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Copyright © TIBCO Software Inc. All Rights Reserved


Chapter 1 Introduction to HIPAA Protocol : HIPAA External Code Lists

HIPAA External Code Lists
The X12 specifications identify standard code lists which should be 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 which 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
or
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 which 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 which maintains the code list (for example, external code list #6 – D-U-N-S Numbers). For more information on 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 utilized by the transaction and the organization responsible for maintaining each code list.
TIBCO BusinessConnect 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 TIBCO BusinessConnect 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
Missing External Code Lists
For some external code lists specified in the HIPAA transaction Implementation Guides or TR3s, there is not an associated external code list in the HIPAA transaction guidelines supplied with TIBCO BusinessConnect EDI Protocol HIPAA Edition powered by Instream.
Some of the external code lists specified in the HIPAA transaction Implementation Guides or TR3s are actually comprised of other external code lists. Another external code list is listed in the HIPAA transaction Implementation Guides or TR3s but is not actually used by any transaction. These code lists are described in Table 3:
4        ABA Transit Routing Number
91     Canadian Bank Branch and Institution Number
External Code Effective Dates
When a new revision of an external code list is released, the external code list file associated with the newly released external code list revision will be updated to reflect any new codes or modifications to existing codes. For new codes, if an effective date has been specified, that date will be used as the effective start date for the new code.
The effective date for a code is used to determine whether the code is valid for use by HIPAA transactions. If a code used in a HIPAA transaction is found to be outside of the code's effective date range, a validation error will occur. The date used in the HIPAA transaction for comparing against a code's effective date is determined as follows:
Update Frequency
Each HIPAA external code list has its own update frequency. Some external code lists are updated yearly, others are updated quarterly, and some can be updated daily. Each release of TIBCO BusinessConnect EDI Protocol HIPAA Edition powered by Instream will contain the latest updates to the external code lists.
If you require more timely versions of external code lists, you can obtain external code list updates by contacting TIBCO Support.
You can also create and register external code list updates as a User External Code List. For further information, refer to User External Code Lists.

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