RE: questions on the appropriate way to reply when there areerrors in a transaction request

[Larry Watkins]

The WEDI SNIP Front End Edits (draft) white paper deals with this issue.  See section entitled "Recommended Levels of Editing" on page 4.  In general, it is recommended that as much of the transmission be accepted as possible.  For example, if the syntax error is at the ISA level, you would need to reject the entire interchange.  However, if the syntax error is in the detail of a claim, only the single claim need be rejected.  You're right, though -- a corrupted loop structure (and other such structural syntax problems) may make it necessary to reject a larger portion of the interchange.   Regards,   Larry Watkins Vice President & COO Claredi Corporation Office: (801) 444-0339 x204 Fax: (770) 419-5295 Mobile: (770) 331-1898 e-Mail: [EMAIL PROTECTED]   -----Original Message----- From: Jim Moores [mailto:[EMAIL PROTECTED]] Sent: Monday, April 15, 2002 8:55 AM To: [EMAIL PROTECTED] Subject: RE: questions on the appropriate way to reply when there areerrors in a transaction request Hi Rachel,     I agree.  However, do you just reject the one claim in error or do you just reject the entire batch of claims in the transmission (assuming that you have gotten other transactions in the transmission)  or do you reject the entire transmission?  In some cases, I think that the entire transmission is appropriate... like when the loop structure is so corrupt that you can't parse it.  But, what about the area between that and the perfect transmission?       Jim Moores - HIPAA Team Leader - Privacy Antares Management Solutions 23700 Commerce Park Road Beachwood, Ohio   44122-5832   [EMAIL PROTECTED] Phone: (216)292-1605 Fax:      (216)292-1619   >>> [EMAIL PROTECTED] 04/13/02 08:30PM >>> Connie, If the incoming transactions contains X12 standards syntax errors it must be rejected. The correct way to report this rejection is via the 997 Functional Acknowledgment transaction. Rachel Foerster Principal Rachel Foerster & Associates, Ltd. Professionals in EDI & Electronic Commerce 39432 North Avenue Beach Park, IL 60099 Phone: 847-872-8070 Fax: 847-872-6860 http:/www.rfa-edi.com -----Original Message----- From: Connie Lagneaux [mailto:[EMAIL PROTECTED]] Sent: Friday, April 12, 2002 1:06 PM To: '[EMAIL PROTECTED]' Subject: questions on the appropriate way to reply when there are errors in a transaction request 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]> ********************************************************************** 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. ====================================================== The WEDI SNIP listserv to which you are subscribed is not moderated.  The discussions on this listserv therefore represent the views of the individual participants, and do not necessarily represent the views of the WEDI Board of Directors nor WEDI SNIP.  If you wish to receive an official opinion, post your question to the WEDI SNIP Issues Database at http://snip.wedi.org/tracking/. 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