Conformance implications

In the SPE Pack for Healthcare Payers, validation requirements are classified as Type 7 if either or both of the following conditions are true:
  • The requirement is more restrictive than the standard requirements as documented in the HIPAA X12 Implementation Guides.
  • The requirement does not apply globally, to all defined business partners.

The scope of the validation performed by Types 1 through 6 is limited to enforcing the ‘standard’ requirements as documented in the HIPAA X12 Implementation Guides (TR3s) and applying those requirements globally to all business partners. Type 7 validation extends that scope with an additional layer of checking that allows selective enforcement of business-specific requirements.

Although the SPE Pack for Healthcare Payer supports Type 7 validation for business-to-business testing, transaction set data must still comply with the basic X12 EDI and HIPAA standard requirements in order to be considered valid.