Type 6 code lists and line of service triggers

Each Business Rule for Type 6 validation includes the information necessary to determine whether the transaction set content meets the Line or of Service criteria. This determination uses the concepts of Line of Service Category and Line of Service Code Source Location together with information stored in Type 6 Code Lists.

In the SPE Pack for Healthcare Payer, specific claim and service related content from HIPAA X12 transaction set data is used to trigger Type 6 validation rules. Each Type 6 Business Rule includes information about the location of this content as well as the name of the Type 6 Code List that contains the line-of-service code values. The concepts of Line of Service Categories and Line of Service Source Locations are used to identify and group information related to line of service triggers.

All Type 6 Code Lists that are included with the SPE Pack for Healthcare Payers installation adhere to a naming convention. It is recommended that if you create your own Type 6 Code Lists that you follow this naming convention. The following List Name components are separated by underscores (_).
  • Validation Type - Use T6 to indicate Type 6
  • Line of Service Source Location - Use one of the Line of Service Source Location codes (PS, ST, or FC) to indicate the location of the data content to be evaluated
  • Line of Service Category - Use one of the Line of Service Category codes
  • Line of Service Subset - Optional
The following conventions must be observed to ensure that the SPE Code List tables are compatible with Type 6 Validation:
  • The List Name that is assigned to the Code List must agree with the Code List ID that is used in the Type 6 validation rules.
  • The List Name must be 20 characters or less.
  • The List Name must begin with T6_ followed by the two-character code for the Line of Service Source Location.
  • Sender ID and Receiver ID fields should be populated with the reserved work: _ANY_
  • A Code List Item must be created for each code value associated with the line of service category and subset.
  • The Code List Items in the table must correspond with the data content that will appear in the location specified by the Line of Service Source Location.
  • Sender Code and Receiver Code fields must both be populated with the code value.
  • To ensure uniqueness, prefix all code values for Product and Service Identification (PS) and Form Identification Codes (FC) with the qualifier value and an underscore (_) character.