Originally posted by: Jim Divoky

The following record in the NM1_IL loop in a 5010X2210A1 834 is generating an error when the Compliance Checker is run, even at the Type 1 level.  Does anyone know where I can make a modification to eliminate this "error"?  The HCC doesn't like the N404, "US", and generates an IK403=2 error, "Conditional Required Data Element Missing."

N4*Nashua*NH*03060*US~

Thanks,
 

Originally posted by: jvanboga

Do you mean '5010X220A1'

I think the problem rule might be

PRESENT(CityName Element:$) &
WHEN(ABSENT(CountryCd Element:$) |
          MEMBER(CountryCd Element:$,{"AS","CA","FM","GU","MH","MP","PW","PR","UM","VI"}),
          (PRESENT(StateProvinceCd Element:$) & PRESENT(PostalCd Element:$)),
          (ABSENT(StateProvinceCd Element:$)))

If so you'll need to make the chjange in a number of places.  Locate the N4 segment it will tell you where it is used.  I only checked 2 locations and they used the same rule.

Originally posted by: Jim Divoky

Yes, of course, '5010X220A1'.

Thanks but that component rule doesn't seem to apply to: N4*Keene*NH*03431*US~".  CountryCd isn't missing nor is it a member of the entities cited.  If I delete the CountryCd, the segment doesn't generate an error.  I may have to delete N404 when it equals "US" in my pre-processor map.

Where did you find the code you cited, I don't recall finding it when I went through what I thought were all the HIPAA type trees.

Originally posted by: jvanboga

The rule I showed was for an older type tree version 4.3.2....  This is for HIPAA pack 4.4.1 (hipaa_x12_type_2.mtt)

WHEN(PRESENT($),
PRESENT(CityName Element:$) & LocQual'r Element:$ != "RJ" & WHEN(ABSENT(CountryCd Element:$) |
MEMBER(CountryCd Element:$,{"AS","CA","FM","GU","MH","MP","PW","PR","UM","VI"}),
(PRESENT(StateProvinceCd Element:$) & PRESENT(PostalCd Element:$)),
(ABSENT(StateProvinceCd Element:$)) &
CountryCd Element:$ != "US"))

Should =

WHEN(PRESENT($),
PRESENT(CityName Element:$) & LocQual'r Element:$ != "RJ" & WHEN(ABSENT(CountryCd Element:$) |
MEMBER(CountryCd Element:$,{"AS","CA","FM","GU","MH","MP","PW","PR","UM","VI", "US"}),
(PRESENT(StateProvinceCd Element:$) & PRESENT(PostalCd Element:$)),
(ABSENT(StateProvinceCd Element:$)) &
CountryCd Element:$ != "US"))

This rule is one that is open for some interpretation the TR3 states ,for n404: "Required when the address is outside the United States of America. If not required by this implementation guide, do not send."  So technically the file is out of compliance is they send 'US' for anything other than a province of the US.  We get it all the time though.

Originally posted by: Jim Divoky

Thanks again.  Yes, I looked at later type trees.  And I have no access to the TR3 or addenda although I keep asking.  Someone at the client has them.  I'm getting beat up because the WTX HIPAA compliance checker doesn't match the local home grown checker that is being phased out.  I'm told it was "certified" by a third party so it must be right and IBM is wrong even though they admit they don't know all that is in the legacy program without a major analysis project.  

[Whining On] To make it more interesting, QA for the clone of a mainframe report I've created in WTX started last Thursday afternoon for initial production today.  [Whining Off]

Originally posted by: jvanboga

Technically, as much as it pains me ;), I think IBM is right but....because it's one of those 'I didn't explicitly say you couldn't send it but I did say not to use it unless I explicitly tell you to...' rules we've chosen not to argue with our partners about it. We actually have one large TP (100,000 members) that sends us 'USA'. We just deal with it. 

Good luck!!!

Originally posted by: Jim Divoky

Here is what I have in HIPAA Pack 4.3.2, hipaa_x12_type_2.mtt.  Who is "DH"?

WHEN(PRESENT($),
     PRESENT(CityName Element:$) &
     LocQual'r Element:$ != "RJ" &
     WHEN(ABSENT(CountryCd Element:$) |
          MEMBER(CountryCd Element:$,{"AS","CA","FM","GU","MH","MP","PW","PR","UM","VI"}),
          (PRESENT(StateProvinceCd Element:$) & PRESENT(PostalCd Element:$)),
          (ABSENT(StateProvinceCd Element:$)) &
          CountryCd Element:$ != "US"))
/* DH - Enforces - The country code element can only be present when address is outside
    the US.  If the address is within the US, including its territories, and Canada, both the
    state province code and the postal code must be present.  If the address is outside
    the US, then the State Province Code must be absent */

Originally posted by: jvanboga

Not sure who 'DH' is and my right hand isn't around today for me to bounce that off of. 

Please bear with me... the 'X12 Insurance Subcommittee' sets the HIPAA X12 standards. 

Those standards/rules are agreed upon by group of technical and non-technical users that meet regularly.  Once they agree on a set of standards and they are approved an implementation date is set indicating when the new version(s) and addendas will become effective.  The HIPAA transactions are a subset of the master X12 transactions and cannot conflict with the masters. 

From there you have entities, like government agencies, that interpret the rules as they want them used and create their documentation.  In theory their standards cannot conflict with HIPAA standards (but that isn't always true).  When a a HIPAA standard is defined by DHS (Dept of Human Services) they can conflict with transaction set rules.  For example, at one time, DHS did not like the format of an 835 (ERA/EOB) transaction because it didn't include certain information they wanted.  They asked for an 837.  Their requested 837 format did not match the HIPAA 837 format.  It was easier to send them a non-compliant file than try to move the government.  Since then a new HIPAA 837 format has been introduced that allows us to build a transaction that will comply with both DHS and HIPAA requirements.

That's about the best short explanation I can give on short notice and half a brain.