EDI HIPAA SNIP Compliance

EdiFabric has helped customers to acquire CAQH Certifications and our products are used to boost claims, remittance, eligibility and claims status processing by several major HIPAA clearing houses.

EdiFabric supports all HIPAA validation level types out of the box. Any extra partner-specific, custom EDI code or product type requirements can be achieved by either amending the EDI C# classes or extending the validation logic.

We support the processing of very large 834 and 835 EDI files by using a unique transaction splitting technology which allows to both validate EDI documents and then generate automatic acknowledgments for these EDI documents regardless of their size.

HIPAA SNIP Type 1

EDI Standard Integrity Testing: Validate basic syntactical integrity of the EDI submission.

EdiFabric's EDI Validator produces a rich set of validations to ensure any HIPAA transaction complies with the implementation guideline.

HIPAA SNIP Type 2

Type 2 HIPAA Implementation Guide Requirement Testing: Validate HIPAA requirement-guide-specific syntax requirement by checking limits on repeat counts, used or not used qualifiers, code, elements, and segments.

This is also covered by EdiFabric's EDI Validator and the range of validation attributes.

The EDI validator also checks the integrity of all EDI data element data types.

HIPAA SNIP Type 3

Type 3 HIPAA Balance Testing: Validate that claim line items amounts are equal to total claim amount.

Balance validation for claims can be additionally included by using the custom validation extension. Our validator can be configured to apply any extra validation requirement to either amend the existing behavior or to apply a new one.

HIPAA SNIP Type 4

Type 4 HIPAA Inter-Segment Situation Testing: Validate inter-segment relationship. For example, if element A exists, then element B must be populated.

EDI Validator supplies a range of conditional validation attributes to execute inter-segment validation.

HIPAA SNIP Type 5

Type 5 HIPAA External Code Set Testing: Validate specific code set values for HIPAA standards.

All EDI codes are represented as strings in the EDI templates and can be edited at any time. EDI code sets validation is included in the general EDI Validator logic.

HIPAA SNIP Type 6

Type 6 Product Type/Type of Service Testing: Validate that segments that differ based on certain Health-care services are properly created and processed.

This type of validation is covered as part of the EDI templates. Our DOM model allows for very detailed transaction composition and the same segment (segment with the same identifier) can have different values or EDI codes at different levels and when included in different groups.

HIPAA SNIP Type 7

Type 7 Trading Partner-Specific Testing: Compliance with payer specific requirement.

Our EDI templates allow you to quickly configure every EDI transaction to conform with your trading partner requirements. EdiFabric employs a comprehensive mechanism to identify EDI transactions by the sender and receiver EDI codes in the ISA or UNB segment and then to load the customized partner-specific version of the EDI template corresponding to the EDI transaction.