HIPAA Data Compliance Parameters

L

A

U

M

W

false*

C:\\DIR\\

Or

/dir/

C:\\DIR\\

Or

/dir/

JDBC

MONGO*

M*

C

B

M (MAP): This default setting sends all data through the pass through validation maps and only the invalid data goes through the subsequent processing, and also valid data that must be processed for rules only supported by the detailed compliance check processing. This is the recommended, and the default setting.

C (COMPLIANCE): This setting causes all data to be passed to the detailed processing done by the Compliance Check application.

B (BOTH): This setting causes all data to be processed both by the pass through validation maps and the detailed compliance check validation. If there is a large amount of data, this option can slow the process. This option is used for troubleshooting purposes, logic modules, or both.

true* - Reject unsupported 5010 versions in the envelope checking process.

false - Don't reject unsupported versions, and validate them at currently supported versions.

false - Never validate the contents of the BIN/BDS segment.

XML - Validate the contents of the BIN/BDS segment for proper XML formatting and against the schema.

false

false*

Indicates whether Functional Group control numbers should be checked for duplicates within an interchange.

false

T*

T (TRANSACTIONAL SET): Rejects the duplicate transaction sets only.

false*

false*

All – Only reject transaction set when all claims are in error or when an error is outside the Provider loops. If error is at the provider, subscriber, or patient level, all claims for that provider, subscriber, or patient will be rejected.

Claim - Reject transaction set when all claims are in error, or when error is outside of Claim Loop.

false*

The Duplicate CLMCheckFullSegment controls whether just CLMO1 or the full CLM segment is used to determine if claim level rejection processing can continue for this transaction.

If the parameter is set to true - Disable Claim level rejection, if the entire CLM segment is not unique for all claims in the transaction.

false*

false*

false

false*

false

false

false*

false*

Errors* - Report exceptions as errors and reject the data.

Warnings - Report exceptions as warnings and accept the data.

This parameter lets you to flag Type 6 validation results as warnings or errors.

Errors - This default setting causes data to be rejected when Type 6 validation errors occur and the errors are reported on the 999 acknowledgment. The errors are not reported on the 824 Application Advice.

false*

Errors* - Report exceptions as errors and reject the data.

Warnings - Report exceptions as warnings and accept the data.

This parameter lets you to flag Type 7 validation results as warnings or errors.

Errors - This default setting causes data to be rejected when Type 7 validation errors occur and the errors are reported on the 999 acknowledgment. The errors are not reported on the 824 Application Advice.

Java

C

None*

(User specific value)

None*

(User specific value)

None*

false*

false*

Indicates whether the results from the WEDI/SNIP Type 1 interchange envelope checks should be reported using the X12

Errors* - Generate an X12 standard TA1 for the interchange only when the results of the compliance check indicate the presence of Type 1 errors in the interchange envelope.

Always - Always generate an X12 standard TA1 for all interchanges even if compliance check does not indicate the presence of Type 1 errors in the interchange envelope.

Requested - Generate an X12 standard TA1 for all interchanges based on the value in the input ISA14.

Input ISA14 value of 0 - No Interchange Acknowledgment Requested will identify the same behavior as Never.

Input ISA14 value of 1 - Interchange Acknowledgment Requested (TA1) will identify the same behavior as Always.

false

false*

Indicates whether the results from the WEDI/SNIP Type 1 checks should be reported using the X12 standard 997 transaction set.

If Type 1 checks are not enabled, this will be set to false.

Errors* - Generate an X12 standard 997 for the interchange only when the results of the compliance check indicate the presence of Type 1 errors in the interchange

Always - Always generate an X12 standard 997 for all interchanges even if compliance check does not indicate the presence of Type 1 errors.

(User-specified numeric value)

9999*

false*

Indicates whether the results from the WEDI/SNIP Type 2 interchange envelope checks using HIPAA specific code values should be reported using the TA1 segment.

Errors* - Generates an X12 standard TA1 for the interchange only Type 1 errors present in the interchange envelope.

Always - Always generates an X12 standard TA1 for all interchanges, even if Type 1 errors are not present in the interchange envelope.

Requested - Generates an X12 standard TA1 for all interchanges based on the value in the input ISA14.

Input ISA14 value of 0 - No Interchange Acknowledgment Requested will identify the same behavior as Never.

Input ISA14 value of 1 - Interchange Acknowledgment Requested (TA1) will identify the same behavior as Always.

false*

Errors - Generates only when WEDI/SNIP type errors are present in the interchange.

Always* - Always generates even if WEDI/SNIP type errors are not present in interchange.

false*

For implementation dependent missing segments (I6), use true for this setting if the missing segment is to be reported in the IK3. This will result in more information in the 999 by allowing the existing segment to be included in a CTX segment. Since the segment is missing, the segment position indicated will vary – it may be the position of the existing segment that caused the requirement, the segment location in the transaction where it was determined the missing segment was not present, or the end of a loop.

Use false to report the existing segment, which caused the requirement for the missing segment to be reported in the IK3.

(User specified numeric value)

9999*

false*

Indicates whether the results from the Claim Level Rejection process should be reported using the 5010 277CA transaction set.

false*

Indicates when the results from the WEDI/SNIP checks should be reported using a 277CA.

Provider* - 277CA reports details at the Provider Level. This option will not provide specific details on each claim, only on the totals accepted/rejected for each Provider.

Claim - 277CA reports details at the Claim Level. This option will provide specific details on each Claim within the transaction.

All - 277CA reports all details at both Provider and Claim. If there are no errors, then the reporting will include the Patient/Claim details.

Indicates the level at which the HIPAA 277 Claims Acknowledgment reports. It can show details at the Provider level, or it can show details down to the Patient/Claim Level. This parameter will only have an impact if the Claim Level Rejection is enabled and the input HIPAA EDI data is a Claim (837). If there are no errors in the HIPAA EDI 837 data, then reporting will only go to the Provider Level, regardless of the setting.

Using options Claim or All may impact performance if there is a large quantity of claims in the data.

false*

Indicates whether to produce a BHT03 value based on the interchange, functional group, and transaction control numbers of the source 837 being validated.

If false, 277X2140001 is always set as a value for the BHT03 element.

false*

Indicates whether the Translated Acknowledgment Report will be produced. This report transforms the 997 and 999 acknowledgments into a more readable report.

Errors* - Generate only when WEDI/SNIP type errors are present in the interchange.

Always - Always generate even if WEDI/SNIP type errors are not present in interchange.

false*

Indicates the level of reporting in the Translated Acknowledgment Report.

Full* – Generates TAck_EDI.html file with all the transactions in the data.

Partial - Generates TAck_EDI.html file with only the transactions in error.

None

Indicates whether the TAck_EDI file, which is a html tagged version of the transactions being validated, is produced with all the original data, or just the transactions that have errors reported.

If Acknowledgments Tack Enabled is false, this parameter is not used.

If Acknowledgments Tack Enabled is true, the default for this is Full.

Options Partial or None may help overall performance.

JSON

BOTH

Use the HTMLOrJSON parameter set to JSON or BOTH to optionally create ../data/compliance_check_TAck.json in output card 13.

When either HTML or BOTH is used, the /data/compliance_check_TAck.html is produced in output card 11.

false

false*

Indicates whether to include the functional group control number in the grouping of functional groups within an acknowledgment.

If the setting is false, only the GS02, GS03, GS07, and GS08 are used to determine a unique functional group for reporting in the acknowledgment.

If the setting is true, then the GS06 is also included in the determination.

false*

The IncludeISA13InAcks parameter is used when it is desired to use the ISA13 (control number) of the input transmission file for acknowledgments produced. If the parameter is set to true, the ISA13 value of the input transmission file will be used.

If the parameter is set to false, a default control number will be used.

false*

Indicates whether to include the functional group control number in the grouping of functional groups within an acknowledgment. It does NOT affect the value of GS06 in the acknowledgment generated, which always starts with 1.

If the setting is false, only the GS02, GS03, GS07, and GS08 are used to determine a unique functional group for reporting in the acknowledgment. So if the input has multiple functional groups with different control numbers (GS06) but have the same values for GS02, GS03, GS07, and GS08, the acknowledgment information is grouped into a single functional group in the output.

If the setting is true, the number of functional groups generated in the acknowledgment will depend on the input.

false*

Create functional group in acknowledgment based on functional groups in the input, regardless of any GS values in the input.

The number of functional groups in the acknowledgment will be the same as the number of functional groups present in the input.

Tuning

Paging

Indicates the page size and page count to be used for the execution of compiled maps that will be executed by hipaa_data_compliance map with the RUN function.

The first number is Page Size, and the second number is page count.

The page size value may be an even integer between 2 and 1024. The page count may be an integer between 1 and 9999.

This setting is not used for all run maps that are called.

Tuning

Audit

Tuning

WorkFile

Tuning

LengthOfDataElementInError

(User Specified numeric value between 1 and 99)

Used for customizing the length of the value produced in the AK404/IK404 elements of the reporting acknowledgments.

Setting this to a value higher than the default may have a negative impact on performance. There may be cases where the entirety of the data in the file being validated is not placed on the acknowledgment even when this parameter is configured to its maximum value: When the length of data being reported exceeds the maximum parameter value or when the length of data exceeds more than twice the defined element length if the defined element length is > 32 characters.

The maximum size is 99, and the default size is 50.

false*

Errors - Generates only when WEDI/SNIP type 6 or 7 warnings are present in the interchange.

Always* - Always generates even if WEDI/SNIP type 6 or 7 warning are not present in interchange.

Indicates when the results from the WEDI/SNIP checks should be reported using a HIPAA specific 824.

(User specified numeric value)

9999*

Standard

Industry

Standard - Use the X12 standard value (i.e., 005010) in the GS08 element of the 824.

Industry - Use the HIPAA or industry-specific value (e.g., 005010X186A1) in the GS08 element of the 824.