X12 Validation for HIPAA Covered Transactions

Summary

In this blog we go through an X12 validation example workflow. I’ll be processing the 837P transaction using our T-Connect EDI Gateway software. This HIPAA covered transactions processing system utilizes our X12 Studio Toolbox desktop application for easy loop and segment navigation and error corrections. This editing tool integrates within our platform but is also available as a standalone free trial download.

Featured HIPAA Covered Transaction Management Software

T-Connect EDI Gateway is an advanced reporting and X12 data management platform for trading partner management, workflow automation, and reporting. This platform is equipped with fully relational SQL Server databases and X12 validation capabilities. Learn More.

HIPAA EDI Databases come optimized for faster data capture and storage of all data elements contained in your various HIPAA transactions. APIs and stored procedures simplify manipulation of data files. This Includes parsing EDI into .Net objects and persisting messages to databases.

X12 Studio Toolbox is commonly used by healthcare software development teams and EDI analysts. Common features of the tool include dynamic search, error resolution, and test file generation.

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TRY IT NOW Example X12 Validation Route Overview

During this claims validation workflow example, our goal is to parse and persist the file into our T-Connect 837P HIPAA transaction database. However, we will have to fix one invalid claim before it can succeed. Remember, any job is easier with the right tools. Our B2B Gateway provides transaction management for all 5010 HIPAA transaction types. In practice these can be any X12N transaction type, such as: claims, enrollments, or payments. These healthcare files are typically transmitted between payers, providers, and third-party benefits administrators. Some organizations appoint entire business units to manage EDI with tens of thousands of 5010 HIPAA transactions. This process is greatly simplified with proper X12 validation tools.

Steps to Validate and Load Claim Data to HIPAA Covered Transaction Databases

Please use these simple steps to perform SNIP-level validation and correct errors. Along the way, I’ll provide tips to save you time correcting structural or syntax abnormalities in your 837 claim files.

1. Enter the Transaction Management Screen

Opening the T-Connect EDI Gateway software brings you to the transaction management screen. There you’ll find a listing of all HIPAA covered transactions of various set types currently authorized for viewing by the logged in user. You’ll also notice dates of last activity for each transaction set type. Note the total number of valid and failed X12N files. Clicking on a row brings us to our next page, one level deeper in the navigation. Next, arriving at the Messages page you’ll see a history of processed files. Here we could use the EDI software to search, sort, or filter to a specific transaction. However, we can see that there was a single error out of ten total records in the first entry of our list. HIPAA Covered Transaction Management Software Screen

2. Viewing Validation Workflow Results

Selecting the first row from the X12 validation results, we are brought to a Details page, showing selected transaction processing history. This information is represented as steps within a HIPAA 5010 transaction processing workflow. These steps below provide a sample route performing SNIP-level EDI validation, 999 acknowledgment generation, and routing for valid and invalid records in the transaction. All routes are user configurable within the portal. EDI X12 Validation Results

Invalid Record Extraction

Below we can see the 837P file error produced in our first step, validation, identifying one out of ten total healthcare claims has a file error. In subsequent steps, we can see our EDI Software highlights that nine valid records were split out and a single invalid record was isolated within its own transaction message. The act of splitting invalid records out from transactions to allow valid records to succeed is one way of processing the X12 transaction. Another option available within our EDI Software is to completely suspend entire transactions. This prevents all ten claims from completing our workflow. For our purposes, we have configured the workflow route to allow partial loading of transactions to our HIPAA databases, nine valid claims in this case. Claims Validation Route

3.Correcting X12 Validation Errors

We are able to view actual EDI file validation failures present within messages at the bottom of our ‘Details’ page. Here we can see that a PER segment had an invalid qualifier ‘AAA’, a SNIP type 2 error, due to a qualifier not matching an expected value. EDI Loop and Segment Errors Next, we correct our now isolated invalid record for reprocessing. Corrections are easily made by clicking on the X12 Studio Toolbox icon to the right of our invalid record. From there we have several capabilities around validating claims and working with HIPAA covered transactions. Claims validation is performed automatically as the software is launched, showing 837P errors in the bottom console and results panes. X12 Studio EDI Editing Tool

Navigating EDI files

We can navigate through the file in X12 Studio Toolbox by expanding tree nodes in the main section. HIPAA Covered Transactions Errors However, finding an invalid line is quite easy, done by clicking on our first row in the EDI X12 validation result pane. This action switches focus to lines containing errors. From this, we can see an error highlighted in segment PER, element 3 (PER03), value ‘AAA’. Here we can clearly see a highlighted EDI X12 validation error. Reviewing the software’s properties pane on the right, we can see a wealth of metadata. This section includes information such as min and max occurrences, rules, and enumeration of expected values. The latter is important for our scenario, as opening the drop-down list for PER03 in the X12 Studio Toolbox provides suggestions on possible values expected for the qualifier, EM, TE, and PH. X12 Validation Tools In our scenario, a correct value for PER03, as a qualifier of PER04 is ‘TE’ for PER04’s telephone number. Selecting ‘TE’ from the list in PER03, we see the entire 837P transaction is immediately re-validated. This results in previous EDI X12 validation failure messages being resolved. HIPAA Covered Transactions to Database

4. Resubmitting Claims

Now that the file is valid, resubmission can commence by clicking on the ‘Resubmit’ button in the toolbar. This brings our file back into the T-Connect EDI Gateway Software services, where it is sent through our HIPAA covered transactions validation workflow route shown previously. The single corrected transaction is then re-validated and can be seen in the portal as such. Tracking HIPAA Covered EDI Transactions We resubmitted the previously invalid 837P file, also removing previous X12 validation failure messages from our transaction management portal. Then, all message history and failures were retained in T-Connect for later viewing.

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Conclusion

X12 validation tools with error resolution of HIPAA covered transactions provide powerful methods for improving the quality of claim data loaded to databases. Leveraging T-Connect EDI Gateway software brings this and other validation workflow management capabilities to your fingertips.

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