As an encounter moves through the submission pathway, from a provider through to a clearinghouse, payer, and/or regulator, it is important to be able to easily track the original encounter identifier in case any corrections are needed. The recommended action details how to create and maintain a Trace ID so that trading partners can accurately match an error back to the original encounter.
IHA in partnership with the Health Industry Collaboration Effort (HICE) Encounters Standardization Team
Why use it
As an encounter moves through the submission pathway, it may be rejected at any ingestion point and sent back to the original submitter for correction. While this process ensures that all encounters pass a variety of completeness and accuracy checks, it’s important to complete corrections as efficiently as possible to ensure timely submission.
Often, when an encounter is ingested into the next party’s data system, it will receive a new encounter ID to match those system requirements. The recommended action to create and maintain a Trace ID helps submitters efficiently identify the original encounter that needs to be corrected. The Trace ID helps ensure a consistent link between the original encounter ID and the “new” encounter ID. Encounter data subject matter experts identified key X12 files and fields used to support this process.
Who it’s for
This resource is intended for health plans, clearinghouses, and submitters (managed care organizations, provider practices, and independent physician associations) that submit encounter data, particularly those that participate in Medi-Cal.
To ensure timely and complete encounter data submissions, the authors recommend implementing a trace ID to be able to efficiently track down the original encounter identifier when correcting a submission. The following details are included in the memo:
- Process flow detailing how to create a trace ID modeled in an encounter submission pathway
- Step-by-step instructions by organization type (provider, clearinghouse, payer, and regulator)
- Table of X12 standard files and their corresponding fields used to create a Trace ID