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Robbi McClane <[EMAIL PROTECTED]>wrote:
There have been similar individual questions posted on various mail lists which are related and beg the bigger question in regards to compliance of INBOUND transactions..re
Is the RECEIVER of an HIPAA transaction OBLIGATED to perform all levels of validations - beyond X12 and HIPAA syntax in order to be considered in COMPLIANCE? Specifically, in regards to two areas:
1) external code sets - both medical and non-medical (e.g. postal codes, HIN numbers, etc.)
and
2) product or service specific (e.g. Patient Weight is required on claims invoking EPO for patients on dialysis)
My personal interpretation of is that I must be able to RECEIVE and PROCESS codes from the external code sets - which is not necessarily the same as validating - for example, as long as my adjudication system can accept a code but doesn't utilize and therefore doesn't kick it out if it is incorrect that I am okay... - but I'm not sure if the same logic can apply to #2 (e.g. I don't require patient weight...)
any thoughts? differences of opinion??
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