Does your API support HIPAA Validations?

Our Institutional Claims Integrated Rules EDI supports the following Edit Types and compliance checking for HIPAA Types 1 through 7:

  • Type 1 EDI Standard Integrity Testing: Validate basic syntactical integrity of the EDI submission.
  • 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.
  • Type 3 HIPAA Balance Testing: Validate that claim line items amounts are equal to total claim amount.
  • Type 4 HIPAA Inter-Segment Situation Testing: Validate inter-segment relationship. For example, if element A exists, then element B must be populated.
  • Type 5 HIPAA External Code Set Testing: Validate specific code set values for HIPAA standards.
  • Type 6 Product Type/Type of Service Testing: Validate that segments that differ based on certain Healthcare services are properly created and processed.
  • Type 7 Trading Partner-Specific Testing: Compliance with payer specific requirement.

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