As a "for instance" Revenue codes, used for facility claims reporting, are
considered "non-medical".
Regards,
-M.J.L.
Phone: (717) 760-9728
Fax: (717) 612-4944
"Hatch, Keith
K." To: "'[EMAIL PROTECTED]'"
<[EMAIL PROTECTED]>
<dkhatch@trigo cc: "'Rachel Foerster '"
<[EMAIL PROTECTED]>
n.com> Subject: TCS: Non-medical Codes
04/16/2002
07:08 AM
Please respond
to
transactions
Rachel - What would you consider "non-medical" codes? The Register is
pretty clear on the medical codes, but I have not seen any definite
criteria
or limitation on "non-medical". Would this include taxonomy codes, zip
codes, -- and what else? What are your thoughts?
D. Keith Hatch
Trigon Blue Cross Blue Shield
System Analyst - Financial Controls
(804)354-4911
"An Information System is: A set of people, equipment, data and procedures
that work together to provide useful information to authorized people in a
useful format."
-----Original Message-----
From: Rachel Foerster [SMTP:[EMAIL PROTECTED]]
Sent: Monday, April 15, 2002 6:41 PM
To: [EMAIL PROTECTED]
Subject: RE: questions on the appropriate way to reply when there
are
errors in a transaction request
Jim,
When and on what basis to reject is basically a business/risk decision on
the part of the receiver. However, I take the following view:
1. The entire interchange must pass the full X12 syntax validation. If
errors, fail and report via 997.
2. If interchange passes X12 syntax then apply HIPAA guide validation
rules.
If a transaction within the interchange does not comply with guide, fail
the
transaction and report via the 824. Keep in mind that validation also
includes validating medical and non-medical codes as being valid within the
referenced code set.
3. If transaction passes HIPAA guide validation, pass transaction data to
internal application and apply internal business rules. Report pass/fail
using various mechanisms, i.e., 271 response to 270, 277 response to 276,
and so on.
But that's just one person's viewpoint.
Rachel
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 <http://www.rfa-edi.com/>
-----Original Message-----
From: Jim Moores [mailto:[EMAIL PROTECTED]]
<mailto:[mailto:[EMAIL PROTECTED]]>
Sent: Monday, April 15, 2002 7:55 AM
To: [EMAIL PROTECTED] <mailto:[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]
<mailto:[EMAIL PROTECTED]>
Phone: (216)292-1605
Fax: (216)292-1619
>>> [EMAIL PROTECTED] <mailto:[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]]
<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]
<mailto:[EMAIL PROTECTED]> >
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