EDI HIPAA SNIP Compliance

HIPAA all the way

EdiFabric has helped customers to acquire CAQH Certifications and our products are used to boost claims, remittance, eligibility, and claims status processing by several major HIPAA clearinghouses.

EdiFabric supports all HIPAA validation level types out of the box. Any extra partner-specific, custom EDI code or product type requirements can be achieved by either amending the EDI C# classes or extending the validation logic.

We support the processing of very large 834 and 835 EDI files by using a unique transaction splitting technology which allows us to both validate EDI documents and then generate automatic acknowledgments for these EDI documents regardless of their size.

 

 

 


 

 

 

HIPAA SNIP Type 1

EDI Standard Integrity Testing: Validate the basic syntactical integrity of the EDI submission.

EDI Templates define the structure of EDI documents. Syntactical integrity is inherently interwoven into the notion of EDI Templates. The translator allows for partial parsing, however partial parsed messages are considered invalid and by default, every time IsValid() is executed against any C# POCO, this is reported together with any missing trailer or mismatch in segments count\transaction reference numbers.

Use the templates without validation attributes to only execute Type 1 validation.

Supported HIPAA Templates

To apply Type 1 validation only whilst using the Enterprise templates, set the  DiscardValidationAttributes flag in ValidationSettings to true.

 

 

 


 

 

 

HIPAA SNIP Type 2

Type 2 HIPAA Implementation Guide Requirement Testing: Validate HIPAA requirement-guide-specific syntax requirement by checking limits on repeat counts, used or not used qualifiers, code, elements, and segments.

This is covered by the default execution of EdiFabric's EDI Validator and the range of validation attributes.

The EDI validator also checks the integrity of all EDI data element data types.

Use the templates without validation attributes to only execute Type 2 validation and don't pass syntax sets as part of the ValidationSettings.

  

 

 


 

 

 

HIPAA SNIP Type 3

Type 3 HIPAA Balance Testing: Validate that claim line item amounts are equal to the total claim amount.

Balance validation for claims can be additionally included by using the custom validation extension. Our validator can be configured to apply any extra validation requirement to either amend the existing behavior or to apply a new one.

Use custom code to enable and execute Type 3 validation.

 

 

 


 

 

 

HIPAA SNIP Type 4

Type 4 HIPAA Inter-Segment Situation Testing: Validate inter-segment relationship. For example, if element A exists, then element B must be populated.

EDI Validator supplies a range of conditional validation attributes to execute inter-segment validation.

Use the full templates (included as part of a purchased plan) to automatically apply Type 4 validation.

By default, EdiFabric validates all syntax notes only. Additionally, we provide conditional attributes that can be used for HIPAA situational validation.

 

 

 


 

 

 

HIPAA SNIP Type 5

Type 5 HIPAA External Code Set Testing: Validate specific code set values for HIPAA standards.

You can import external codes either statically, by specifying custom Code set classes, or dynamically, by specifying a code set map:

All EDI codes are represented as strings in the EDI templates and can be edited at any time. EDI code sets validation is included in the general EDI Validator logic.

Use the full templates (included as part of a purchased plan) to automatically apply Type 5 validation together with EDI Code Maps passed as part of the ValidationSettings.

  

 

 


 

 

 

HIPAA SNIP Type 6

Type 6 Product Type/Type of Service Testing: Validate that segments that differ based on certain Health-care services are properly created and processed.

This type of validation is covered as part of the EDI templates. Our DOM model allows for very detailed transaction composition and the same segment (a segment with the same identifier) can have different values or EDI codes at different levels, and when included in different groups.

Supported HIPAA Templates

Use both the templates without validation attributes or the full templates (included as part of a purchased plan) to automatically execute Type 6 validation.

 

 

 


 

 

 

HIPAA SNIP Type 7

Type 7 Trading Partner-Specific Testing: Compliance with the payer-specific requirement.

Our EDI templates allow you to quickly configure every EDI transaction to conform with your trading partner requirements. EdiFabric employs a comprehensive mechanism to identify EDI transactions by the sender and receiver EDI codes in the ISA or UNB segment and then to load the customized partner-specific version of the EDI template corresponding to the EDI transaction.

Use both the templates without validation attributes or the full templates (included as part of a purchased plan) to automatically execute Type 7 validation. You'll need to manually model template copies per partner and reflect the desired changes in the dedicated template.

Was this article helpful?
4 out of 4 found this helpful