Claims Split Acks Re-batching Profile Workflow

The route Processing in this profile shows you a typical end-to-end 837 transaction processing flow.

The route picks up an 837 transaction from the file system. The corresponding route component splits the data into separate claims, validates the resulting data, and generates a processing acknowledgment for each separate claim. The Aggrigation route component batches all the good claims and stores them in the files system. The route batches all the acknowledgments into a single XML multi-message exchange and transforms the data into an EDI acknowledgment batch.

Route structure

Route Components Description

Component Name Component Type Description
837 In FS Inbound Picks up transactions from the file system.
Split by Claims XE Native

Validates the incoming 837 transactions and splits the data into individual claims.

After the last individual claim goes through the output split.good or split.bad, the component directs the original 837 Professional Claim Payment batch through the output original and sets the following property:

  • LastMessage = true: A marker property that is used to notify the route component Aggregation that the last message has been received and the aggregation is complete. The message that carries this property is not included in the batch.
Bad Claims FS Outbound Stores the claims that have failed to pass the validation on the file system.
Batch 837P Aggregation Batches all the good claims into one EDI file using the HIPAA Merger strategy. The trigger for the batch completion is a custom expression {Prp[LastMessage]} = 'true' passed in the message properties file.
Good 837 FS Outbound Stores a batch of good claims on the file system.
MM Exchange Aggregation Batches acknowledgements to an XEServer multi-message exchange. The trigger for the batch completion is a custom expression {Prp[LastMessage]} = 'true' passed in the message properties file.
XData Processing XData Processing Processes the multi-message exchange and creates an EDI batch of acknowledgments.
Batched Acks FS Outbound Stores the batch of acknowledgements on the file system.