What are the HIPAA SNIP types available in T-Connect EDI Software products? We get this question a lot, so we’ve been blogging about the different categories WEDI has defined to validate healthcare EDI transactions. Thus far, we’ve covered:
WEDI SNIP Levels:
- SNIP 1 & 2 Integrity and Requirement Testing
- SNIP 3 Claim Balancing
- SNIP 3 Remittance Advice Balancing
- SNIP 4 Intersegment Situational Testing
- SNIP 5 External Code Set Testing
These rules are sometimes referred to as SNIP levels – although that may wrongly imply that each type builds upon the previous category. In actuality, each SNIP type is a standalone set of validations rules.
In this article, we’ll focus on SNIP 6.
Type 6 ( Snip 6 )
SNIP 6 enforces situational rules specific to service lines and products. While SNIP 4 also focuses on situational rules that analyze the relationships between loops, segments and elements, SNIP 6 differs in that the rules apply to subsets within the transaction sets.
For example, within an 837 claim transaction, there are many service line subsets. Some examples are:
- Durable Medical Equipment (DME)
- Workers Comp
- Home Health Care
The complete listing of SNIP 6 rules resides in the TR3s published by WPC. The following examples illustrate situational rules specific to service line subsets within claims.
In this example, the validation rule requires coordination between the provider and the payer. The payer has determined the presence of the CR2 segment will impact adjudication processing. Providers can reasonable expect the payer to communicate this situational requirement in a companion guide.
This requirement specifies the 2300 CR1 must be present on claims in which ambulance transportation was required, although CR1 may be present on both the claim and service line levels. A payer may enable this SNIP rule when their adjudication system requires documentation of medical necessity. For example, CR1 may be used to supply relevant information such as patient weight and the reason for ambulance transport.
Validation with T-Connect
The T-Connect EDI Gateway allows administrators to enable and disable SNIP 6 rules on an individual basis. Rules may be enabled globally, or based on transaction type or trading partner.