Well, not to be too controversial, but I think there is a reasonable
compromise here. I agree with Rachel that 997 should be limited to X12
syntax and code set lists, and so on. I agree that when we start to
introduce X12N Implementation Guide edits it will be hard to know where to
stop. But, I suggest there are some very reasonable Implementation Guide
edits that could be added to the 997. In fact, I believe the 997 would be
a better place to handle some edits because it will be done on the front
end rather than the back end of processing and wouldn't require a new
implementation guide to implement, which will be needed for the 824.
My suggestion is where X12N transactions have limited (reduced) the code
set list for certain data elements within certain segments or transaction
loops, that translators could easily do this edit and report errors with
the 997. We're still reporting what code values are permitted, but we're
restricting the list to a subset of what X12 permits. This seems
reasonable to me. This would not really enter into situational as much as
just what the health care industry has defined to be a logical set of
values for our industry.
Don
[EMAIL PROTECTED] on 04/16/2002 01:20:41 PM
Please respond to <[EMAIL PROTECTED]>
To: <[EMAIL PROTECTED]>
cc:
Subject: RE: questions on the appropriate way to reply when there are erro
rs in a transaction request
Ditto -- Bruce
Bill Chessman
<bill.chessman@pere To:
"'[EMAIL PROTECTED]'"
grine.com> <[EMAIL PROTECTED]>
cc:
04/16/2002 11:39 AM Subject: RE: questions
on the appropriate way
Please respond to to reply when there are erro
rs in a
transactions transaction request
I think the big question is, once you start, where do you stop? The idea
of
situational and required elements being flagged as missing in 997 seems
reasonable to me, but once we start adding these things, there'll always be
something else. I think that Rachel's guideance was right on target. I
know that there's a lot of resistance to 824 vs. 997, but there's a
legitimate distinction between application-specific (ie., HIPAA) problems
and mechanical EDI problems (IMHO).
I also note that there's an implementation of 997 included in the
appendices
of each of the HIPAA IGs. I haven't spent a lot of time, but I imagine
they're all pretty much the same (boilerplate, I hope). This presents the
potential that, at some point going forward--if it should be decided to
report HIPAA IG failures via 997, the IGs might start to vary their
implementations of 997...that would be no fun.
Best regards,
Bill Chessman
Peregrine Systems, Inc.
-----Original Message-----
From: Ajay K sanghi [mailto:[EMAIL PROTECTED]]
Sent: Tuesday, April 16, 2002 3:42 AM
To: [EMAIL PROTECTED]
Subject: RE: questions on the appropriate way to reply when there are
errors in a transaction request
My view is that to the maximum extent possible, translators should handle
HIPAA guide validation failures using 997 and not stick to just X12
"standard" syntax validation.
If a "situational" element/segment, which is "required" in certain
condition
is missing, 997 should generate "Mandatory Data Element/Segment Missing"
code for such elements/segments and likewise.
Ajay
-----Original Message-----
From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED]]On
Behalf Of Rachel Foerster
Sent: Tuesday, April 16, 2002 4:11 AM
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
-----Original Message-----
From: Jim Moores [mailto:[EMAIL PROTECTED]]
Sent: Monday, April 15, 2002 7:55 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]>
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