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All of the HIPAA guidelines provided by TIBCO BusinessConnect EDI Protocol HIPAA Edition powered by Instream are organized into subdirectories under BC_HOME/protocols/tibedi/samples/sampleDocs/guidelines according to the version of the guideline. For example, version 5010 guidelines are located in the following directory:BC_HOME/protocols/tibedi/samples/sampleDocs/guidelines/5010_txnsTable 5 lists the HIPAA transactions and their associated guidelines:
Table 5 HIPAA Transactions Guidelines To facilitate the configuration of HIPAA transactions, it is not necessary to upload the .std files for the guidelines listed in Table 5.
The Committee on Operating Rules for Information Exchange (CORE®) Connectivity & Security Subgroup of the Council for Affordable Quality Healthcare (CAQH) has defined envelope, submitter authentication, and error processing standards to improve interoperability and utilization between healthcare providers, clearinghouses, health plans as part of its CORE Phase II and Phase IV Connectivity Rules.The complete rules for Phase II and Phase IV are available in the following docs: https://www.caqh.org/sites/default/files/core/phase-ii/policy-rules/270-v5010.pdfThe CAQH CORE Connectivity Rule requires that health providers, clearinghouses, and health plans support sending, receiving, and processing and SOAP message envelopes. Further, the rule requires that these message envelopes follow specified normative (for SOAP+WSDL envelopes) schemas. These schemas require that fields such as PayloadID, PayloadType, and CORERuleVersion be included in the message envelope. TIBCO BusinessConnect EDI Protocol HIPAA Edition powered by Instream supports CORE-compliant transactions sent using the X12 protocol over HTTPS by packaging private process messages according to these requirements. See Chapter 5 Setting Up Trading Partners, CAQH Tab in the TIBCO BusinessConnect EDI Protocol powered by Instream X12 Configuration document for more information about configuring BusinessConnect to package messages in conformance to CAQH CORE requirements.
• enableCAQHPackage This boolean field specifies if it is a CAQH or non-CAQH package. You set the value to 1 to enable if it is a CAQH package or set the value to 0 to specify that it is not a CAQH package.
• CAQHOperationID This string field describes the pre-defined CAQH operation ID.
• PayloadType This conversational field describes the type of document (request, response, confirmation, or acknowledgement) and the type of transaction. You must define this field in the private process message for CORE-compliant packaging.
• PayloadID This string field is the ID for the payload of the message.
• SenderID This string field is the ID of the sender of the message.
• ReceiverID This string field is the ID of the receiver of the message.
• authenticationToken This field combines the user name and password fields.
• userName This string field is the user name that is entered to validate at the responder side.
• password This string field is the password that is entered to validate at the responder side.
• CAQHOperationID This string field describes the pre-defined CAQH operation ID.
• PayloadType This conversational field describes the type of document (request, response, confirmation, or acknowledgement) and the type of transaction. For Initiator Response messages, the payload type is received from the trading partner as part of an actual request.
• ProcessingMode This field describes the type of transaction - real-time or batch.
• PayloadID This string field is the ID for the payload of the message received from a trading partner.
• TimeStamp This string field indicates the time at which the message is sent.
• SenderID This string field is the ID of the sender of the message.
• ReceiverID This string field is the ID of the receiver of the message.
• ErrorCode This string field is the error code that is displayed.
• ErrorMessage This string field is the error message that is displayed against the corresponding error code.
• CAQHOperationID This string field describes the pre-defined CAQH operation ID.
• PayloadType This is the payload type received from a the trading partner when an actual request is received from the partner.
• ProcessingMode This field describes the type of transaction - real-time or batch.
• PayloadID This string field is the ID for the payload of the message received from a trading partner.
• TimeStamp This string field indicates the time at which the message is sent.
• SenderID This string field is the ID of the sender of the message.
• ReceiverID This string field is the ID of the receiver of the message.
• ErrorCode This string field is the error code that is displayed.
• ErrorMessage This string field is the error message that is displayed against the corresponding error code.
• CAQHOperationID This string field describes the pre-defined CAQH operation ID.
• PayloadType This string field describes the type of the response file that is sent back to BusinessConnect.
• PayloadID This string field is the ID for the payload of the message.
• SenderID This string field is the ID of the sender of the message.
• ReceiverID This string field is the ID of the receiver of the message.The CAQH CORE Connectivity Rule requires that clearinghouses, health plans, health providers, and other organizations that act as a server support an authentication method to enforce access control. Organizations that act as clients must authenticate themselves to the server. TIBCO BusinessConnect EDI Protocol HIPAA Edition powered by Instream supports authentication by populating the user name and password fields of outbound SOAP message envelopes. The trading partner—generally a clearinghouse or health plan—that receives such messages uses these fields to authenticate against its external authentication system. See Chapter 4 Setting Up Trading Hosts, General Tab in the TIBCO BusinessConnect EDI Protocol powered by Instream X12 Configuration document for more information about configuring BusinessConnect to package messages in conformance to CAQH CORE requirements.For detailed information on how to configure X12 transactions see Chapter 3, Managing X12 Interchanges, Functional Groups, and Transactions, in the document TIBCO BusinessConnect EDI Protocol powered by Instream, X12 Configuration.
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