I have some additional questions regarding the HIPAA transaction sets and "rules" for
rejecting them.
In X12 formats, I believe the receiver of the data can reject a transaction set via
functional acknowledgment if the data does not meet correct X12 syntax.
My question comes into play with the variable levels of acceptance for the 997. Since
an interchange can fail at the functional group, transaction set and segment level,
what is our responsibility for accepting a file that fails within a single transaction
set when there are multiple trans. sets in the file?
Can we legally process the good portions of the file and reject only the bad?
What if there is a problem with a single claim within a transaction set?
Additionally, since the Regulation is not intended to change the way a payer "does
business", we should still be able to deny/reject claims based on certain business
rules (i.e. invalid diagnosis code, invalid procedure / modifier code combo, invalid
dates, non-numeric data in a numeric field, etc.) correct??
Finally, (for now) what are the liabilities for notifying the sender of the data if
there are problems with both the data validity and the syntax?
If anyone can point us to references in the Regs. or tell us how they plan to handle
these issues it would be GREATLY appreciated!
Jon Fox
Independent Health
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