INTERCHANGE LVL & COMMS EXCHANGE
“A ______ occurs during a logical communications exchange and includes one or more envelopes exchanged between partners.” (Sec. 5.1)
Plain: The large container that holds EDI content.
Claims Example: A MAC sends CMS a nightly claims batch inside this envelope.
What is an interchange?
“The ISA and IEA form the header and trailer of the interchange.” (Implied Sec. 5.2)
Plain: Start and end tags of the outer envelope.
Claims Example: Used to confirm all claim batches have been received.
What are the interchange header and trailer segments?
“A _____ is a repeated ordered group of segments.” (Sec. 5.6)
Plain: A repeatable block of data.
Claims Example: Multiple service-line ___ in 837.
What is a loop?
“Interchange sender and receiver IDs are used for ______.” (Sec. 6.4.3)
Plain: Addresses that deliver the file.
Claims Example: CMS verifies which MAC sent the batch.
What is external routing?
“The data contents of each parent structure are relevant to its child structures.” (Sec. 6.1)
Plain: Higher-level data applies downward.
Claims Example: Interchange sender applies to all claim batches it contains.
What is belonging?
“A _____ is the environment in which EDI information is exchanged electronically.” (Sec. 5.1)
Plain: The session during which files move.
Claims Example: The time-window when MACs transmit 837s to CMS.
What is a logical communications exchange?
“The GS and GE segments identify the application sender/receiver and control the functional group.” (Sec. 6.4.2)
Plain: Labels for internal routing.
Claims Example: MAC internal codes for routing 837P vs 837I.
What are the functional group header and trailer?
“A _____ is a loop contained within another loop.” (Sec. 5.6)
Plain: Loops inside loops.
Claims Example: Subscriber loop under patient loop.
What is a nested loop?
“At the functional group level, ________ have no universal meaning.” (Sec. 6.4.2)
Plain: Only the sender understands these codes.
Claims Example: MAC’s internal code for 837P.
What are internal identification codes?
“Data in a child structure can _____ data in a parent.” (Sec. 6.3)
Plain: More specific beats general.
Claims Example: A service-line provider overrides header provider.
What is a functional equivalence override?
“Each interchange includes interchange-level control segments and ______.” (Sec. 5.2)
Plain: Inside the outer envelope are folders grouping related documents.
Claims Example: One interchange may include multiple 837 professional and institutional groups.
What is a functional group?
“The ST and SE segments bound the transaction set.” (Sec. 5.4)
Plain: The cover page and closing page of a claims batch.
Claims Example: Each 837 begins with ST and ends with SE.
What are the transaction set header and trailer?
“HL segments allow identification of parent-child relationships among loops.” (Sec. 5.6)
Plain: Shows which loop belongs to which.
Claims Example: Claim HL → Service HL.
What is an HL-initiated loop?
“_____ appears inside the transaction set, often in segment groups starting with N1.” (Sec. 6.4.1)
Plain: Who the claim is about.
Claims Example: Billing provider address inside 837.
What is business application addressing?
“There is no semantic relationship among instances at the same level.” (Sec. 6.2)
Plain: Siblings do not influence each other.
Claims Example: Two claims in the same 837 batch are independent.
What is same-level independence?
“Each instance of the interchange is the parent of the control segments and functional groups enclosed within it.” (Sec. 5.2)
Plain: The outer envelope owns everything inside it.
Claims Example: CMS expects each claims group inside a MAC’s interchange to belong clearly to that envelope.
What is the interchange parent-child relationship?
“The _____ contains information that pertains to the entire transaction set.” (Sec. 5.4)
Plain: Info applying to every claim inside the file.
Claims Example: Billing provider appears once at the top.
What is the heading area?
“A repeated occurrence of the first segment in a loop indicates a new loop instance.” (Sec. 5.6)
Plain: When the starting segment repeats, a new loop begins.
Claims Example: Each new SV1 indicates a new service line.
What is a loop initiator?
“No semantic relationship exists between addressing at the interchange and functional group levels.” (Sec. 6.4.3)
Plain: External routing ≠ internal routing.
Claims Example: MAC’s internal code cannot override CMS routing.
What is addressing independence?
“Segment order within a loop does not alter semantics.” (Sec. 6.2.3)
Plain: Order doesn’t change meaning.
Claims Example: Line-item segments can appear in different sequences.
What is segment-level order independence?
“Each_____ applies to a specific business function defined by the application to which it applies.” (Sec. 5.2)
Plain: A folder dedicated to one type of business action.
Claims Example: All 837P transactions belong to one _____.
What is a functional group?
“The _____ encompasses the actual body of the business transaction.” (Sec. 5.5)
Plain: Where the actual claim/service-line data lives.
Claims Example: Service lines in an 837.
What is the detail area?
“There is no limit to how deeply loops may be nested.” (Sec. 5.6)
Plain: Unlimited hierarchy.
Claims Example: Complex institutional claims with many nested components.
What is unbounded nesting?
“_____includes attributes that describe the logical or physical location of a party.” (Sec. 6.4)
Plain: Information about where to deliver something.
Claims Example: Ship-to or provider address loops.
What is semantic addressing?
“If two segments with the same identifier and qualifier appear, they may be functionally equivalent.” (Sec. 6.3)
Plain: Duplicate meaning segments.
Claims Example: Two N1 segments identifying the same entity.
What is segment-level functional equivalence?