ITX Pack for Healthcare Payer

Overview
The SPE Pack for Healthcare Payer is a healthcare industry accelerator that provides Business-to-Business (B2B) enablement for use with the IBM Standards Processing Engine (SPE).
Healthcare industry
This documentation discusses technical terms and other information that is used to exchange data in the Healthcare industry.
HIPAA EDI Type trees
Maps
The SPE Pack for Healthcare Payer includes data transformation maps, and maps for data validation. Data validation maps are either pass-through maps, or they are related to the Compliance Check application.
Sample data
Sample data is provided for use with the type trees and maps in the SPE Pack for Healthcare Payer.
SPE HIPAA Compliance Checker
The IBM SPE HIPAA Compliance Checker for HIPAA X12 data validation and compliance reporting contains a series of executable maps used to validate HIPAA X12 transmission data and to report compliance with industry requirements. The compliance_check.mms file is the source file for the SPE HIPAA Compliance Checker.
Claim Level Rejection
The SPE Pack for Healthcare Payer allows invalid claims to be rejected, and valid claims to be processed. Validation is run on the document level (claim) for the 5010 837 Claims Transactions.
Global Configurable Rules
The SPE Pack for Healthcare Payer allows you to enable, or disable WEDI/SNIP extended Level 2, Level 3 Level 4 and Level 6 rules, as defined in the Compliance Check module.
SPE Pack for Healthcare Payer samples
This documentation describes how to use the samples that are installed with the SPE Pack for Healthcare Payer.
Type 5 validation
The SPE Pack for Healthcare Payers includes the option to validate data content against external code sources. This process can also be referred to a WEDI/SNIP Type 5 or external code list (ECL) validation or Type 5. The documentation that is provided here describes the objects and the processes that the Standards Processing Engine uses for Type 5 checking of HIPAA X12 data. It also contains information on how to activate and modify Type 5 validation for your environment and business needs.
Type 6 validation
The SPE Pack for Healthcare Payer includes the option to validate data content against requirements specific to a product type or line of service. This process can also be referred to as WEDI/SNIP Type 6 validation or simply Type 6.
Type 7 validation
Performance tuning
HIPAA X12 data structures tend to be hierarchal in nature, the semantic and business rules tend to many and complex, and some of the data files can be large. Taking these facts together it is easy to see why the topic of performance is important when processing HIPAA data. There are several techniques, which can be applied to improve the performance of the HIPAA data processing within SPE, which can be used to separate, combine, validate and transform data. Some of these techniques rely on the standard IBM performance tuning recommendations.
Acknowledgment errors