Copyright © TIBCO Software Inc. All Rights Reserved
Copyright © TIBCO Software Inc. All Rights Reserved


Chapter 1 Introduction to HIPAA Protocol : HIPAA Validation Error Severity

HIPAA Validation Error Severity
By default, any validation errors that occur cause a transaction to be rejected. When a transaction is rejected, the 997 generated contains an AK5 segment with a Transaction Set Acknowledgement Code of 'R' for the transaction. When validating HIPAA transactions, it is desirable to be able to control whether a validation error should cause the rejection of the entire transaction or not.
Sometimes we may want the error reported and the transaction rejected. At other times we may want to report the error in the 997 but to accept the transaction anyway (for example, the generated 997 would have a Transaction Set Acknowledgment Code of 'E' for accepted with errors). We might want validation errors ignored altogether or we might want only some validation errors ignored.
In conjunction with TIBCO Foresight HIPAA Validator Desktop, TIBCO BusinessConnect EDI Protocol HIPAA Edition powered by Instream provides the ability to configure the severity of validation errors which occur in HIPAA transactions.
Controlling the severity of validation errors is done through the use of validator profile files. For general information on creating and configuring validator profile files for use with X12 transactions, see the section Configuring Validation Profile (.apf) Files in the document TIBCO BusinessConnect EDI Protocol powered by Instream, X12 Configuration. The remainder of this section contains information on validator profile files that is specific to HIPAA transactions.
Error Severity Types
Following are the segments in the generated 997 acknowledge when a transaction is rejected:
   ST~997~0001'
   AK1~HC~000000001'
   AK2~837~000000001'
   AK3~CLM~36~2300~8'
   AK4~11+3~1362~1~AP'
   AK5~R'
   AK9~R~1~1~0'
   SE~9~0001'
The AK2 segment identifies the transaction which was rejected. The AK3 and AK4 segments give information about where the error(s) occurred in the transaction. The AK5 segment indicates the transaction was rejected and contains a transaction status code of 'R'. The AK9 segment indicates that the group was rejected, 'R', since there was only one transaction in the group and that transaction was rejected.
If some of the transactions in the group were accepted while others were rejected, the status of the group in the AK9 segment would be 'P', which indicates that at least one transaction in the group was rejected.
When a transaction is rejected, error information is also sent to the private process on the subject AX.BC.installation.X12.ERROR.VALIDATION.
This error information contains the transaction ID of the transaction which had validation errors and descriptive information about the validation errors similar to the following:

 
controlNumInfo={^class^="ControlNumberInfo
" ^idx^=1 interchange="000008361" group="1" transaction="000000001"}
errorInfoList={^class^="ConversionEngineInfo" ^idx^=2 ^1^={^class^="ConversionEngineInfo" ^idx^=1 errorSeverity="Normal" errorCategory="Rejecting" errorMsg="The Previous Claim does not balance. Formula used CLM02 (93534) = sum of SV102 (93533)." errorID="30092" errorContext="Loop/Group-2440 | Segment-HL" errorDataParent="HL~4~2~2
3~0'" errorSegmentCount=178 errorLoopGroupCount=1}}

 
Setting different error severity types to validation errors affect the information about the validation errors that is contained in 997 acknowledgements and the error information reported to the private process. It also affect whether or not the given transaction is converted from EDI to XML or from XML to EDI. When a transaction is rejected, no conversion takes place.
The following table describes the four levels of severity which can be configured for validation errors and their affect on how error information is reported.
Only the five severity types listed in Table 2 are supported for TIBCO BusinessConnect EDI Protocol HIPAA Edition powered by Instream. User defined severity types are not supported.
Control Validation Severity Levels
How the validation engine reports the severity of errors is controlled by creating and configuring Validator Profile (.apf) files. Either TIBCO EDISIM Validator or TIBCO Foresight HIPAA Validator Desktop can be used.
Once Validator is started, do the following to create a profile file with your custom settings:
1.
Select Options>Validator Profile.
2.
Select the Filter tab.
The Filter tab contains two groups of settings: Severity Level and HIPAA Types, as depicted in Figure 3.
Figure 3 Validator Options Profile
By default all of the Severity Levels listed are checked, which means all of these categories of errors will be included and reported when validating transactions.
Suppress Severity Level
To cause the validation engine to suppress a particular severity level:
1.
2.
Click Save As...
3.
4.
For example, to tell the validation engine to ignore Warning errors during validation of a 00401/004010X098A1/837 transaction, uncheck the box next to Warning in the Validator Options Profile page, save the profile, and then add the .apf file to the configuration of the 00401/004010X098A1/837 transaction in the Operations Editor.
Suppress HIPAA Type
The HIPAA Types settings are used to tell the validation engine the types of HIPAA errors to include during its validation of transactions.
By default, all of the HIPAA Types are included during validation. Unchecking a HIPAA type indicates that the validation engine should ignore errors of that type during its validation of a transaction. For example, to prevent balancing errors from causing a transaction to fail validation, you would uncheck the box next to 3-Balancing.
Controlling Severity by Error ID
With validator profile (.apf) files, you can also control the severity and HIPAA type of a particular error. Once Validator is started, create a profile file with settings which change the default behavior for a particular error ID.
1.
Select Options>Validator Profile.
2.
Select the Messages tab.
The Validator Options Profile dialog appears:
Figure 4 Validator Options Profile Messages
3.
4.
Select the Severity to apply to the error from the drop down list.
5.
Select the HIPAA Type to apply to the error from the drop down list.
6.
Click Save As...
7.
Use the TIBCO BusinessConnect Operations Editor to upload the .apf file into the configuration for the transaction you wish to apply the .apf file to during validation.
When using TIBCO Foresight HIPAA Validator Desktop to perform design-time validation of data files, it is also possible to create or modify .apf files to control the validation results you see during your design-time validation and then apply the .apf file to your TIBCO BusinessConnect configuration.
Sometimes, it is easier to determine the error ID you for which you need to specify new settings when you validate the data file using TIBCO Foresight HIPAA Validator Desktop. In this case, select the error when it is displayed and specify the settings to use. For example, if you used TIBCO Foresight HIPAA Validator Desktop to validate a 004010X098A1 837 Professional data file that contains an error in the format of the zip code, at the end of validation you would see something similar to Figure 5:
Figure 5 Desktop Validator Diagnostic Message
By selecting the error message in the Diagnostic message pane and then right- clicking, you will see following menu options as shown in Figure 6:
Figure 6 Diagnostic Message Options
The menu options tell you which error message ID is associated with the displayed error and also allows you to set the Severity Level and HIPAA Type to associate with that error ID.
Save the .apf file after configuring new settings for an error ID
Once you have configured new settings for an error ID in this manner, you need to save the .apf file created by these actions by doing the following:
1.
Select Options>Save Profile.
2.
3.

Copyright © TIBCO Software Inc. All Rights Reserved
Copyright © TIBCO Software Inc. All Rights Reserved