1. If there are actual syntax errors in an incoming X12, what exactly is the
correct way to respond? By this I mean it is not a valid X12 at all. We
are unclear as to whether it is appropriate to respond with a 997 vs
something, for example, in a 271 or 277).
2. If there are "logical" errors in an incoming X12, what exactly is the
correct response? By this I mean it is a valid X12 but it does not meet the
HiPAA specs.
Examples:
If 276 - IG 54, 98 - is not set to the code "PR" for payor but to something
else, what do we do? (if we would be receiving requests only from payors) A
997 response?
If 276 - IG 67, 98 - is not set to "1P" for provider but to something else,
what do we do? (if we are only expecting 1P) A 997?
3. If there are "business" errors in an incoming X12, what exactly is our
response? By this I mean that the request is both a valid X12 and a valid
HIPAA transaction but contains other errors.
Examples would be an unknown information source (payor), and unknown
provider, etc. Also I think this would include issues like the dependent
given is not a dependent of the given subscriber.
It appears that each level of a 271 has request validation segments / reject
reason codes in the 270 request. Are these codes used for business errors
while a 997 is used for other errors? Since the 277 lacks these codes, are
all errors handled using 997s? If so doesn't this stop all further
processing of the 276 transactions in the transmissions?
<<...OLE_Obj...>>
Connie Lagneaux, RN, BSN, MBA
Senior Business Analyst
5151 E. Broadway Boulevard, suite 1050
Tucson, AZ 85711
Phone (520) 571-1988 ext. 153
Fax (520) 571-1927
<mailto:[EMAIL PROTECTED]>
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