All, If you have been following this thread you can see an interesting dilemma.
1. If the transaction has one bad code, like V22, it is non compliant 2. A non compliant transaction should not be put through the adjudication system. 3. Without putting the transaction through the adjudication system some people will not be able to generate a 277 or an 835. So, how do you reject the non compliant transaction? Personally I think there are three solutions: A. Reject the entire file with a 997. Since the transaction is syntactically compliant with X12, the 997 rejection is not appropriate. B. Reject the specific "claim" in the transaction with an 824. But we don't have a standard 824 implementation guide yet. C. Put the non compliant transaction through the adjudication system and reject or deny that claim with an 835 or a 277 as appropriate. Obviously, what we can do today is C, but that implies that the recipient will be knowingly accepting an processing non-standard transactions, which is contrary to some generalized trend that non-compliant transactions MUST be rejected in the front-end and never put through the adjudication system. Are we cornered yet? Thoughts? Kepa Julie Thompson wrote: > > 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. 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