There have been similar individual questions posted on various mail lists which are
related and beg the bigger question in regards to compliance of INBOUND transactions..
Is the RECEIVER of an HIPAA transaction OBLIGATED to perform all levels of
validations - beyond X12 and HIPAA syntax in order to be considered in COMPLIANCE?
Specifically, in regards to two areas:
1) external code sets - both medical and non-medical (e.g. postal codes, HIN numbers,
etc.)
and
2) product or service specific (e.g. Patient Weight is required on claims invoking
EPO for patients on dialysis)
My personal interpretation of is that I must be able to RECEIVE and PROCESS codes
from the external code sets - which is not necessarily the same as validating - for
example, as long as my adjudication system can accept a code but doesn't utilize and
therefore doesn't kick it out if it is incorrect that I am okay... - but I'm not sure
if the same logic can apply to #2 (e.g. I don't require patient weight...)
any thoughts? differences of opinion??
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