Jonathan, Me too.....there are a variety of mechanisms: phone, email, fax, or the 824.....
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: Jonathan Fox [mailto:[EMAIL PROTECTED]] Sent: Wednesday, April 17, 2002 9:15 AM To: [EMAIL PROTECTED]; [EMAIL PROTECTED] Subject: RE: questions on the appropriate way to reply when there areerrors in a transaction request Rachel, I'm sorry, by unnamed, I meant by the TCS of HIPAA. I don't really have a problem with it other than it being yet another transaction set we have to develop. I would be very interested to know how all the payers out there will be handling the reporting of HIPAA (IG) edits? Thanks for your response. Jonathan Fox eCommerce Analyst Independent Health CONFIDENTIALITY NOTICE. This e-mail and attachments, if any, may contain confidential information which is privileged and protected from disclosure by Federal and State confidentiality laws, rules or regulations. This e-mail and attachments, if any, are intended for the designated addressee only . If you are not the designated addressee, you are hereby notified that any disclosure, copying, or distribution of this e-mail and its attachments, if any, may be unlawful and may subject you to legal consequences. If you have received this e-mail and attachments in error, please contact Independent Health immediately at (716) 631-3001 and delete the e-mail and its attachments from your computer. Thank you for your attention. >>> [EMAIL PROTECTED] 04/16/02 11:02PM >>> Jonathan, Yes. The 824 is not unnamed as you call it. It's been a valid X12 transaction for over a decade in widespread use in other industries. I strongly recommend that the 824 be used to report errors re non-compliance against a HIPAA guide. It can be used now; however, there is a work group at X12 working on adding additional codes that will make it even more useful to report HIPAA guide non-compliance errors. You seem to have a problem with this. Why? 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: Jonathan Fox [mailto:[EMAIL PROTECTED]] Sent: Tuesday, April 16, 2002 1:27 PM To: [EMAIL PROTECTED]; [EMAIL PROTECTED] Subject: RE: questions on the appropriate way to reply when there areerrors in a transaction request Rachel, So, are we left with the un-named 824 to report HIPAA-level (WEDI-SNIP 3-7) errors? Jonathan Fox eCommerce Analyst Independent Health 716-631-3001 x2472 CONFIDENTIALITY NOTICE. This e-mail and attachments, if any, may contain confidential information which is privileged and protected from disclosure by Federal and State confidentiality laws, rules or regulations. This e-mail and attachments, if any, are intended for the designated addressee only . If you are not the designated addressee, you are hereby notified that any disclosure, copying, or distribution of this e-mail and its attachments, if any, may be unlawful and may subject you to legal consequences. If you have received this e-mail and attachments in error, please contact Independent Health immediately at (716) 631-3001 and delete the e-mail and its attachments from your computer. Thank you for your attention. >>> [EMAIL PROTECTED] 04/16/02 01:54PM >>> Ajay, I totally disagree. The 997 transaction is specifically for the purpose of reporting syntax errors within functional groups and transactions according to the X12 standards. A transaction can comply with the X12 standards and not comply with the HIPAA guides. A covered entity conducting a transaction that does not comply with the HIPAA guides is subject to economic penalties under the law. The originator and receiver need to know explicitly if the transaction fails X12 validation or HIPAA guide validation. It's a huge difference. Furthermore, the 997 is not capable of reporting all HIPAA guide compliance validation errors. There must be firm and clear boundaries between compliance with the X12 standard and compliance with the HIPAA guides. 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: Ajay K sanghi [mailto:[EMAIL PROTECTED]] Sent: Tuesday, April 16, 2002 5:42 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. 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