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TIBCO BusinessConnect™ Container Edition - EDI Protocol HIPAA Edition powered by Instream® 1.0.0

# HIPAA External Code Lists

The X12 specifications identify standard code lists is used to determine the correct values for the various data elements of X12 transactions. The HIPAA Implementation Guides or Type 3 Technical Reports (TR3s) specify the code list values that should be used for the data elements of HIPAA transactions.

The HIPAA Implementation Guides or TR3s can specify various types of code lists. For example, a code list could be:

| • | a subset of the allowed values specified in the X12 specifications.

or

| • | a new code list to apply to a data element, which previously had no code list applied to it.

In some cases, the HIPAA Implementation Guides for TR3s specify the exact codes to use for a particular code list. In other cases, the HIPAA Implementation Guides for TR3s refer to existing sets of codes that are maintained by various organizations throughout the government and health care industry.

The code lists, which are maintained by these various organizations are referred to as external code lists. Some of the external code lists are freely available (for example, external code list #139–Claim Adjustment Reason Codes). Other external code lists must be purchased from the organization that maintains the code list (for example, external code list #6–D-U-N-S Numbers). For more information about external code list sources, refer to Appendix C, External Code Sources, of the HIPAA Implementation Guides or Appendix A, External Code Sources, of the HIPAA TR3s. These appendices list the external code lists used by the transaction and the organization responsible for maintaining each code list.

BusinessConnect Container Edition - EDI Protocol HIPAA Edition powered by Instream contains most of the HIPAA external code lists. The HIPAA external code lists are used in guidelines, which are provided with BusinessConnect Container Edition - EDI Protocol HIPAA Edition powered by Instream, to provide type 5 validation of the HIPAA transactions. The external code lists are not contained in the guidelines but are referenced in the guidelines through the following external files:

TIBCO_HOME`/instream/`version_number`/bin/fs_hipaa.dat`

TIBCO_HOME`/instream/`version_number`/bin/fs_cci.dat`

TIBCO_HOME`/instream/`version_number`/bin/fs_occi.dat`

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TIBCO BusinessConnect™ Container Edition - EDI Protocol HIPAA Edition powered by Instream®

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