Interpret IBR files

How to interpret IBR files in EDI.

After each file transmission, check your ReceiveFiles mail box for an immediate batch response (IBR) file and interpret it to determine if errors occurred in the transmission file at Availity.

The file immediately provides information about the initial validation of your file and the claims it includes, enabling you to correct and resubmit erroneous claims and avoid payment delays. This report, which you can download to your computer or print, includes the following information:

• HIPAA-compliance errors that Availity detects

• Payer-specific errors that Availity detects on behalf of the payer

• Accepted claims

• Claim counts and charges for submitted and rejected claims at the claim level and transmission file level. If you received a partial negative implementation acknowledgement because some transaction sets in the file were rejected during file format, structure, and syntax validations, the count of total claims submitted excludes the claims in those rejected transaction sets.

• Both accepted and rejected claims are itemized and included in this report

Header Information

• If an IBR with a .ibt extension is present, open that file. It's a readable text report. The IBR file ending in .ibr is the data file, intended to be imported into your system. Providers can also select to receive the claim acknowledgement 277CA. The file extension is .277ibr and it is intended to be imported into your PMS or HIS system.

• The first two sections of the text file contain header information about the transmission file, coinciding with line 1 in a data response file, and the payer, coinciding with line 2 in a data file.

• The following two fields display in the first section (coinciding with line 1 in a data file):

  • Availity File ID – A unique number assigned by the Availity system in the following format: 1-123456789.

  • File Name – The name the submitter assigned to the file being submitted to Availity.

• In the header information of the IBR text file at the claim level, the Submitted Claims, Accepted Claims, and Rejected Claims fields and accompanying charges shown are calculated during the processing step at Availity.

Claim Information

• Information about the claims display below the header and coincide with line 3 in the data file.

• Some fields, such as the Availity Trace # field and some payer-specific fields, may display NA (not applicable).

Errors, Warnings, and Informational Messages

• If errors occurred in a claim, the following fields identifying the errors display in the lower part of the claim section, coinciding with line 3e in the data file: Error Initiator, Loop, Segment ID, Element #, Error Message, and Version.

• The Error Initiator field identifies the entity that initiated the error, such as <payer ID>-PSE (for a payer-specific error detected at Availity), HIPAA (for a HIPAA-compliance edit), or Availity (for an invalid payer ID error).

• The Version field displays the X12 version the claim was in when the error occurred.

• If you must contact the vendor of your EDI transactions system for assistance, the vendor might ask for the loop number, the segment ID, and the data element number.

• If Availity rejects any claims at this stage, you must correct and rebatch the rejected claims in your EDI transactions system, and then upload and resubmit the transmission file. You do not need to include accepted claims in the file, since those claims have already been routed to the payer. See the sections below for more information on these errors.

• If you encounter any problems while interpreting errors in the IBR and cannot resolve them yourself, contact Availity for assistance.