Validation Report

Date
Wednesday, 9 June 2010 2:15:45 PM NZST
Validator Version
0.76

This report is for the submitted HIPAA message. Errors, if any, are indicated below. The report was generated automatically by Rhapsody.

Interchange

Control Number
170928001
Date
090928
Time
0632
ErrorLineDescription
11038
Loop 2000A requires a 2010AA loop. The 2010AA loop is missing.
IK3*NM1*6**3~
110385
Loop 2000B requires a 2010BB loop. The 2010BB loop is missing.
IK3*NM1*83**3~
1243110
SE01 ("112") must be 108. SE01 must be the total number of segments included in a transaction set including ST and SE segments.
IK3*SE*108**8~
IK4*1*96*I12*112~

Segment Listing

1
ISA*00*          *00*          *ZZ*123456789      *ZZ*999999999      *090928*0632*^*00501*170928001*1*T*:~
2
GS*HC*123456789*999999999*20090928*0632*170928001*X*005010X222~
3Transaction Set Header
ST*837*0001*005010X222~
4Beginning of Hierarchical Transaction
BHT*0019*00*0001*20090928*063213*CH~
51000ASubmitter Name
NM1*41*2*CARTOON CHARACTERS*****46*123456789~
6Submitter EDI Contact Information
PER*IC*CARTOON CHARACTERS*TE*7190000000~
71000BReceiver Name
NM1*40*2*INGENIX*****46*999999999~
82000ABilling Provider Hierarchical Level
HL*1**20*1~
1103Loop 2000A requires a 2010AA loop. The 2010AA loop is missing.
IK3*NM1*6**3~
92000BSubscriber Hierarchical Level
HL*2*1*22*0~
10Subscriber Information
SBR*P*18*******CI~
112010BASubscriber Name
NM1*IL*1*WHALE*SHAMU*G***MI*111012345~
12Subscriber Address
N3*654 WAY~
13Subscriber City, State, ZIP Code
N4*OAKLAND*CA*8070~
14Subscriber Demographic Information
DMG*D8*19380323*M~
152010BBPayer Name
NM1*PR*2*AETNA*****PI*60054~
16Payer City, State, ZIP Code
N4*PAYER CITY NAME*MO*12345~
17Payer Secondary Identification
REF*FY*NOCD~
18Billing Provider Secondary Identification
REF*G2*647318~
192300Claim Information
CLM*06010949*720***11:B:1*Y*A*Y*Y~
20Mammography Certification Number
REF*EW*FALSE~
21Claim Note
NTE*ADD*OON~
22Health Care Diagnosis Code
HI*BK:5921~
23Claim Pricing/Repricing Information
HCP*02*600*120*999999999~
242310BRendering Provider Name
NM1*82*1*FUDD*ELMER~
25Rendering Provider Specialty Information
PRV*PE*PXC*208D00000X~
262310DSupervising Provider Name
NM1*DQ*1*KILLIAN*BART*B**II~
27Supervising Provider Secondary Identification
REF*1G*A11111~
28Supervising Provider Secondary Identification
REF*LU*111~
292400Service Line Number
LX*1~
30Professional Service
SV1*HC:00918:P2*720*MJ*92*22**1~
31Date - Service Date
DTP*472*RD8*20020917-20020917~
32Line Pricing/Repricing Information
HCP*02*600*120*999999999~
332000ABilling Provider Hierarchical Level
HL*3**20*1~
342010AABilling Provider Name
NM1*85*1*CARTOON*CHARACTERS~
35Billing Provider Address
N3*789 STREET~
36Billing Provider City, State, ZIP Code
N4*THE SUN*CO*806311111~
37Billing Provider Tax Identification
REF*EI*111222333~
38Billing Provider Contact Information
PER*IC*OFFICE MANAGER*TE*9705553456~
392010ABPay-to Address Name
NM1*87*1~
40Pay-to Address - ADDRESS
N3*999 VISTA DRIVE~
41Pay-To Address City, State, ZIP Code
N4*THE SUN*CO*80633~
422000BSubscriber Hierarchical Level
HL*4*3*22*0~
43Subscriber Information
SBR*P*18*******CI~
442010BASubscriber Name
NM1*IL*1*SIMPSON*BART****MI*123456789~
45Subscriber Address
N3*654 BOULEVARD~
46Subscriber City, State, ZIP Code
N4*THE SUN*CO*80631~
47Subscriber Demographic Information
DMG*D8*19430702*M~
482010BBPayer Name
NM1*PR*2*HUMANA*****PI*61101~
49Payer City, State, ZIP Code
N4*SMIGGLES*MO*111112222~
50Payer Secondary Identification
REF*FY*NOCD~
51Billing Provider Secondary Identification
REF*G2*647318~
522300Claim Information
CLM*06017574*900***11:B:1*Y*A*Y*Y~
53Mammography Certification Number
REF*EW*FALSE~
54Claim Note
NTE*ADD*OON~
55Health Care Diagnosis Code
HI*BK:73027~
56Claim Pricing/Repricing Information
HCP*02*800*100*999999999~
572310AReferring Provider Name
NM1*DN*1*SUN DPM*YELLOW*D~
58Referring Provider Secondary Identification
REF*1G*F12345~
592310BRendering Provider Name
NM1*82*1*FLINSTONE*FRED*T***XX*1114015450~
60Rendering Provider Secondary Identification
REF*1G*OTH000~
612310CService Facility Location Name
NM1*77*2*A OK MOBILE CLINIC*****XX*1609040484~
62Service Facility Location Address
N3*123 MAIN STREET~
63Service Facility Location City, State, ZIP Code
N4*ANY TOWN*CO*806311111~
64Service Facility Location Secondary Identification
REF*LU*111~
652400Service Line Number
LX*1~
66Professional Service
SV1*HC:01470:P3*780*MJ*125*21**1~
67Date - Service Date
DTP*472*RD8*20021010-20021010~
68Line Pricing/Repricing Information
HCP*02*693*87*999999999~
692400Service Line Number
LX*2~
70Professional Service
SV1*HC:99140*120*UN*1*21**1~
71Date - Service Date
DTP*472*RD8*20021010-20021010~
72Line Pricing/Repricing Information
HCP*02*107*13*999999999~
732000ABilling Provider Hierarchical Level
HL*5**20*1~
742010AABilling Provider Name
NM1*85*2*LOONEY TUNES*****XX*1023100500~
75Billing Provider Address
N3*123 CIRCLE~
76Billing Provider City, State, ZIP Code
N4*VENUS*CO*803011111~
77Billing Provider Tax Identification
REF*EI*849999999~
78Billing Provider Contact Information
PER*IC*OFFICE MANAGER*TE*3035554567~
792010ABPay-to Address Name
NM1*87*2~
80Pay-to Address - ADDRESS
N3*999 UNION~
81Pay-To Address City, State, ZIP Code
N4*VENUS*CO*80310~
822000BSubscriber Hierarchical Level
HL*6*5*22*1~
83Subscriber Information
SBR*P**999999******CI~
842010BASubscriber Name
NM1*IL*2*BEAUTY SLEEPING*****MI*GG77777~
85Subscriber City, State, ZIP Code
N4*DUNEDIN**9012*NZ~
1103Loop 2000B requires a 2010BB loop. The 2010BB loop is missing.
IK3*NM1*83**3~
862000CPatient Hierarchical Level
HL*7*6*23*0~
87Patient Information
PAT*19~
882010CAPatient Name
NM1*QC*1*BEAUTY*SON~
89Patient Address
N3*777 AVE~
90Patient City, State, ZIP Code
N4*WATER*CO*80310~
91Patient Demographic Information
DMG*D8*19961221*M~
922300Claim Information
CLM*0000004407*75***11:B:1*Y*A*Y*Y~
93Prior Authorization
REF*G1*2020202A0202~
94Claim Note
NTE*ADD*9999DUMMYDATA~
95Health Care Diagnosis Code
HI*BK:4148~
96Claim Pricing/Repricing Information
HCP*02*50*25*999999999~
972310BRendering Provider Name
NM1*82*1*BIRD*TWEETY*D~
98Rendering Provider Secondary Identification
REF*G2*B74853~
992310CService Facility Location Name
NM1*77*2*A OK MOBILE CLINIC~
100Service Facility Location Address
N3*999 STREET~
101Service Facility Location City, State, ZIP Code
N4*AUCKLAND**1024*NZ~
102Service Facility Location Secondary Identification
REF*LU*012~
1032400Service Line Number
LX*1~
104Professional Service
SV1*HC:99213*75*UN*1*11**1~
105Date - Service Date
DTP*472*D8*20021010~
106Line Pricing/Repricing Information
HCP*02*50*25*999999999~
1072420CService Facility Location Name
NM1*77*2*ABC CLINIC*****XX*1234567891~
108Service Facility Location Address
N3*123 STREET~
109Service Facility Location City, State, ZIP Code
N4*AUCKLAND**1024*NZ~
110Transaction Set Trailer
SE*112*0001~
1243SE01 ("112") must be 108. SE01 must be the total number of segments included in a transaction set including ST and SE segments.
IK3*SE*108**8~
IK4*1*96*I12*112~
111
GE*1*170928001~
112
IEA*1*170928001~

Raw Message