Type 5 validation overview

Type 5 Validation can be defined as the process of confirming that HIPAA X12 transaction data content complies with the requirements of the External Code Sources as documented in the Implementation Guides.

Each HIPAA X12 Implementation Guide contains descriptive information about External Code Sources in an appendix. This, typically, is Appendix A of the TR3. This information generally consists of the code source name and identifier, contact information and an abstract of the related code set contents for each External Code Source referenced in the document.

Specifics about the data content to be validated using External Code Sources is embedded throughout the Implementation Guides, primarily in the Segment Detail portion of the guides. Typically, these External Code Source references are placed at either the data element or qualifier data element level. They include the Code Source identifier followed by the name. In the SPE Pack for Healthcare Payer the following principles have been applied to distinguish between Type 5 and other validation types in the WEDI/SNIP model.
  • The validation of a data element against a set of one or more code values that are explicitly listed in the HIPAA Implementation Guide is considered a Type 2 check rather than a Type 5 check. For example, the entry for the BGN05 Time Zone Code element in the 834 Benefit Enrollment and Maintenance document references Code Source 94: International Organization for Standardization (Date and Time). However, the External Code Source reference is followed by an explicit list of values. The validation of this element against the list of permitted values is implemented as a Type 2 check.
  • The validation of a data element against a set of code values that are referenced in the HIPAA Implementation Guide is considered a Type 5 check. For example, the entry for N402 (State or Province Code) may reference CODE SOURCE 22: States and Provinces. When this reference is made and no specific states or provinces are listed in the implementation guide then this is considered to be a Type 5 check.
  • Type 5 Validation checks for conformance with published code sets that apply globally to all HIPAA X12 trading partners defined in the Standards Processing Engine. Any partner-specific external code set validation is considered to beyond the scope of WEDI/SNIP Type 5.