Considerations when Mapping HIPAA Transactions

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Considerations when Mapping HIPAA Transactions

HL segment hierarchy

HL segments are generated automatically and do need to be mapped manually. It is however possible to map values if there is such a need. 

 

Autocompletion

The configuration files for HIPAA transactions contain many codes and are used for auto-completion of fields whenever possible. Autocompletion is context sensitive, so fields in different places may have different values. To disable auto-completion, clear the Auto-complete missing fields check box in the Component Settings dialog box (see EDI Component Settings).

 

Validation

Validation is similar to auto-completion in that it is also context sensitive. Validation errors are handled in the same way as per X12 validation (see ASC X12 Validation Rules). 

 

Editing of configurations files

HIPAA configuration files uses a newer schema version than the X12 configuration files (see EDI Configuration Schemas). Therefore, HIPAA configuration files are similar to X12 configuration files, with a few additions:

 

Code values at field level
Conditions
Completion flags
“Not Used” Data Elements

 

Code values

Field instances can have a built-in code list which is used for validation and/or autocompletion. Values can be manually added or removed (see Changing Possible Code Values of Data Elements).

 

<Data ref="F365" info="Communication Number Qualifier" nodeName="F365_1">

<Values>

         <Value Code="EM" />

          <Value Code="FX" />

 <Value Code="TE" />

</Values>

</Data>

 

Conditions

Conditions work in conjunction with values. As there can be multiple repetitions of a segment, or group (loop), they are identified by a specific condition. A Condition requires a value to be present for it to be fulfilled, otherwise the specific group is not found. 

 

For example, Loop1000 is repeated multiple times, but each instance has a different semantic meaning. 

 

To tell which is which, MapForce uses a condition that specifies that Loop1000A must have a Value Code of “41”, in Field F98 of segment NM1. If this is not the case, then Group name Loop1000A is not found.

 

<Group name="Loop1000A" info="Submitter Name">

  <Segment name="NM1" info="Submitter Name">

     <Condition path="F98" />

     <Data ref="F98" info="Entity Identifier Code">

 <Values>

    <Value Code="41" />

 </Values>

     </Data>

(…)

 

Condition codes are auto generated in the target component, if they contain single value. 

 

Configuration files are generated by a method that ensures that condition values are guaranteed to be unique across the sequence of repeating segments/loops.

 

If there is a need to edit conditions, or their values, the uniqueness constraint must be taken into account.

 

Completion flags

Autocompletion can be adjusted on the configuration file level. A new element "Completion", having three attributes, has been introduced to define this:

 

singleConditions – auto-complete single conditions for all fields in the target component
singleValues – auto-complete single values for all fields in the target component
HL – generate appropriate fields in the HL segment in the target component (for all HL segments)

 

(Where "1" means true)

 

<Message>

  <MessageType>837-Q2</MessageType>

  <Completion singleConditions="1" singleValues="1" HL="1" />

  <Description>Health Care Claim: Dental</Description>

(…)

 

"Not Used" Data Elements

HIPAA omits several optional elements that are present in standard X12 transactions. These optional elements are hidden in MapForce components.

 

The validation engine checks to make sure that these unused fields are not present in source files. Since these fields cannot be mapped to the target component (because they are hidden), they cannot appear in target output files either.

 

These fields are defined to have the maxOccurs attribute equal to 0, in the configuration files. If necessary, you can manually hide (or unhide) specific fields by using the maxOccurs attribute.

 

<Data ref="F1037" minOccurs="0" info="Submitter Middle Name or Initial" />

<Data ref="F1038" minOccurs="0" maxOccurs="0" />

<Data ref="F1039" minOccurs="0" maxOccurs="0" />

 

Scope of validation

Semantic validation is not supported in MapForce. This means that “situational” fields are simply treated as optional. 


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