Type 6 Validation
This support is only available with the HIPAA Data Compliance application.
Overview
Type 6 validation can be defined as the process of confirming that HIPAA X12 transaction data for claims complies with specific line of service requirements. Details about line of service requirements are included in the HIPAA X12 Implementation Guides.
These line of service requirements are generally expressed as situational rules and may be
associated with segments or data elements. Line of service categories such as ambulance,
chiropractic, and podiatry are given as examples of line of service categories in the Type 6
definition. In the Pack for Healthcare, the following principles have been applied to distinguish
line of service requirements from recommendations or other types of situational rules:
- Self-contained requirements - A self-contained requirement is one where all situational criteria can be evaluated using only the information present in the transaction set. A situational rule that includes a condition such as "when the distance of transportation is known" or "when the data is present in the UMO's system" is a recommendation, not a requirement.
- Unambiguous requirements - A requirement is considered unambiguous if all of its criteria can be evaluated using information from identifiable locations.
- Distinct requirements - A distinct line of service requirement is one that is not already enforced by another HIPAA X12 validation such as a syntax rule enforcing the presence of related elements.
The scope of Type 6 validation is limited to the Health Care Claim (837) and Health Care Services Review (278) transaction sets.