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.
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…
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.