TA3 Interchange Delivery Notice

Companion Guide

TA3 Interchange Delivery Notice

DXC Technology Arkansas Title XIX Account

500 President Clinton Avenue, Suite 400

Little Rock, AR 72201

501.374.6608

Arkansas MedicaidTA3 Interchange Delivery Notice

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Arkansas MedicaidTA3 Interchange Delivery Notice

Modification Log

Use the Modification Log to ensure that changes are accurately tracked.

Include all authors for this document. Under Section, cross-reference programs to individuals.

Rev # / Date / Author / Section / Nature of Change
1.0 / 10/13/03 / Robert Kirkpatrick
01/04/11 / Abby Perrine per Angelia Norris / Updating EDS logo with HP logo

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Modification Log

This guide

Scope

Contact

Links

Conventions

TA3 Interchange Delivery Notice

ISA Segment (Interchange Control Header)

TA3 Segment (Interchange Delivery Notice)

IEA Segment (Interchange Control Trailer)

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This guide

Scope

This document is to be used in conjunction with the companion guides that are located on the Arkansas Medicaid website: Updates to this document will also be found at the same location.

Contact

See the Arkansas Medicaid website for contact information:

Links

HIPAA Implementation Guides:
Arkansas Medicaid companion guides:

Conventions

Most of this document is in table format (see example below).

The table lists the following information:

Data Element / Specific data element within the segment.
Start Byte / The starting byte.
Length / Data length. Clarifications in field length only indicate what Arkansas Medicaid uses or returns to process the transaction. Arkansas Medicaid still accepts the minimum and maximum field lengths required by the implementation guide for each field.
Type / Alphanumeric (“AN”) or Numeric (“N”).
Notes / Comments or clarifications for Arkansas Medicaid. Segment identifiers, values, and element delimiters are also listed here.

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TA3 Interchange Delivery Notice

If any type of system error is encountered which interrupts the start-to-finish processing flow of the interactive transaction, a TA3 Interchange Delivery Notice is generated.

The TA3 segment is wrapped only within the Interchange Control Envelope (ISA/IEA). The Functional Group Envelope (GS/GE) and the Transaction Set Envelope (ST/SE) are not used for this transaction. The TA3 should look like the following sample when it is built:

ISA*00* *00* *30*716007869 *ZZ*MC00XXXX *030215*1733*U*00401*000000001*0*P*:~TA3*30*716007869*029*ISA*000000001*030215*1733*ZZ*MC00XXXX*30*716007869*RJ*030306*1314~IEA*1*000000001~

The following tables contain the specifications for the TA3 segment. The TA3 segment is variable length, so it will contain no start byte with a minimum/maximum length (e.g., 3/5 = min 3 / max 5 bytes).

ISA Segment (Interchange Control Header)

Data Element / Start Byte / Length / Type / Notes
1 / 3 / AN / Segment Identifier
Value = “ISA”
4 / 1 / Element Delimiter (Value = *)
ISA01 / 5 / 2 / AN / Authorization Information Qualifier
Value = “00”
7 / 1 / Element Delimiter (Value = *)
ISA02 / 8 / 10 / AN / Authorization Information
Value = <spaces>
18 / 1 / Element Delimiter (Value = *)
ISA03 / 19 / 2 / AN / Security Information Qualifier
Value = “00”
21 / 1 / Element Delimiter (Value = *)
ISA04 / 22 / 10 / AN / Security Information
Value = <spaces>
32 / 1 / Element Delimiter (Value = *)
ISA05 / 33 / 2 / AN / Interchange ID Qualifier
Value = “30”
35 / 1 / Element Delimiter (Value = *)
ISA06 / 36 / 15 / AN / Interchange Sender ID
Value = “716007869”
51 / 1 / Element Delimiter (Value = *)
ISA07 / 52 / 2 / AN / Interchange ID Qualifier
Echoed from original input ISA05 data element
54 / 1 / Element Delimiter (Value = *)
ISA08 / 55 / 15 / AN / Interchange Receiver ID
Echoed from original input ISA06 data element
70 / 1 / Element Delimiter (Value = *)
ISA09 / 71 / 6 / AN / Interchange Date (Format = YYMMDD)
Value = <current system date>
77 / 1 / Element Delimiter (Value = *)
ISA10 / 78 / 4 / AN / Interchange Time (Format = HHMM)
Value = <current system time>
82 / 1 / Element Delimiter (Value = *)
ISA11 / 83 / 1 / AN / Interchange Control Standards ID
Value = “U”
84 / 1 / Element Delimiter (Value = *)
ISA12 / 85 / 5 / AN / Interchange Control Version Number
Value = “00401”
90 / 1 / Element Delimiter (Value = *)
ISA13 / 91 / 9 / N / Interchange Control Number
Value = “000000001”
100 / 1 / Element Delimiter (Value = *)
ISA14 / 101 / 1 / AN / Acknowledgment Requested
Value = “0”
102 / 1 / Element Delimiter (Value = *)
ISA15 / 103 / 1 / AN / Usage Indicator
Echoed from original input ISA15 data element
104 / 1 / Element Delimiter (Value = *)
ISA16 / 105 / 1 / AN / Component Element Separator
Value = “:” (Colon)
106 / 1 / Segment Delimiter (Value = ~)

TA3 Segment (Interchange Delivery Notice)

Data Element / Start Byte / Length / Type / Notes
3 / AN / Segment Identifier
Value = “TA3”
1 / Element Delimiter (Value = *)
TA301 / 2/2 / AN / Service Request Handler ID Qualifier
Echoed from original input ISA07 data element
1 / Element Delimiter (Value = *)
TA302 / 1/15 / AN / Service Request Handler ID
Echoed from original input ISA08 data element
1 / Element Delimiter (Value = *)
TA303 / 3/3 / AN / Error Reason Code
029 – Time out, Delivered
Possible resolutions (in this order):
- verify usage of MC* submitter ID
- retry the transaction
- contact the help desk
032 – Abnormal Conditions
Possible resolutions (in this order):
- retry the transaction
- contact the help desk
1 / Element Delimiter (Value = *)
TA304 / 2/3 / AN / Reported Start Segment ID
Value = “ISA”
1 / Element Delimiter (Value = *)
TA305 / 1/14 / AN / Reported Control Number
Echoed from original input ISA13 data element
1 / Element Delimiter (Value = *)
TA306 / 1/8 / AN / Reported Date
Echoed from original input ISA09 data element
1 / Element Delimiter (Value = *)
TA307 / 1/8 / AN / Reported Time
Echoed from original input ISA10 data element
1 / Element Delimiter (Value = *)
TA308 / 1/4 / AN / Reported Interchange Sender ID Qualifier
Echoed from original input ISA05 data element
1 / Element Delimiter (Value = *)
TA309 / 1/35 / AN / Reported Sender ID
Echoed from original input ISA06 data element
1 / Element Delimiter (Value = *)
TA310 / 1/4 / AN / Reported Interchange Receiver ID Qualifier
Echoed from original input ISA07 data element
1 / Element Delimiter (Value = *)
TA311 / 1/35 / AN / Reported Receiver ID
Echoed from original input ISA08 data element
1 / Element Delimiter (Value = *)
TA312 / 2/2 / AN / Action Code
Value = “RJ”
1 / Element Delimiter (Value = *)
TA313 / 6/6 / AN / Action Date (Format = YYMMDD)
Value = <current system date>
1 / Element Delimiter (Value = *)
TA314 / 4/6 / AN / Action Time (Format = HHMM)
Value = <current system time>
1 / Segment Delimiter (Value = ~)

IEA Segment (Interchange Control Trailer)

Data Element / Start Byte / Length / Type / Notes
3 / AN / Segment Identifier
Value = “IEA”
1 / Element Delimiter (Value = *)
IEA01 / 1/5 / N / Number of Included Functional Groups
Value = “1”
1 / Element Delimiter (Value = *)
IEA02 / 9/9 / N / Interchange Control Number
Value = “000000001”
1 / Segment Delimiter (Value = ~)

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TA3 Interchange Delivery Notice

Contents