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Edit and Resubmit X12 HIPAA EDI with the T-Connect Management Suite

Kevin Morillo

An EDI software’s ability to identify and respond to invalid X12 HIPAA EDI transactions is a major contributor to the effectiveness of EDI dependent organizations. Many healthcare companies appoint a business unit as stewards of the tens of thousands of transactions that are transmitted between payers, providers, and trading partners providing auxiliary services. These business units are often hard-pressed to respond to the quantity of incorrect claims, enrollments and payments received within their current EDI solutions or products.

The T-Connect EDI Management Suite is Tallan’s healthcare EDI product, providing actionable insight, alerting, and painless mechanisms to respond to invalid X12 EDI transactions flowing in and out of the organization. The following is a brief introduction into some of these capabilities.

The EDI solution consists of several components working in unison to introduce, augment or replace an EDI processing system.

· The T-Connect Management Portal, providing an area to track, remediate, or route EDI transactions.

· The T-Connect HIPAA Database, is a SQL Server EDI relational database used to store the full spectrum of HIPAA transactions.

· The T-Connect API rapidly parses EDI files into .Net objects and persists them to SQL Server databases.

· The T-Connect X12 Studio EDI Toolbox is an EDI development toolkit with a wide range of features that are essential to simplifying the EDI development process. There you’ll find features such as edi mapping, editing, validation, and the HIPAA Test File Generator which can generate various sample EDI files for any healthcare EDI transaction type.To demonstrate this remediation and resubmission scenario we will save an X12 EDI file with 10 837 Professional claims to the T-Connect intake folder, one of the many ways to consume and process an EDI transaction within T-Connect. This file contains 9 valid claims and a single invalid claim. The goal of the intake is to parse and persist the file into our T-Connect EDI 837 P Professional database, however as will be shown in the proceeding sections, the invalid claim will have to be fixed before it can succeed.

The below screenshot shows the home page of the site, showing all X12 EDI transaction set types currently authorized for viewing by the logged in user, in this case Administrator. This page also shows the date of last activity for a transaction set, as well as total number of successful and failed transactions.


Clicking on a row, such as 837P Claim, brings us to the next page, one level deeper in navigation to the Messages page, showing a history of processed files (transactions). We could search, sort or filter to a specific transaction, however, we can see that there was a single error out of the 10 total rows in the first entry in the rest list.


Selecting the first row from the results, we are brought to the next page (Details) showing the resulting processing history of the transaction selected. This history is represented as steps within a workflow route. These steps below provide a sample route performing WEDI SNIP Validation, acknowledgment generation, and routing of the valid and invalid records of the transaction. The route is user configurable within the portal.

In the below page, we can see an error produced by the first step, SNIP Validation, identifying one of the 10 total records as invalid. In subsequent steps, we can see the 9 valid records split out of the claim, and the single invalid record isolated within its own transaction message. The act of splitting the invalid records out of the transaction to allow the valid records to succeed is one way of processing the EDI. Another option available within T-Connect is the complete suspension of the entire transaction, in this case all 10 claims would have been prevented from completing the workflow. For our purposes, we have configured the workflow route to allow partial loading of transactions, the 9 valid claims in this case.


We are able to view the actual validation failure present within the message at the bottom of the Details page. Here we can see that the PER segment had an invalid qualifier ‘AAA’, a SNIP Type 2 HIPAA Implementation Guide Requirement Testing error, due to the qualifier not matching an expected value.


The next logical action may be to correct the now isolated invalid record for reprocessing. Correction is easily done by clicking on the X12 Studio icon to the right of the step with the invalid record, launching the X12 Studio Toolkit, an X12 EDI editor with several capabilities around the validation and manipulation of EDI transactions. Validation of the claim is done when launched, showing validation failures in the bottom console and validation results panes.


We can navigate through the file by expanding the tree nodes in the main section.


However, finding the invalid line is quite easy, done by clicking on the first row in the validation result pane. This switches the focus to the line containing the error. From this, we can see the error highlighted in segment PER, element 3 (PER03), value ‘AAA’. Not only do we clearly see the highlighted validation error, but reviewing the properties pane on the right we can see a wealth of metadata including min and max occurrences, rules, enumeration of expected values. The latter is important for our scenario, as opening the drop down list for PER03 , we can see the possible values expected for the qualifier, EM, TE, and PH.



In our scenario, the correct value for PER03, as a qualifier of PER04 is ‘TE’ for PER04’s telephone number. Selecting ‘TE’ from the list in PER03, the entire transaction is immediately re-validated resulting in the removal of the previous validation failure message.


Now that the file is valid, resubmission can commence by clicking on the ‘Resubmit’ button on the toolbar. This allows for the resubmission of the now valid file back into the T-Connect Management Suite’s services, where it is sent through the workflow route shown previously. The single corrected transaction is then revalidated, and can be seen in the portal as such.


The resubmission of the file allowed the one remaining previously invalid, also removing the previous validation failure message from the portal, though all message history and failures are retained in T-Connect for later viewing.


Tracking and resolution of invalid HIPAA EDI transactions is a powerful capability with many applications. Leveraging the T-Connect EDI Management Suite brings this and other capabilities to your fingertips.

To begin a conversation with Tallan and see T-Connect in action, contact us today to discuss how we can improve your EDI management capabilities.

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