Testing Procedures for ANSI x12 837 v4010x096A1 Institutional Claims

1. UGS’ policy is only to test software from vendors, clearinghouses and providers that actually submit claims to UGS.
2. Download the SmartTransfer Information sheet (If you are a vendor or provider do not choose the Clearinghouse version, as this does not apply.)
3. Download the EDI Enrollment Form
4. Complete both forms and fax them to (414) 459-2638. Please note: Clearinghouses are responsible for submitting the EDI Enrollment Form for each of the provider numbers they are submitting claims for. The original three page form must be mailed to:
   
   
   UGS LLC
   Attention: EDI Department
   6775 West Washington Street
   Milwaukee, WI 53214
5. UGS' EDI department will assign a logon ID and password, and will send it to you via fax.
6. Please download the ANSI 837 Companion Document from the website. This document is designed to assist the submitter in setting up the claim format specifically to send claims to UGS. Please read this document thoroughly, as it will expedite the testing process.
7. Please download the SmartTransfer instructions from the website for setting up your communication software for submitting test claims.
8. The logon ID contains the phone number to dial into for testing. It is required that testers send 25 test claims. It is recommended that multiple bill type submitters test a variety of claims. Home Health submitters must submit RAPS on one day and the matching finals 24 hours later to complete their testing process. We understand that this may not be possible in certain circumstances. Please send 25 test claims when possible.
9. SmartTransfer generates a minimum of three reports and four reports when TA1 is activated, if claims and the file structure are acceptable. Reading these reports, is imperative to passing the testing process.

• The first report is TRN. This represents a transmission report and essentially indicates UGS received a file and SmartTransfer can read the file. If SmartTransfer cannot read the file, the TRN report will indicate the reason it cannot read the file. Please open this file in Notepad to read it.
• The second report is an ACK. This is equivalent to the 997 Acknowledgment report required by CMS to report back to the submitter. This report is a structural level report. If the file does not meet the structure of the Implementation Guide, i.e. missing required data to complete the segment, the file will fail at this level. This file is written in ANSI code and requires someone who knows how to read ANSI to determine the error. If you are the provider, please submit this file to your vendor to translate it. If the file fails at the ACK level it will stop here and no additional reports will be generated.
• The third report is the GENRPT. This is a claims confirmation report. It reads the file on three levels: First the file level determining if it is compliant. If it is not, it will fail at this level. An example of an error at the file level is an invalid submitter id. However, SmartTransfer will continue to read the file at the Batch level and Claim level. The main error may be at the file level, but the other errors must also be corrected for the file to move onto FISS.
• You may want to review the ANSI 837 edits on the web page to help determine why the edit fired. (add link to 837 edits).

10. Once the GENRPT indicates the claims are accepted please call the UGS EDI Department 48 hours after transmission for test results. You can reach them at (414) 459-5999-Option 3 than Option 6. The EDI Department will review the test file to determine if the claims pass testing. If so, a fax will be sent with the production phone number, logon and new password. UGS will call if the claims failed to discuss the issues with the file. A new test file will need to be submitted.

11. UGS reserves the right of UGS to request the submitter to get CLAREDI certified if the submitter continues to send numerous incorrect tests files.

Please call us with questions regarding testing at: (414) 459-5999 option 3 than option 6