The organization of the EDI information can be challenging, especially before establishing a streamlined process for EDI files. Often we find that EDI healthcare transactions can be easily managed in EDI Software systems that have a healthcare focus. There may be countless methods or trade secrets that each system utilizes to achieve that goal. However, there are some patterns or common practices such as the Invalid Records Extraction process that are proven effective.
Separating invalid records is essentially the same concept as the Transaction Split discussed in the blog post Splitting 835 Healthcare Claim Payment . The focus of this discussion is the 835 transaction, but the concept applies to others. The main goal is to extract the ST records out of the original file. In the invalid Records Extraction process, some details are a bit different; however, being familiar with the splitting process is a big step up.
Before we can begin extracting any invalid records, we must perform a validation process on the EDI file. Many HIPAA EDI Solutions offer EDI validation functionality. however, it is not entirely out of the question to validate the EDI manually (we have a FREE EDI editor tool for that). In most cases, it is recommended only for transactions with a lighter format or when there are only a few records to go through.
Regardless of the validation method, the next important thing is marking these invalid records. EDI files usually contain multiple records and we need a way to keep track them throughout the entire extraction process. Using line numbers is one way to do this, but that limits us from modifying the file during the extraction. Removing or adding records to the file can cause shifting line numbers up or down. We can be more careful with this issue or simply not make changes to the original file at all. More often than not, you will find it more convenient to reduce the number of records as we go.
What we find useful for this scenario is utilizing the record’s unique identifier. A correct formatted EDI file should have a unique ST02 value for each record. The idea is simply to write the bad ones down during the validation and revisit those later. A simple string search will bring up the record. These identifiers are only unique within the interchange and the choice is ours to redo these values. The more popular method is to start from 1 and increment. The element ST02 requires a minimum length of 4 characters so the value 1 should be represented as ‘0001’ with no space.
One final detail is to keep track of record counts within the GE01 in the envelope. This is also discussed in our blog post: Splitting 835 Healthcare Claim Payment . Finally, do not forget to reset the GE01 value to match the number of records within the file.
X12 Studio Toolbox
Caliber Health’s X12 Studio Toolbox has an Invalid Record Extractor feature that helps to smooth out the HIPAA processes.
X12 Studio toolbox loads EDI transactions into a hierarchical tree view. With search features and expandable nodes, it is easy to navigate and understand the structure of your EDI documents. The Invalid Record Extractor feature offers a solution to organize the EDI into a streamlined process. The EDI parser engine can detect any error that is not compliant to the X12 standardized format and flag those specific errors. The invalid records can be separated into a different batch for subsequent remediation processes.