HIPAA Situational Validation

HIPAA situational validation is part of HIPAA SNIP Level 4 and is considered cross-segment type validation, where if a data element in a certain position exists or is of a certain value, then another data element in that segment needs to conform to certain rules.

EdiFabric allows you to implement this functionality by using either a custom validation attribute or implementing custom validation at the segment level.

In addition to that, there are two attributes that enforce the situational type of validation and are currently used for the rules in the table below.

  • RequiredIf
  • ExclusionIf

HIPAA situational validation attributes.

The attributes were applied to the following HIPAA 5010 transactions: 270, 271, 276 and 277, and are available as part of the Enterprise plan.

  • 270
    -----------------------------------------------------------------------------------------
    Loop:2100A
    Segment:NM1 - INFORMATION SOURCE NAME
    Page:69
    Class:NM1_InformationSourceName
    Added:[RequiredIf(2, ",1,")]
    -----------------------------------------------------------------------------------------
    Loop:2100B
    Segment:NM1 - INFORMATION RECEIVER NAME
    Page:75
    Class:NM1_InformationReceiverName
    Added:[RequiredIf(2, ",1,")]
    -----------------------------------------------------------------------------------------
  • 271
    -----------------------------------------------------------------------------------------
    Loop:2100B
    Segment:REF - INFORMATION RECEIVER ADDITIONAL IDENTIFICATION
    Page:236
    Class:REF_InformationReceiverAdditionalIdentification
    Added:[RequiredIf(1, ",0B,")]
    -----------------------------------------------------------------------------------------
    Loop:2100C
    Segment:REF - SUBSCRIBER ADDITIONAL IDENTIFICATION
    Page:254
    Class:REF_SubscriberAdditionalIdentification_3
    Added:[RequiredIf(1, ",18,6P,N6,")]
    -----------------------------------------------------------------------------------------
    Loop:2110C
    Segment:REF - SUBSCRIBER ADDITIONAL IDENTIFICATION
    Page:314
    Class:REF_SubscriberAdditionalIdentification
    Added:[RequiredIf(1, ",18,6P,N6,")]
    -----------------------------------------------------------------------------------------
    Loop:2100D
    Segment:REF - DEPENDENT ADDITIONAL IDENTIFICATION
    Page:358
    Class:REF_DependentAdditionalIdentification_3
    Added:[RequiredIf(1, ",18,6P,N6,")]
    -----------------------------------------------------------------------------------------
    Loop:2110D
    Segment:REF - DEPENDENT ADDITIONAL IDENTIFICATION
    Page:417
    Class:Loop:REF_DependentAdditionalIdentification
    Added:[RequiredIf(1, ",18,6P,N6,")]
    -----------------------------------------------------------------------------------------
    Loop:2110C
    Segment:EB
    Page:290
    Class:EB_SubscriberEligibilityorBenefitInformation
    Added:
    [ExclusionIf(1, ",A,")]
    [RequiredIf(1, ",B,C,G,J,Y,")]

    [ExclusionIf(1, ",B,C,G,J,Y,")]
    [RequiredIf(1, ",A,")]
    -----------------------------------------------------------------------------------------
    Loop:2110D
    Segment:EB
    Page:394
    Class:EB_DependentEligibilityorBenefitInformation
    Added:
    [ExclusionIf(1, ",A,")]
    [RequiredIf(1, ",B,C,G,J,Y,")]

    [ExclusionIf(1, ",B,C,G,J,Y,")]
    [RequiredIf(1, ",A,")]
    -----------------------------------------------------------------------------------------
    Loop:2100A
    Segment:NM1 - INFORMATION SOURCE NAME
    Page:218
    Class:NM1_InformationSourceName
    Added:[RequiredIf(2, ",1,")]
    -----------------------------------------------------------------------------------------
    Loop:2120C
    Segment:NM1 - SUBSCRIBER BENEFIT RELATED ENTITY NAME
    Page:329
    Class:NM1_DependentBenefitRelatedEntityName
    Added:[RequiredIf(2, ",1,")]
    -----------------------------------------------------------------------------------------
    Loop:2120D
    Segment:NM1 - DEPENDENT BENEFIT RELATED ENTITY NAME
    Page:432
    Class:NM1_DependentBenefitRelatedEntityName
    Added:[RequiredIf(2, ",1,")]
    -----------------------------------------------------------------------------------------
  • 276
    -----------------------------------------------------------------------------------------
    Loop:2100B
    Segment:NM1 - INFORMATION RECEIVER NAME
    Page:45
    Class:NM1_InformationReceiverName_3
    Added:[RequiredIf(2, ",1,")]
    -----------------------------------------------------------------------------------------
    Loop:2100C
    Segment:NM1 - PROVIDER NAME
    Page:49
    Class:NM1_ProviderName
    Added:[RequiredIf(2, ",1,")]
    -----------------------------------------------------------------------------------------
    Loop:2100D
    Segment:NM1 - SUBSCRIBER NAME
    Page:56
    Class:NM1_SubscriberName_2
    Added:[RequiredIf(2, ",1,")]
    -----------------------------------------------------------------------------------------
  • 277
    -----------------------------------------------------------------------------------------
    Loop:2100B
    Segment:NM1 - INFORMATION RECEIVER NAME
    Page:118
    Class:NM1_InformationReceiverName_3
    Added:[RequiredIf(2, ",1,")]
    -----------------------------------------------------------------------------------------
    Loop:2100C
    Segment:NM1 - PROVIDER NAME
    Page:126
    Class:NM1_ProviderName
    Added:[RequiredIf(2, ",1,")]
    -----------------------------------------------------------------------------------------
    Loop:2100D
    Segment:NM1 - SUBSCRIBER NAME
    Page:135
    Class:NM1_SubscriberName_2
    Added:[RequiredIf(2, ",1,")]
    -----------------------------------------------------------------------------------------
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