Tallan's Blog

Tallan’s Experts Share Their Knowledge on Technology, Trends and Solutions to Business Challenges

SNIP 6 – Line of Service or Product

What are HIPAA SNIP types? 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:

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 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…

SNIP 4 – EDI Intersegment Situational Rules

WEDI SNIP Types define sets of rules for validating EDI transactions such as 837 claims, 834 enrollments or 835 Remittance Advice.
Previously, we’ve blogged about:

SNIP 1 & 2 Integrity and Requirement Testing
SNIP 3 Claim Balancing
SNIP 3 Remittance Advice Balancing
SNIP 5 External Code Set Testing

This article focus on SNIP 4, which test situational rules spanning separate loops, segments, or elements. What differentiates these rules from Type 2 is that the situational tests span distinct segments, while Type 2 is considered intrasegment testing. Intrasegment tests validate the presence of elements within the same segment based on syntax rules.
Type 4
SNIP 4 situational rules break into two categories. Both categories consist of a condition statement, then a data item (loop, segment, or element) which should (or should not) be present based on the rule evaluation.
Category 1
The first category of situational rules specifies that sending the specified data item is up…

SNIP 5 – HIPAA External Code Set Testing

The HIPAA X12 EDI specification allows for the inclusion of code values that may be pertinent to the transaction set, such as a claim or encounter. These code values can represent a data point as widespread as a postal or zip code, or as complex as diagnosis and procedure codes.
WEDI describes seven types of validation, referred to as SNIP 1-7, as covered in some of our previous blog posts on SNIP 3 Balancing of Claims and Payments. SNIP 5 – HIPAA External Code Set Testing is the validation of code values against the external code sets they represent.
SNIP 5
As previously stated, SNIP 5 validates that code value exists within an external code list. For example, if a postal (zip) code is present in a subscriber’s address, then it should align with an actual postal code in as determined by the USPS, the…

Designing & Developing The Award-Winning malegislature.gov

At this year’s National Conference of State Legislatures (NCSL) Legislative Summit in Los Angeles, the Commonwealth of Massachusetts took home the NALIT/LINCS Online Democracy Award for the best legislative website in the country. Tallan has worked hand-in-hand with the Massachusetts General Court for the better part of a decade, and this is the second time we have helped them take home this prestigious award. This is, however, the first time we’ve done it with a complete website redesign from beginning to end. This will be an exploration of some components of the redesign, and what helped make it such a successful effort.

Accessibility First
A key component of any government website is accessibility. Designers and developers need to make sure that all information is available to all users through the same interface. With Massachusetts, we approached every feature or idea by asking…

Rapid EDI Trading Partner Onboarding with T-Connect

HIPAA X12 EDI transmission between the many entities in the HealthCare industry is performed using files conforming to ANSI X12 specifications. These Claim, Premium Payment and Remittance Advice EDI files may originate from payers, providers, clearinghouses, or third party administrators (TPAs). One prevalent hurdle in sending or receiving these EDI transactions is the often complex onboarding process of new trading partners.
HIPAA EDI files in X12 format may typically look similar to the sample below.

Submitting Workers Compensation Claims as 837s

Workers compensation claims contain a special set of requirements when submitted in the EDI 837 format. This article describes these specific characteristics.

In a standard 837, the 2000B loop always contains subscriber information (the primary insured individual). Claim level information (2300 loop) is nested beneath the 2000B loop in this scenario. The 2000C (Patient) loop is present in the case in which the claim is related to a dependent of the subscriber. In these cases, the 2300 loop is nested under 2000C. In workers comp claims, a 2000B and 2000C loop always exist, and their purposes are a bit different. Information related to the employer goes into the 2000B loop, while the 2000C loop is used for the claimant (the injured worker). The concept of a dependent doesn’t exist in workers comp claims.

The SBR segment present in 2000B is a required…

Why Insurers Should be Helping Their Customers Complain More

Here’s an interesting fact from a Forbes article published earlier this year, regarding end-consumers in the insurance industry:
“91% of non-complainers just leave”1
This tells us that there are two types of customers in the insurance world: complainers, and non-complainers.  Among non-complainers, more than nine out of ten actively choose to take their business to another company.  The insurer they leave behind must deal with the following consequences:

Loss of future revenue streams
Negative word-of-mouth
Lack of insight into why the customer chose to leave in the first place

The significance these metrics have on bottom line revenue can’t be understated.  These are customers that were already paying for a service – that had already gone through a decision-making process, chosen one insurer, and were so dismayed with some aspect of their service that they chose to begin this entire search process again.
But there’s a simple…

CAQH CORE Certification Tips

CAQH CORE certification demonstrates that health plans, clearinghouses and software vendors meet federally mandated operating rules when exchanging HIPAA EDI transactions. Internally for organizations, the certification process provides value by exercising a broad variety of test cases. Last but not least, CORE specifies the message envelope details for exchanging EDI over two types of HTTP endpoints, reducing the implementation times that custom message formats can incur.
The CAQH website is the complete resource for understanding the types and variations of CORE certification. In this article, we’ll take a complementary approach. Rather than attempt to summarize the full spectrum of options, we’ll focus on a single use case in order to highlight key information and technical challenges. Tallan’s T-Connect Eligibility Module places us in the software vendor category. Our EDI management solution enables health plans to act as an information source to respond to 270 Eligibility requests with a…

Three Reasons Chatbots are Transforming the Automotive Industry

We’ve partnered with our client, Valassis Digital, to produce a Webinar this Thursday (9/20) in an effort to highlight the successes Chatbots have created for their clients. 
Valassis, a digital advertising agency, commissioned our AI team to build a Bot that can be replicated quickly, and at scale,  crossing the many industries they work with.  These bots have been padding their customers sales pipelines and have been credited specifically with a record sales month, in one instance!
Take a look at this article on ‘3 Reasons Chatbots are Transforming the Automotive Industry’ and then tune in on Thursday to see and hear about some of these use cases yourself.
By Robin Shapiro, Strategy Development, Valassis Digital
Published Wednesday, Aug 1, 2018

It is no surprise that today’s consumers are increasingly engaging in chat and messenger apps. A recent survey reports that 89 percent of consumers…

Tracking and Fixing Encounters, Enrollments and other EDI with T-Connect

There are several ways to intake, parse and route encounters, enrollments, payments and other HIPAA X12 EDI files. However, there are often deficiencies that become quickly apparent, as not many systems provide an adequate level of insight into the status of the in-flight files, nor do they have the tools needed to respond to issues once they arise.

\\\