Example details

The validation method (function) is Type7_Checks and performs the following checks:

• Checks that the Subscriber Eligibility Segment EQ and the repeating element EQ01 occur less than 30 times in 005010X279A1 270 transaction sets (HIPAA Allows 99).
• For 837 transactions, checks the DTM and DTP dates for future dates and checks that DTP dates are not prior to DTM dates and also checks to ensure that the number of claims in the transaction set is less than 100.
• For 837 transactions with a GS03 (application receiver code) of STATE, limit the dollar amount in AMT02 to $500 when AMT01 is F5 in the CLM loop.

The validation method Type7_Checks receives the following two inputs from the hipaa_data_compliance maps:

1. Delims– a string that indicates the delimiters that are used in the transaction set. It is used for parsing the segments and elements. It is passed in the following format:
   Element Separator (ISA Element separator)
   Repetition Separator (ISA11)
   Component Element Separator (ISA16)
   Segment Terminator (ISA Terminator)
2. hipaaData- a string of EDI HIPAA data generated during the run time of the compliance check application. It contains the transaction set data, including the ST/SE segments, but the loop ID is also included as the first element in each segment. If the parameter ExitPartnerDetail is set to true, then the hipaaData string will have limited ISA and GS information before the transaction set data.