Compliance with x12 vs. HIPAA IG

[Cynthia Korman]

Title: RE: questions on the appropriate way to reply when there are error in a transaction request

Given the "up in the air" aspects of HIPAA TCS error reporting, I wonder whether or not the HIPAA transaction certification engines that are out there today come "out of the box" configured so that they won't "let through" a transaction if it's missing a HIPAA-required field that is optional per X12...given the obvious competence of the folks who are working the HIPAA effort, and the fact that some of those folks use the WEDI SNIP testing levels 1-6 model, I'd assume the answer is that they won't "let through" these transactions...but we all know the dangers of assuming...perhaps some certification engines do and some don't...   More relevant to this week's discussion is the same question applied to transactions managers that generate 997s in response to submitted 837s...Rachel pointed out that "... the 997 can be kludged to report guide syntax errors, such as missing mandatory segment or element..." (Thank you Rachel!)  I wonder if the transactions managers that are being billed as "HIPAA-ready" currently come kludged (configured?) to do the appropriate HIPAA-specific mandatory data element error reporting...(I'm not asking about the inter-segment dependency errors, just the black-and-white HIPAA-mandated, X12-optional).   Sounds like there won't be a 997 or 824 IG before the 10/16/03 deadline, so what we have today is what we have...And the 997 is what everyone is reading as the standard if they're only looking at the IGs and addenda, which is all that they're required by law to look at...   Cynthia Korman, Principal Strategic System Solutions, LLC 973 394-9529 [EMAIL PROTECTED] www.healthcare-systems.com   ----- Original Message ----- From: Bill Chessman To: '[EMAIL PROTECTED]' Sent: Friday, April 19, 2002 12:41 PM Subject: RE: compliance with x12 vs. HIPAA IG When X12 says an element is optional and HIPAA says it's "Not Used", that doesn't violate X12 because transmission of the segment without that element is OK with X12 (because it was optional anyway).  When X12 says the element is optional and HIPAA says it's "Required", that doesn't violate X12 either because transmission of the segment with the element always present is OK with X12 (because optional means you can use it as often as you like...including always).  So what the HIPAA IG is doing is creating restrictions on X12 that don't violate the original definitions...that's pretty much how IGs are supposed to work.  I think the 997 reporting of HIPAA usage errors is still up in the air (based on the discussion that's been going on this week).   Best regards, Bill Chessman Peregrine Systems, Inc. -----Original Message----- From: Cynthia Korman [mailto:[EMAIL PROTECTED]] Sent: Friday, April 19, 2002 9:11 AM To: [EMAIL PROTECTED] Subject: compliance with x12 vs. HIPAA IG Regarding Mike's comment below: "I would have to also contend that the HIPAA IGs are a subset of X12. If you can't get the X12 right, you're non-compliant, right?. "  My understanding is that one CAN get the X12 right and be out of compliance from a HIPAA perspective.  Specifically, in the HIPAA Implementation Guides, the data element attributes to the right of the data element names and descriptions are X12; the "usage" column to the left of the de names/descrips are HIPAA-specific.  The two sometimes contradict, in which case the "usage" column on the left takes precedence.    For example: 837P IG, p. 172 shows "Claim Filing Indicator Code" as "O" or Optional from the X12 perspective, but NOT USED from the HIPAA perspective.  That same page shows "Health Care Service Location Information" as Optional from the X12 perspective, but REQUIRED from the HIPAA perspective.   To summarize, my understanding is that it's the left hand column that's the bible when it comes to USAGE (Required/Situational/Not Used).  If anyone believes that to be off base, please advise!    Can the 997 report errors in (HIPAA-specific) USAGE?  Thanks in advance...    Cynthia Korman, Principal Strategic System Solutions, LLC 973 394-9529 [EMAIL PROTECTED] www.healthcare-systems.com ********************************************************************** 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/. Posting of advertisements or other commercial use of this listserv is specifically prohibited.