Texas Medicaid Network

TexMedNet Electronic Data Interchange Standards

Transaction Mode	Standard	Standard Title	Version	Notes
Interactive	EDIFACT	Health Care Benefit Inquiry and Response	3050	ANSI approved interactive format. Ability to initiate search by using several data element combinations and span dates. Returns complete eligibility information including Medicare, Lock-in, prior authorization, other insurance, managed care, CIDC and service limitations.
Batch	ANSI 270	Health Care/Benefit Inquiry	3050	Ability to initiate search by using several data element combinations and span dates.
Batch	ANSI 271	Health Care/Benefit Response	3050	Returns complete eligibility information including Medicare, Lock-in, prior authorization, other insurance, managed care, CIDC and service limitations.
Batch	Internal	Appeal Submission	N/A	Batch format to submit request for review and reconsideration of previously dispositioned claims.
Batch	ANSI 837	Health Care Claim	3050	All claim types.
Batch	ANSI 277	Health Care Claim Status Notification	3040	Each processed claim submitted via ANSI 837 format receives a 277 response. Rejection codes may be internal Texas Medicaid codes.
Batch	UB92	Institutional Health Care Claim	4	Uses current Texas Medicaid UB92 data set. Continued use of modified record type 61. Additional codes added for other insurance information.
Batch	Internal	Health Care Claim Response	0001	Each processed claim submitted via UB92 format receives a TexMedNet internal accepted or rejected response.
Batch	NSF	Professional Health Care Claim	1.04	All professional claims, including EPSDT Medical, EPSDT Dental and Eyeglass. Some claim restrictions still apply such as ambulance claims. Additional fields added for Texas Medicaid-specific policy and other insurance requirements.
Batch	Internal	Health Care Claim Response	0001	Each processed claim submitted via NSF format receives a TexMedNet internal accepted or rejected response.
Batch	ANSI 835	Health Care Claim Payment/Advice	3041	Format used for paid or denied claims. Weekly distribution. Uses internal Texas Medicaid Explanation of Benefit (EOB) codes.
Batch	ANSI 277	Health Care Claim Status Notification	3040	Format used for pended claims. Weekly distribution. Uses internal Texas Medicaid Explanation of Pending Status (EOPS) codes.
Batch	ANSI 997	Functional Acknowledgment	3050	Trading partner relationship establishes use. Only used for ANSI submissions.

Discontinued EDI Formats:

Texas Local Format - 110 Byte Records
UB82 - 192 Byte Records

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