as the 997 acknowledgment was rejected for processing.

The final piece of the puzzle is matching up the 997 with the corresponding 837 transaction. Continue reading the next article where we discuss matching 997 acknowledgment with the 837 transaction.