ASC X12/HIPAA inbound GS GE (Group level) envelope properties

These ASC X12/HIPAA properties are displayed when you view or edit an inbound GS GE (Group level) envelope. Not all properties can be edited.

Basic properties

See General properties.

Control Numbers properties

See General properties.

Advanced properties: 1. Inbound Properties

(GS01) Functional ID Code

Required.

Coded identifier of the functional ID as used in the interchange. Required.

Valid value: * (asterisk) as wildcard, two standard characters

Parent ISA envelope to be used as the GS envelope filter

The parent interchange envelope (ISA) to use as the group (GS) envelope filter.

Select from the list of available envelopes.

Accepter lookup alias

Identifying string used with the sender ID and the receiver ID to look up this envelope with the encoder service. This alias associates a document with the service it requires. Required.

Valid value: At least one standard character

Use global control number

Whether this envelope definition must use a global transaction set number to uniquely identify message group headers. Valid values:

Yes: (Default) Select an existing global control number from the list that is displayed with the (GS06) Global Group Control Number property.
Yes (and generate name from data): Global number name is generated by using values from the inbound data or envelope definition.
No: You specify a control number that is owned only by this envelope. Default.

These are the Generate control number properties.

If Use global control number is set to Yes, this Assign control number property is displayed:

(GS06) Global Group Control Number: Group control reference number that is used globally. Required.
Valid value: Select a previously defined number.

If Use global control number is set to No, these Assign control number properties are displayed:

(GS06) Local Group Control Number: Group control reference number that is used locally. Select a previously defined number to reference. Required.
Valid value: Nine standard characters
Sequence type: Type of control number sequencing to use.
Valid values: SPE, Database

If Sequence Type is set to SPE, this Locking Mode property is displayed:

Hold locks until commit: Whether to restrict access to the messages until all changes are committed.
Valid values: Yes, No (default)

If Use global control number is set to Yes (and generate from data), these Generate control number properties are displayed:

Primary Name Format

Information to include to generate a global number name from data.

Selected
(GS01) Functional ID Code (default)
(GS08) Version, Release, Industry Identifier Code (default)
Test Indicator

Use first backup name format

Default.

Yes: Use the Backup Name Format that directly follows and that specifies (GS01) Functional ID Code for inclusion.
No

Backup Name Format

Information to include to generate a Global Number Name. Used when a valid name cannot be determined from the Primary Name Format.

Select all
(GS01) Functional ID Code (default)
(GS08) Version, Release, Industry Identifier Code
Test Indicator

Use second backup name format

Valid values:

Yes: Use second Backup Name Format. Specify properties to include.
No: Do not use second backup name format.

Backup Name Format

Information to include to generate a second Global Number Name. Used when a valid name cannot be determined from the Primary Name Format or the first Backup Name Format.

Valid values:

Select all
(GS01) Functional ID Code
(GS08) Version, Release, Industry Identifier Code
Test Indicator

(GS07) Responsible Agency Code: Agency responsible for relaying the message group on the sending side. Required.
Valid values: * (asterisk) as wildcard, alphanumeric code with two standard characters
(GS08) Version, Release, Industry Identifier Code: Version, release, and coded identifier of the industry for this interchange. Required.
Valid values: * (asterisk) as wildcard, alphanumeric code with 12 standard characters
Perform Control Number Sequence Checking: Compare the sequence of control numbers in the data with the Control Number parameter for this envelope. Required.
Valid values: Yes, No (default)
Perform Duplicate Control Number Checking: Whether to determine control number duplications. Required.
Valid values: Yes, No (default)
Retain Enclosing Envelope: Whether to copy the envelope segments (ISA, GS and GE, IEA) into each transaction set extracted from the functional group. Required.
Valid values: Yes, No (default)
Business Process for Non-Compliant Documents: (Sterling B2B Integrator hosted mode only) Sterling B2B Integrator business process to use to further process noncompliant documents. Optional.
Valid value: Select from the list of available business processes.
SPE Driver for Non-Compliant Documents: (Default installations only) SPE driver to use to further process noncompliant documents. Optional.
Valid value: Select from the list of available drivers.

Advanced properties: 2. Compliance and Acknowledgment Settings

Perform HIPAA compliance check: Whether to check the document for HIPAA compliance.
Valid values: Yes, No (default)

If Perform HIPAA compliance check is set to Yes, these HIPAA Compliance Check Validation Settings are displayed:

Check Companion Guide Rules (Type 7)

Enable Companion Guide (WEDI/SNIP Type 7) validation for a trading partner.

Valid values:

Yes: Enable level 7 validation
No: Default. Do not enable level 7 validation.

If Check Companion Guide Rules (Type 7) is set to Yes, these Companion guide rules will be checked properties are displayed:

Companion Guide Rule Group

A set of one or more envelopes that are governed by a particular Companion Guide. A Companion Guide Rule Group can refer to a single envelope; however, in most cases it will refer to multiple envelope.

Example: CMS has a set of Companion Guides which give additional guidance for MAC processors. If you receive a particular message from three trading partners which are MACs, then all three trading partners envelopes for inbound and outbound are most likely to be governed by the rules in that companion guide.

Valid values:

None (Use global rule): Default
Use Envelope Name: Use the companion guide that governs this envelope name.
Assign Rule Group Identifier: Use an identifier that you assign.
How to assign a rule group: To assign a Rule Group Identifier, edit all three sets of envelopes to enable WEDI/SNIP Type 7 and give them a designation such as "MAC_CLAIM." In the rules customization UI, copy or create the additional rules and assigning an extent of "MAC_CLAIM" to each specialized rule.

Type 7 Custom User Exit Language: Language that is used for any user-defined rule extensions that override existing HIPAA Type 1-4 rules with more restrictive rules, or that override the default WEDI/SNIP Type 1-6 HIPAA validation behavior.; Valid values: None (default), C program, Java program

If Type 7 Custom User Exit Language is set to C program, these C program will be run properties are displayed:

Type 7 exit library name: C library that contains the Type 7 custom exit. Required.
Valid value: String
Type 7 exit function name: Name of the Type 7 custom exit function. Required.
Valid value: String

If Type 7 Custom User Exit Language is set to Java program, these Java program will be run properties are displayed:

Type 7 exit class name

Java library that contains the Type 7 custom exit. Required.

Valid value: String

Type 7 exit method name

Name of the Type 7 custom exit method. Required.

Valid value: String

Exception Handling for Type 7

Type 7 exceptions are reported using the 824 application advice, the 999 implementation acknowledgment transaction set, or both.

Valid values:

Error (Report exceptions as errors and reject the data): Default.
Warning (Report exceptions as warnings and accept the data)

Check Line of Service Rules (Type 6)

Whether to enable WEDI/SNIP type 6 validation at the transaction set and trading partner level.

Valid values:

Yes: Enable Type 6 validation for the transaction set and trading partner that is associated with the envelope document. This value automatically enables validation for Types 2-4.
No: Default. Do not use HIPAA level 6 validation.

If Check Line of Service Rules (Type 6) is set to Yes, these Line of Service rules and MultiSegment HIPAA rules will be checked properties are displayed:

Exception Handling for Type 6

Valid values:

Error (Report exceptions as errors and reject the data). Default.
Warning (Report exceptions as warnings and accept the data)

Check Referenced Code Set Rules (Type 5)

Valid values: Yes, No (default)

Transform non-compliant transactions

Process to follow when non-compliant transactions are encountered. Optional.

Valid values:

Yes: Accept compliant and non-compliant transactions
No: Accept compliant transactions, reject non-compliant transactions (default)

Generate an acknowledgment when this group is received

Whether to generate an acknowledgment that notifies the sender when the receiver receives an interpretable group transmission. Optional.

Valid values: Yes (default), No

Companion Guide Rule Group Identifier

Enter a value that was assigned to identify the rule group.

To assign a Rule Group Identifier, edit all three sets of envelopes to enable WEDI/SNIP Type 7 and give them a designation such as "MAC_CLAIM." In the rules customization UI, copy or create the additional rules and assigning an extent of "MAC_CLAIM" to each specialized rule.

Displayed only if Rule Group Identifier is selected.

Report Type 6 as Errors or Warnings

Determines the reporting and disposition of data that contains Type 6 exceptions, which are reported using the 824 application advice and/or the 999 implementation acknowledgment transaction set.

Error: Default. The HIPAA compliance checker reports Type 6 validation exceptions as errors and noncompliant data is rejected.
Warning: The HIPAA compliance checker issues a warning message and accept the data as valid transaction set content.

Check Referenced Code Set Rules (Type 5)

Whether to enable WEDI/SNIP Type 5 validation. Type 5 validates data content against code sets from external code sources, as explicitly defined in the implementation guides for use with HIPAA standards.

Valid values:

Yes: Use HIPAA level 5 validation.
No: Default. Do not use HIPAA level 5 validation.

Check Balancing and MultiSegment Rules (Types 3 and 4)

Whether to enable WEDI/SNIP Types 3 and 4 validation. Type 4 tests specific inter-segment situations described in the HIPAA implementation guides. Type 3 ensures that claim line item amounts equal the total claim amount, and is a special case of Type 4 testing.

Valid values:

Yes: Default. Use HIPAA level 3 and 4 validation.
No: Do not perform HIPAA level 3 and 4 validation

Check HIPAA Structure and Segment Rules (Type 2)

Whether to enable WEDI/SNIP Type 2 validation. Type 2 validation tests for HIPAA implementation guide-specific syntax requirements.

Yes: Use HIPAA level 2 validation.
No: Do not perform HIPAA level 2 validation

Generate an Acknowledgment when this group is received

Displayed when Check HIPAA Structure and Segment Rules (Type 2) is set to No.

Also Report Standard X12 (Type 1) Exceptions

Type 1 exceptions are reported through the X12 997 functional acknowledgment, the 999 implementation acknowledgment transaction set, or the TA1 interchange acknowledgment segment.

Valid values: Yes, No (default).

These are the A HIPAA acknowledgment will be generated. Additional settings properties:

Allow Relaxed Type 2 Structure Checking

Whether to allow relaxed structure on the input data if the data fails WEDI/SNIP type 2 structure checking. Relaxed Type 2 structure checking is done only if errors are found during type 2 structure checking. This option produces more errors, both structural and those related to HIPAA compliance, in a single pass.

If the data fails at both standard WEDI/SNIP type 2 and relaxed type 2 structure checking, then validation stops and only the errors as reported in the structure checking are reported.

Valid values: Yes, No (default)

Yes: Perform relaxed Type 2 structure checks if WEDI/SNIP level 2 structure checking fails.
No: Default. Do not perform relaxed Type 2 structure checks on the data.

Also Report Standard X12 (Type 1) Exceptions

Exceptions to Type 1 (basic syntactical integrity) testing are reported by means of a X12 997 functional acknowledgment.

Valid values: Yes, No (default)

Acknowledgment Detail Level

Level of detail to send acknowledgments. If you select Segment level, the segment, transaction, and group levels are acknowledged. Optional.

Valid values:

Group Level only: Default.
Transaction Level
Segment Level: Segment, transaction, and group levels are all acknowledged.
Data Element Level

Send acknowledgment immediately

Whether to send the acknowledgment immediately on receipt of the message. Required.

Valid values: Yes, No (default)

Accepter Lookup Alias format for generated 997/999s

Alias for accepter lookup for generated 997 acknowledgments. Optional.

Valid values:

99X (default)
99X_[group version]
99X_[test indicator]
99X_[group version]_[test indicator]

Validation Method

Valid values:

Map: Use pass-through maps to bypass compliance steps where possible. Default.
Compliance (Do not bypass any compliance steps)
Both Map and Compliance (Reserved for debugging)

Transform Non-Compliant HIPAA Transactions

Valid values: Yes, No (default)

HIPAA Claim Level Rejection (277CA)

Whether results from the Claim Level Rejection process are reported using the 5010 277CA transaction set.

Valid values:

Yes (Enable for Health Care Claims)
No: Default.

If HIPAA Claim Level Rejection (277CA) is set to Yes (Enable for Health Care Claims), these HIPAA Claim Level Rejection Settings properties are displayed:

Splitting Level for Claim Level Rejection

Level at which incoming messages are split into separate transactions, based on repeated elements, for further processing.

Valid values:

Provider (Recommended for performance)
Claim

HIPAA Claim Level 277CA Reporting

When to report the status of inbound HIPAA EDI claims.

Valid values:

Never
Always (For all valid and invalid Health Care Claims
Exceptions (Only when errors are encountered in Health Care Claims data)

Validate XML Data in BIN Segments

Indicates whether, and to what level, data within the BIN segment of a 4050 275 transaction set is to be validated.

Valid values:

Never (Do not validate XML content): Perform no validation.
XML (Validate XML formatting only): Perform format validation only.
Schema (Validate against HL7 CDA requirements): Perform validation against a schema from the HL7 organization.

Generate the Translated Acknowledgment Report

Valid values: Yes, No

If Generate the Translated Acknowledgment Report is set to Yes, these Translated Acknowledgment Trigger Settings properties are displayed:

Translated Acknowledgment Trigger

Generate a translated acknowledgment that links to the EDI data.

The Compliance Check application transforms 997 and the 824 acknowledgments into a more readable report format. The acknowledgment report displays the entire segment in error, not just the data, by linking to additional output from the application.

Valid values:

Always (For all valid and invalid data)
Exceptions (Only when errors or warnings are encountered): Default. Includes all exceptions are included, regardless of whether they are being handled as errors or warnings.

Unique File names for Translated Acknowledgments

Assign a unique filename that links to exceptions data.

Valid values: Yes, No

Compliance Check Page Count: Page count to be used for the execution of most maps from within compliance check.
Valid value: Integer from 1 through 9999. Default setting: 8 pages.
Compliance Check Page Size: Page size in Kb to be used for map execution from within compliance check. In general, larger page size and count settings improve overall compliance check performance when the transaction sets being processed are large.
Valid value: Even integer 2 - 1024. Default: 64 Kb

If Perform HIPAA compliance check is set to No, these Non-HIPAA Compliance settings properties are displayed:

Transform non-compliant transactions: Valid values: Yes, No (default)
Generate an Acknowledgment when this group is received: Valid values: Yes, No (default)

If Generate an acknowledgment when this group is received is set to Yes, these Acknowledgment Settings properties are displayed:

Acknowledgment Detail Level

Levels to include in acknowledgments. Optional.

Valid values:

Group Level only (default)
Transaction Level
Segment Level: Segment, transaction, and group levels are all acknowledged.
Data Element Level

Send acknowledgment immediately

Whether to send the acknowledgment immediately on receipt of the message.

Valid values: Yes, No (default).

Accepter Lookup Alias Format for generated 997/999s

Format of accepter lookup alias for generated 997/999 messages. Optional.

Valid values: Select a format:

99X
99X_[group version]
99X_[group indicator]
99X_[test indicator]
99X_[group version]_[test indicator]

Handling of Non-Compliant Groups: Process to follow when non-compliant groups are encountered.
Valid values: Accept, Reject

Advanced properties: 3. User data parameters

User data name n

A user-supplied name that is set in the process data of an envelope as part of a name-value pair for use in later steps of the process flow.

Valid value: String

User data value n

A user-supplied value that is set in the process data of an envelope as part of a name-value pair for use in later steps of the process flow.

Valid value: String

Versions

See Working with versions.

Usage

See Viewing the usage of an envelope.