PH16251: COMPLIANCE CHECK ISSUE IN VALIDATION OF UM SEGMENT DATA USING 278N HIPAA TYPE 2 TYPE TREE

APAR status

• Closed as program error.

Error description

• Encountering unexpected error/issue in validation of UM segment
  data using 278N HIPPA type2 tree.
  
  For the below segment value
  UM*AR*I*1*11:A**03~
  
  Error in the component rule validation is occurring. As per the
  rule, we can have LevelOfServiceCd only when Cert'nTypeCd is 1
  but in the implementation guide it is mentioned that we may
  have LevelOfServiceCd for Cert'nTypeCd other than 1 also in
  some cases. This is not being allowed currently in the type
  tree.
  
  The situation rule clearly says required when UM02 = 1 (OR) if
  the patient event requires a level of service for care other
  than routine.
  
  The condition - (OR) if the patient event requires a level of
  service for care other than routine - seems to be not included
  in the type tree.
  
  Issue recreated using modified sample data file
  (278n_5010_examples.dat), as follows:
  
  ISA*00*     *00*     *ZZ*HEALTHCARE_DEV *ZZ*HEALTHCARE_PS...
  GS*HI*DEVELOPMENT*PROFSERV*20080318*1846*59*X*005010X216
  ST*278*2250*005010X216
  BHT*0007*CN*2004000345628*20040601*1410*NO
  HL*1**20*1
  NM1*1P*2*St Joseph Hospital*****XX*1234567890
  HL*2*1*21*1
  NM1*X3*2*Maryland Capital Insurance Company*****46*789312
  HL*3*2*22*1
  NM1*IL*1*Smith*Joe****MI*12345678901
  DMG*D8*19580322*M
  HL*4*3*EV*0
  TRN*1*040601002349A*9000012121
  UM*AR*I*1*11:A**03
  :
  :
  
  The resultant compliance_check_TAck.html:
  
  TRANSMISSION
  - TYPE 2: ERRORS NOTED TYPE 3: ACCEPT TYPE 4: ACCEPT
  - INTERCHANGE Sequence: 1 Control Number: 000000001
  - TYPE 2: ERRORS NOTED TYPE 3: ACCEPT TYPE 4: ACCEPT
  - FUNCTIONAL GROUP Sequence: 1 ID: HI Control Number: 59
  - TYPE 2: ERRORS NOTED TYPE 3: ACCEPT TYPE 4: ACCEPT
  - TRANSACTION SET Sequence: 1 TransactionSetID: 278
    Transaction Set Control Number: 2250
  - TYPE 2: REJECT TYPE 3: ACCEPT TYPE 4: ACCEPT
  - SEGMENT At position: 12 UM {Health Care Services Review
    Information} in loop 2000E
  - TYPE 2: error
  - ELEMENT UM06 {Level of Service Code}
  - TYPE 2: error
  - Error Code: 10 {Exclusion Condition Violated}
  - Data Content: 03
  - TRANSACTION SET Sequence: 2 TransactionSetID: 278
    Transaction Set Control Number: 2251
  - TYPE 2: ACCEPT TYPE 3: ACCEPT TYPE 4: ACCEPT
  - TRANSACTION SET Sequence: 3 TransactionSetID: 278
    Transaction Set Control Number: 2252
  - TYPE 2: ACCEPT TYPE 3: ACCEPT TYPE 4: ACCEPT
  

Local fix

• ITXCQ - ITX00059963
  JK / JK
  Circumvention: None
  

Problem summary

• Users affected:
  Transformation Extender Pack for Healthcare Payer HIPAA
  
  Problem Description:
  UM06 element in 278N failing if absent and UM02 = 1
  
  Platforms affected:
  ALL
  

Problem conclusion

• Rule was too restricitive. UM06 had to be present if UM02 = 1,
  but nothing indicated had to be ABSENT otherwise. ABSENT check
  was removed from trees
  
  Applies to:
  Healthcare Payer 9.0.2, 10.0
  
  Fixed in the next Service Pack and releases.
  
  To obtain the fix for this APAR:
  
  To see if the next service pack or product release is available,
   check the IBM Transformation Extender Release Notes page:
  http://www.ibm.com/support/docviews.wss?uid=swg27008337
  
  If the service pack or product release is available, download it
  from Fix Central:
  http://www.ibm.com/support/fixcentral/
  
  If the service pack or product release is not available and you
  require the APAR fix immediately, request a Limited Availability
  Interim Fix (LAIF) by openung a PMR:
  http://www.ibm.com/mysupport/
  
  Prior to version 9.0.0, IBM Transformation Extender was called
  IBM WebSphere Transformation Extender.
  

Temporary fix

Comments

APAR Information

• APAR is sysrouted FROM one or more of the following:

• APAR is sysrouted TO one or more of the following:

Fix information

• Fixed component name

  TX HIPPA EDI

• Fixed component ID

  5724M6100

Applicable component levels