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,")]
  -----------------------------------------------------------------------------------------