January 22, 2009 - Deciphering 997 Files
(applies to Suzy Dental, Suzy Medical, and Suzy Facillity)

The 997 file can be accessed by either trying to open it from the Website or downloading it first, depending on the insurance agency.

For NJ Medicare, the file must be downloaded by selecting 'Get Confirmation'. Remember that when you download the file keep track of where it is stored. After the download you need to locate the file and try to open it by double clicking o it. If it opens it will most likely be using the Notepad program, but it does not really mater.

If it does not open Windows will ask you whether you want to use a web service or select a program to open the file. Check select a program, then click OK. Look through the programs and locate Notepad. Click on it to highlight it, check the box on the bottom that says "Always use the selected program to open this kind of file", then click OK.

For NJ and NY Medicaid, you can open the file directly from the website.

Other agencies may or may not be similar.

When the file opens you will see a single line. The 997 file contains one long line of data. Put the cursor anywhere on the line, then hit the END key. You will be at the end of the file. The last 90 characters will look like

ST*997*0001~AK1*HC*1~AK2*837*0851~AK5*A~AK9*A*1*1*1~SE*6*0001~GE*1*3760001~IEA*1*800000376~

Look at the 2 characters following the 'AK5' and 'AK9' text. They should both be '*A'. If so there are no serious errors and the 997 scan has been successful. From this point on each claim is treated separately, so the claims can all be unflagged (if they have not already been unflagged).

If the 2 characters after the 'AK5' and 'AK9' are '*R', as in the example below

*8~AK4*3*127*1~AK5*R*5~AK9*R*1*1*0~SE*8*4001~GE*1*233802047~IEA*1*233802047~

Then a serious error has been encountered. There will be AK3 and AK4 codes in the file which will contain more information about the errors. Please contact Suzy Support as the codes are not easy to decipher.

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