> HIPAA ANSI (v4010) Implementation Guides list valid codes or direct you to > an external source. When applying edits to transactions that are received > how are you addressing the following? > > 1. The IG provides a specific list of codes. When this data > element is REQUIRED: > a. Do you edit to validate that a value is > there, > b. Do you validate that the value is one of the > ones allowed, > c. Do you validate that the value is valid? > (i.e.; 834 - Enrollment, Loop 2000 - Member Level Detail, Data Element > 1069 - Individual Relationship Code) > d. If the value is invalid, do you reject the > transaction or do you accept the transaction into your processing system > and apply a business rule (i.e.; suspend for manual correction, etc.)? > > 2. The IG directs you to external sources for some codes (i.e.; > zip codes, ICD9, NDC, etc.). > a. Will you edit to verify that the value is > valid or will you just check to see if a value is present? > b. If the value is invalid, do you reject the > transaction or do you accept the transaction into your processing system > and apply a business rule (i.e.; suspend for manual correction, etc.)? > > 3. If the field is REQUIRED (i.e.; 834 - Enrollment, Loop 2100 > - Member Residence City, State Zip Code, Data Element 116 - Postal Code) > but you do not need it for business processing purposes to what depth of > editing do you go before allowing the transaction into your processing > system? > > 4. Is there any risk (penalty for non-compliance) to the payer > if a code, that is content compliant but invalid, is passed into the > processing system(s)? > > Your feedback would be appreciated. > > Noelle Polson > Blue Cross Blue Shield of Florida > HIPAA-AS Corporate Integration > > Building DC6-4 > 4800 Deerwood Campus Parkway > Jacksonville, FL 32246 > > Phone (904) 905 - 0052 / Fax (904) 997-5399 > Email [EMAIL PROTECTED] <mailto:[EMAIL PROTECTED]> > > Click on link to visit us on the BCBSFL Intranet <http://hipaa.bcbsfl.com > > > CONFIDENTIALITY NOTICE: This e-mail message, including any attachments, is > for the sole use of the intended recipient and may contain confidential > and privileged information. Any unauthorized review, use, disclosure or > distribution is prohibited. If you are not the intended recipient, please > contact the sender by reply e-mail and destroy all copies of the original > message. > >
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