A transaction using a non compliant code makes the entire transaction non compliant.
There is no need to use non compliant codes. Code specific to an application that are not used within HIPAA can be cross walked within the EDI gateway or as part of the processing after the EDI gateway into the applicaiton. Method 1: Some code significant to processing may be validated and rejected at the EDI gateway. Method 2: Code value are validated within the core application system in which they are used. If there are invalid codes, the claim would suspend (or deny?) For full details on resolving all code set issues, please feel free to join our Code Set Resolution Group. To subscribe go to: http://snip.wedi.org/forms/form.cfm?id=4 Within Transaction box, click on code sets to receive white paper working documents. Julie A. Thompson, chairman SNIP Code Set Resolition White Paper From: "Polson, Noelle" <[EMAIL PROTECTED]> To: [EMAIL PROTECTED] Subject: Code Editing Date: Wed, 10 Oct 2001 15:10:04 -0400 > 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. > > Blue Cross Blue Shield of Florida, Inc., and its subsidiary and affiliate companies are not responsible for errors or omissions in this e-mail message. Any personal comments made in this e-mail do not reflect the views of Blue Cross Blue Shield of Florida, Inc. ********************************************************************** To be removed from this list, send a message to: [EMAIL PROTECTED] Please note that it may take up to 72 hours to process your request. _________________________________________________________________ Get your FREE download of MSN Explorer at http://explorer.msn.com/intl.asp ********************************************************************** To be removed from this list, send a message to: [EMAIL PROTECTED] Please note that it may take up to 72 hours to process your request.
