Encounter Data Certification Requirements


 ENCOUNTER TESTING/CERTIFICATION

All Plans

(Medicare Advantage, Cost, PACE)

and Third-Party Submitters

1 file containing a minimum of 50 encounters

Submission Requirements:

  • Files must be identified using the Authorization Information Qualifier data element “Additional Data Identification” in the ISA segment (ISA01 = 03).
  • Files must be identified using the Authorization Information data element to identify the “Test Certification File” in the ISA segment (ISA02 = TSTCERTFIL).
  • Files must be identified as “Test” in the ISA segment (ISA15 = T).
  • All files must pass with 100% acceptance rate.
  • In the event more than the required number of encounters are submitted, the file must still receive a 100% acceptance rate.
  • Upon certification for one of the 3 Encounter Data lines of business (Part A, Part B and DME), the submitter will be certified for ALL Encounter Data lines of business.
Last Updated: 03/10/2022