HIPAA Sample Documents
You can expect to receive the following electronic format transactions or reports as a result of your batch transmission:
Claims Audit Report Sample
This sample document illustrates the Blue Cross NC proprietary Claims Audit Report. Providers can download the Claims Audit Reports from their Blue Cross NC electronic mailboxes or receive them from their clearinghouses. The Claims Audit Report is returned for 837 Health Care Claim transactions only.
999 Functional Acknowledgement Sample
This sample provides illustrations of three different 999 Functional Group Acknowledgements. The 999 transaction serves as both a positive acknowledgement and a report of Implementation Guide errors within a Functional Group (GS/GE) or a Transaction Set (ST/SE).
TA1 Acknowledgement Sample
This sample provides two illustrations of the TA1 Interchange Acknowledgement Transaction. The TA1 may provide a positive acknowledgement of the transmission or a negative acknowledgement that includes a report of Implementation Guide errors within an Interchange Control (ISA/IEA).