claims-submission

name	claims-submission
description	Use when a provider needs to submit an assembled EDI 837P claim to a payer via AWS B2B Data Interchange, track submission status, or check for acknowledgment responses (997/999 and 277CA).

Claims Submission

When to use this skill

• Submit an assembled 837P claim to a payer electronically
• Track the status of a previously submitted claim
• Check for functional acknowledgments (997/999)
• Retrieve claim status responses (277CA)
• Manage B2B trading partner connections

MCP Servers Used

• AgentCore Gateway — for AWS B2B Data Interchange tools (EDI submission, acknowledgment retrieval, status tracking)

Workflow: Submit Claim via B2B Data Interchange

Step 1: Verify submission readiness

Before submitting, confirm:

• Claim has been validated and assembled (837P structure exists)
• Payer trading partner is configured in B2B Data Interchange
• Correct payer_id and submission endpoint are available
• The claim has not already been submitted (avoid duplicates)

Step 2: Submit claim

Use Gateway B2B tools to:

• Package the 837P EDI transaction
• Route to the correct payer trading partner
• Capture the submission transaction ID for tracking

Step 3: Monitor acknowledgments

Track two levels of acknowledgment:

1. 997/999 Functional Acknowledgment — confirms EDI envelope was received and syntactically valid
   • TA1: Interchange acknowledgment (envelope level)
   • 999: Implementation acknowledgment (transaction set level)
   • Watch for: AK9 segment with accept/reject status
2. 277CA Claim Acknowledgment — confirms claim was accepted for adjudication
   • Per-claim acceptance/rejection status
   • Rejection reasons with specific error codes

Step 4: Handle rejections

If rejected at any level:

• Parse rejection reason codes
• Map to specific claim fields that need correction
• Report actionable errors to provider
• Claims rejected at 997/999 level need EDI structure fixes
• Claims rejected at 277CA level typically need data corrections

Step 5: Report submission status

Provide clear summary:

• Submission timestamp and transaction ID
• Current status (submitted, acknowledged, accepted, rejected)
• Any pending acknowledgments
• Next steps for the provider

Submission Status Flow

Submitted → 997/999 Received → 277CA Received → In Adjudication
    ↓              ↓                  ↓
 Timeout    999 Rejected       277CA Rejected

Key Conventions

• Never submit the same claim twice without confirming the first was rejected
• Always wait for 997/999 before reporting success — submission alone doesn't mean acceptance
• B2B Data Interchange handles EDI envelope wrapping (ISA/GS/ST segments)
• Payer-specific submission windows may apply (some reject claims outside business hours)
• Timely filing limits vary by payer — check before submission if claim is near deadline
• Keep submission transaction IDs for audit trail and follow-up queries