EHC_E04
EHC^E04 Acknowledgment Choreography
EHC^E04
This message is used to submit a single Re-Assess HealthCare Services Invoice Request to a TPA/Payer for processing. The Re-Assess HealthCare Services Invoice Request is used by a Provider, to request review of a previously adjudicated HealthCare Services Invoice, with optional specification of a Product/Service Line Item within that Invoice. Note that the HealthCare Services Invoice need not necessarily be sent to a TPA/Payer using the EHC^E01 – Submit HealthCare Services Invoice: it may be manually submitted.
Adjudication for a HealthCare Services Invoice may be re-assessed either because background information, such as a Provider's billing rate may have changed or if some of the adjudication rules have changed since original adjudication of the Invoice.
Acknowledgment Rules(5)
| Mode | MSH-15 | MSH-16 | Immediate ACK | Application ACK |
|---|---|---|---|---|
| Original | blank | blank | - | ^^ |
| Enhanced | NE | NE | - | - |
| Enhanced | AL,SU,ER | NE | ^^ | - |
| Enhanced | NE | AL,SU,ER | - | ^^ |
| Enhanced | AL,SU,ER | AL,SU,ER | ^^ | ^^ |
Legend
blank - Field is empty/not valuedNE - Never (no acknowledgment)AL - AlwaysSU - Success onlyER - Error/reject only