PI98186: CLAIMS PASSING COMPLIANCE WHEN PAYMENT IS INDICATED IN 2320 AMT*D 2330B DTP IS MISSING AND NO 2430 LOOP FOR PAYER ID

APAR status

• Closed as program error.

Error description

• Claims are passing compliance when a payment is indicated in
  2320 AMT*D when the 2330B DTP is missing and there is no 2430
  loop being for the payer ID for which payment was reported.
  

Local fix

• ITXCQ - ITX00058829
  LV / LV
  Circumvention: None
  

Problem summary

• Users affected:
  Transformation Extender Pack for Healthcare Payer HIPAA
  
  Problem Description:
  The validation requirement for healthcare claims (837)
  transaction sets that is stated in the TR3 documentation as -
  The Claim Check or Remittance Date (2330B DTP_573) segment
  (containing the claim level Adjudication or Payment Date) is
  required when the payer identified in the 2320 Other Payer loop
  has previously adjudicated the claim and the Line Check or
  Remittance Date (2430 DPT_573) segment is not used, is not being
   enforced by HIPAA X12 Compliance Check.
  
  Platforms affected:
  ALL
  

Problem conclusion

• Code was added to ediexit.cpp and rules.h to implement Rule Type
  51 for 837 claims transaction sets. This new rule type provides
  the capability to check Type 4 rules of the form
  WHEN(PRESENT(2320 AMT_D) & ABSENT(2430 FOR PAYER), PRESENT(2330B
  DTP_573)) using COB payer-by-payer matching.
  
  Rules 59104, 59106, and 59108 were added for 837p, 837i, and
  837d respectively. The new rules have a validation sub-type of
  XT as payer-by-payer matching is not enforced in pre-content
  checking type trees. These rules have been defined as disabled
  by default to allow the delivery of customer patches without
  disrupting existing customer implementations. This should be
  changed to enabled for the next pack release.
  
  Applies to:
  HCIP IP HIPAA 4.4.1.7, Healthcare Payer HIPAA 9.0.2
  
  Fixed in the next service packs and releases.
  
  To obtain the fix for this APAR:
  
  To see if the next service pack or product release is available,
  check the IBM Transformation Extender Downloads page:
  http://www.ibm.com/support/entry/portal/product/other_software/t
  ransformation_extender
  
  If the service pack or product release is available, download it
  from Fix Central:
  http://www.ibm.com/support/fixcentral/
  
  If the service pack or product release is not available and you
  require the APAR fix immediately, request a Limited Availability
  Interim Fix (LAIF) by opening a PMR:
  http://www.ibm.com/support/servicerequest/Home.action
  
  Prior to version 9.0.0, IBM Transformation Extender was called
  IBM WebSphere Transformation Extender.
  

Temporary fix

Comments

APAR Information

• APAR is sysrouted FROM one or more of the following:

• APAR is sysrouted TO one or more of the following:

Fix information

• Fixed component name

  TX HIPPA EDI

• Fixed component ID

  5724M6100

Applicable component levels