TIBCO Foresight HIPAA Validator Desktop

Transcription

1 TIBCO Foresight HIPAA Validator Desktop Using HIPAA Validator Desktop Software Release June 2014 Two-second advantage

2 Important Information SOME TIBCO SOFTWARE EMBEDS OR BUNDLES OTHER TIBCO SOFTWARE. USE OF SUCH EMBEDDED OR BUNDLED TIBCO SOFTWARE IS SOLELY TO ENABLE THE FUNCTIONALITY (OR PROVIDE LIMITED ADD-ON FUNCTIONALITY) OF THE LICENSED TIBCO SOFTWARE. THE EMBEDDED OR BUNDLED SOFTWARE IS NOT LICENSED TO BE USED OR ACCESSED BY ANY OTHER TIBCO SOFTWARE OR FOR ANY OTHER PURPOSE. USEOF TIBCO SOFTWARE AND THIS DOCUMENTIS SUBJECTTO THE TERMS AND CONDITIONSOFA LICENSE AGREEMENT FOUNDIN EITHERASEPARATELY EXECUTED SOFTWARE LICENSE AGREEMENT, OR, IF THERE IS NO SUCH SEPARATE AGREEMENT, THE CLICKWRAP END USER LICENSE AGREEMENT WHICH IS DISPLAYED DURING DOWNLOAD OR INSTALLATION OF THE SOFTWARE (AND WHICH IS DUPLICATED IN THE LICENSE FILE) OR IF THERE IS NO SUCH SOFTWARE LICENSE AGREEMENT OR CLICKWRAP END USER LICENSE AGREEMENT, THE LICENSE(S) LOCATED IN THE LICENSE FILE(S) OF THE SOFTWARE. USE OF THIS DOCUMENT IS SUBJECT TO THOSE TERMS AND CONDITIONS, AND YOUR USE HEREOF SHALL CONSTITUTE ACCEPTANCE OF AND AN AGREEMENT TO BE BOUND BY THE SAME. This document contains confidential information that is subject to U.S. and international copyright laws and treaties. No part of this document may be reproduced in any form without the written authorization of TIBCO Software Inc. TIBCO, The Power of Now, TIBCO Foresight EDISIM, TIBCO Foresight HIPAA Validator Desktop, and TIBCO Foresight Instream are either registered trademarks or trademarks of TIBCO Software Inc. in the United States and/or other countries. EJB, Java EE, J2EE, and all Java-based trademarks and logos are trademarks or registered trademarks of Sun Microsystems, Inc. in the U.S. and other countries. All other product and company names and marks mentioned in this document are the property of their respective owners and are mentioned for identification purposes only. THIS SOFTWARE MAY BE AVAILABLE ON MULTIPLE OPERATING SYSTEMS. HOWEVER, NOT ALL OPERATING SYSTEM PLATFORMS FOR A SPECIFIC SOFTWARE VERSION ARE RELEASEDAT THE SAME TIME. SEE THE README FILE FOR THE AVAILABILITYOF THIS SOFTWARE VERSIONONASPECIFIC OPERATING SYSTEM PLATFORM. THIS DOCUMENT IS PROVIDED AS IS WITHOUT WARRANTY OF ANY KIND, EITHER EXPRESS OR IMPLIED, INCLUDING, BUT NOT LIMITED TO, THE IMPLIED WARRANTIES OF MERCHANTABILITY, FITNESS FORAPARTICULAR PURPOSE,OR NON-INFRINGEMENT. THIS DOCUMENT COULD INCLUDE TECHNICAL INACCURACIES OR TYPOGRAPHICAL ERRORS. CHANGES ARE PERIODICALLY ADDED TO THE INFORMATION HEREIN; THESE CHANGES WILL BE INCORPORATED IN NEW EDITIONS OF THIS DOCUMENT. TIBCO SOFTWARE INC. MAY MAKE IMPROVEMENTS AND/OR CHANGES IN THE PRODUCT(S) AND/OR THE PROGRAM(S) DESCRIBED IN THIS DOCUMENT AT ANY TIME. THE CONTENTS OF THIS DOCUMENT MAY BE MODIFIED AND/OR QUALIFIED, DIRECTLY OR INDIRECTLY, BY OTHER DOCUMENTATION WHICH ACCOMPANIES THIS SOFTWARE, INCLUDING BUT NOT LIMITED TO ANY RELEASE NOTES AND "READ ME" FILES. Copyright TIBCO Software Inc. ALL RIGHTS RESERVED. TIBCO Software Inc. Confidential Information General Contact Information TIBCO Software Inc., Foresight Group 655 Metro Place South Suite 900 Dublin OH Phone: (614) Fax: (614) Technical Support support@tibco.com Web: (Note: Entry to this site requires a username and password. If you do not have one, you can request one. You must have a valid maintenance or support contract to use this site.)

3 Contents 1 Introducing Desktop 1 Intended audience... 1 Capabilities... 1 Guidelines used... 1 System requirements... 2 Data requirements... 2 How Desktop ensures compliance Basics 4 Starting Desktop... 4 Tutorial... 4 Keyboard controls... 7 Toolbar... 7 Activating a pane... 7 Sizing a pane Validating data 8 Selecting a file to validate... 8 Selecting a standard or guideline... 9 Running the validation... 9 Navigating through the results Understanding the results Segment errors Element errors Library Link Copying individual results Printing Printing to a printer Printing to a file Debug Correcting validated data Customizing your validation 22 Options overview General options Diagnostic colors Filtering diagnostic messages Changing individual diagnostic messages Saving and loading a profile Validator Contents i

4 Saving a profile Loading a saved profile Default profiles Standard-specific profiles CCI edits Saving a validation Appendices 37 Data types Diagnostic messages Index 41 Validator Contents ii

5 1 Introducing Desktop Intended audience This document is written for business analysts and technical staff members who need to check the validity of data against a standard or guideline. Capabilities TIBCO Foresight HIPAA Validator Desktop checks data against published guidelines and your own company guidelines. Please see FileFormatsAtForesight.pdf for a list of formats that it can process. You can do this at your desk without special access to translators or other software. HIPAA Validator Desktop s average speed is 274 segments, or 6235 bytes, per second. You can optionally correct the data. Guidelines used Desktop comes with an extensive set of guidelines. In addition, you can add guidelines (.STD files) by: Copying guidelines from TIBCO Foresight EDISIM s User Files\Public Guidelines directory to Desktop s Database directory Copying merged guidelines to Desktop s Database directory (see GuideMerge.pdf) Validator Introducing Desktop 1

6 System requirements Please see System_Requirements.pdf in Desktop s Doc directory. Data requirements Desktop validates files of up to 2,097,151 segments or records. This limit will be smaller on computers with limited memory and disk space. Consider TIBCO Foresight Instream for files that exceed the capacity of your Desktop installation. Your EDI data must include interchange and functional group enveloping. It can be wrapped, padded, or be formatted in any way recognizable as EDI data. For example: Each line can end with a segment terminator, followed by a carriage return (CR) and line feed (LF). Each line can end with a CR/LF as the segment terminator. Blanks can pad the interchange trailer. CR/LF can be embedded in mid-segment (simulated fixed-length records containing wrapped data). How Desktop ensures compliance Desktop checks your EDI data and reports on any deviations from the guideline of your choice. Here is a partial list of items checked by Desktop: Industry Codes. Verifies more than 50 different external code sources (currency codes, ICD9 diagnostic codes, etc). Delimiters. Checks segment, element, and subelement delimiters. Checks for extra trailing delimiters in segments and composites. Enveloping. Verifies that interchange and functional group envelopes are present, correct, and paired up correctly; that nothing is outside the enveloping; etc. Counts and Control Numbers. Checks the segment counts in the transaction, compares control numbers in all enveloping including ST and SE, and checks HL loop nesting. Segments, Elements, and Composites. Checks hundreds of conditions concerning segments, elements, and composites to ensure that X12, HIPAA, and your own business rules are followed. Values. Verifies length and data type for all values. Checks code values specified by X12, HIPAA, and your own business rules. Checks for unprintable data. Can check dates to see that their format matches the qualifier. Validator Introducing Desktop 2

7 Unused Loops. If a loop is included in the data, even though the guideline says it is unused, Desktop will provide a diagnostic on the trigger (first) segment. To prevent a blizzard of diagnostics, the segments in the loop will not be flagged as being present, though unused in the guideline. Instead, Desktop performs a full compliance check on the enclosed segments, exactly as if they were marked as used. Ambiguous Loops or Segments. A standard may have many loops or segments with the same name, but they may be actually quite different. Desktop uses code values to tell them apart (see Validating Ambiguous Loops and Segments). Validator Introducing Desktop 3

8 2 Basics Starting Desktop You can start Desktop using either of these methods: Select Start Programs Foresight Desktop Validator. Go to Desktop s Bin folder and double-click on Validtr.exe. Tutorial Running a Validation 1. Open Desktop. 2. Open an EDI file: a. Choose File Open. b. Navigate to Desktop s DemoData folder. By default, this is C:\Program Files\ Desktop\DemoData. c. Choose Tutorial837IA.txt. This file contains one 837I with 10 claims: The claims are numbered from 1 to 10, and the amounts increment: the first claim is claim number 1 and is for , the second claim is claim number 2 and is for , etc. Even claims have errors and odd claims do not. Validator Basics 4

9 3. Choose guideline B41A837I and click OK. 4. Click OK when the analysis is complete. Viewing the Results The top pane contains diagnostic messages and the bottom pane contains the EDI segments. 1. Click on the first line in the top pane. The ISA is the corresponding segment, so it is highlighted in the bottom pane. 2. Use your cursor keys to move down line by line in the top pane, noticing what happens in the bottom pane. 3. When you reach the first blue line (an error), the bottom pane highlights the CR7 segment. There should have been a DTP segment before it. 4. Continue scrolling down and looking at each message. 5. Click on the error on the PWK segment and read the information in the diagnostic message at the top. Validator Basics 5

10 Element with error is red Using Library Link To get more information about this error: 1. Choose Options Library Link. Library opens and highlights the PWK segment in the guideline you are using. 2. Double-click on the PWK segment to display its elements. 3. Click on the PWK-01 element. The top right pane shows that this element is mandatory (M), has code values (ID) and has a minimum and maximum length of 2. The middle right pane lists the code values allowed for this element. 4. Return to Validator and scroll down to the SV2-04 error. 5. Click the orange Library toolbar button. Now that Library Link is on, this button returns to Library with the current location highlighted. Congratulations! You have completed your first analysis of an EDI file. Validator Basics 6

11 Keyboard controls Ctrl+Home Ctrl+End Esc F6 F7 Moves cursor to top of current window Moves cursor to bottom of current window Cancels the current operation Toggles between the top and bottom panes Zooms the active pane (toggle) Toolbar Rest your cursor over a toolbar button to see a tooltip. Activating a pane To switch panes, do one of the following: Click anywhere in the pane with your mouse. Press F6 to toggle between the two. Use the View menu to select Diagnostics (or Alt+d) Segments (or (Alt+s) Sizing a pane To size the panes, drag the splitter bar between the top and bottom panes. To zoom or fill the entire window with the active pane, do one of these: Press F7. Double-click on its header bar. Use the toolbar magnifying glass button. These all toggle: to display both panes, repeat your action. Validator Basics 7

12 3 Validating data Selecting a file to validate Open a file for validation in any of these ways: Select File Open. Use Desktop s first toolbar button. Use Ctrl-O. Drag a data file from an Explorer folder and drop it into either Desktop pane Select from recently opened files at the bottom of the File menu. Validator Validating data 8

13 Selecting a standard or guideline After selecting an EDI file, choose the standard or guideline to use for compliance checking. If the data is EDI, Desktop highlights the first standard or guideline with a version, release, and industry identifier code (VRI) that matches your data. The list is sorted by the Standard column. If no match is found, the line directly below the standard that most closely matches is highlighted. Select the standard you want to use and click OK. To skip this dialog box and let Desktop use the first standard or guideline that could match the data file, select Options Validator Profile and unselect Ask for Standard Name. Each time you start a validation, Desktop reloads the guideline or standard. If you change the guideline, there is no need to exit and re-open Desktop. Running the validation After selecting your data file and standard, segments and diagnostics scroll as validation proceeds. To speed up the process by 20-30%, click on any segment or diagnostic to stop the scrolling. After validation finishes, click OK to dismiss the Analysis Completed box. Validator Validating data 9

14 Navigating through the results The top pane displays diagnostics, and the bottom shows each line in your data file. The panes are synchronized so that: Clicking on a diagnostic in the top pane highlights its corresponding line in the bottom. Clicking on a line in the bottom pane highlights any related diagnostic in the top. Understanding the results You can follow the examples in this section by validating Tutorial837IA.txt in Desktop s DemoData directory against guideline B41A837I. Segment errors Interpreting the Error The first error in Tutorial837IA.txt is a missing DTP segment. The top pane shows this message: Missing Segment DTP (Statement Dates) at 2-135, though marked "Must Be Used" Where: Missing Segment DTP (Statement Dates) at though marked "Must Be Used" The Statement Dates DTP is missing. It is in Table 2 at segment position 135. This is the position from the X12 standard, not the segment s position in the EDI data. The guideline says it must be used. The bottom pane is highlighting the CR7 segment, the segment that should have appeared after the Statement Dates DTP. Library will show information about this DTP. See Library Link on page 12. Validator Validating data 10

15 Finding the Error in the EDI How do we know which claim contains the missing DTP? To find the approximate location of an error, look at the box in the scroll bar. To find the exact location of an error, look at the segment highlighted in the bottom pane and start going up segment-by-segment until you see something familiar and definitive. In this example, you can go up 10 segments and see the CLM segment the beginning of a claim loop: CLM*2*200.00***11:A:1*N*A*N*A*********Y**2! This is claim number 2. That pinpoints the claim loop that contains the missing DTP. You can usually identify a segment by its first code value. A Statement Date DTP will have a different first value than an Admission Date DTP. Element errors Interpreting the Error The third error in Tutorial837IA.txt is a bad code value. The top pane shows this message: Code Value "NDDDGDN" not found in the dictionary code list for PWK01 (D.E. 755) at col. 5 The segment with the element error is: PWK*NDDDGDN*AA***AC* ! Where: The error Code Value "NDDDGDN" not found in the dictionary code list for PWK01 (D.E. 755) at col. 5 This element has a list of acceptable codes and NDDDGDN is not on it. The error is on the first element in the PWK segment, an element 755. The code starts at the fifth character position in the segment. The erroneous value may be shown in red in the bottom pane. Library will show you information about this PWK-01 from the guideline. See Library Link on page 12. Validator Validating data 11

16 Finding the Error in the EDI How do we know which PWK contains the wrong code value? In the bottom pane, start going up segment-by-segment until you see something definitive like a claim number. In this case, you can go up 5 segments and see the CLM segment for claim number 6. Library Link Library Link opens a guideline viewer and takes you directly to the segment that you are highlighting in the bottom pane. To use Library Link: 1. With a validation completed in Desktop, click on a line in the bottom pane. 2. Choose Options Library Link. This opens Library and takes you to the current location in the last guideline used for validation. When validating nested data (such as. XML within EDI), Library opens the outer (EDI) guideline. 3. When finished reading about the item, return to Desktop by clicking on it at the bottom of your screen. 4. Click on another segment in the bottom pane. 5. Now that you have Library Link started, click on the toolbar button to go to that segment in Library. Validator Validating data 12

17 Copying individual results After validation is complete, you can copy one selected line from the active pane to the clipboard with Edit Copy, by clicking the Copy toolbar button, or by using your right mouse button. You can then paste the copied line into an or other Windows program. Printing After validation, you can print your results to a printer or to a file. Printing to a printer To print validation results to a printer: 1. Choose File Print. 2. Choose the Report Type: Diagnostics only Segments only Both (separately) Both (interleaved) Information displayed in Desktop's top pane Information displayed in Desktop's bottom pane (the EDI file) Contents of the diagnostics pane followed by the contents of the segments pane Segments and the corresponding diagnostics printed together 3. In the Segments area, choose one of these: All segments Referenced segments Every segment, regardless of whether it had a diagnostic Only segments that have a diagnostic The Counts, Depth, and Position check box is only active when you are printing to a file. 4. Click OK to display your printer dialog box. Validator Validating data 13

18 Printing to a file You can create a plain text report by printing to a file: 1. Choose File Print to File. 2. Choose the Report Type (see Printing to a printer above). 3. You can also select Counts, Depth and Position (see page 14). 4. Click OK to see the Text File Format box. Here you can set the page width and height and the margins. Eject last page inserts line feeds, which fill up a page. Use Formfeeds inserts a formfeed command at the end of the file. 5. Click OK to see a file save box where you can name and save the report file: Counts, Depth and Position This option gives the report these additional columns: Prev Previous Dp Depth Occur Occurrences Loc Location Rcd Record number In the report, these are located on the left: Validator Validating data 14

19 Prev The Prev (or Previous) column in the Counts, Depth, and Position report shows: The record number of the previous iteration of the loop. The record number of the trigger (first) segment of the enclosing loop if there is no previous iteration of the loop. The record number of the first segment in the document if there is no enclosing loop. Examples without nested loops The N1 trigger segment with 3 in the Prev column shows the record number of the ST segment, the first segment in the parent of the N1 loop. Validator Validating data 15

20 This example shows the second iteration of the SVC loop with a Prev value of 19, which is the record number of the first iteration of the SVC loop. Example with a nested loop The loops are nested like this: ST LX CLP SVC The LX loop has a 3 in the Prev column, which is the record number of the parent ST segment in the first example above. The first CLP loop has 15 in the Prev column, the record number of the LX loop containing it. The first SVC has a Prev value of 16, the number of the CLP loop. Validator Validating data 16

21 Dp The Dp column in the Counts, Depth, and Position report gives the depth of the segment or loop. All segments not in a loop are at depth 1. A segment in a loop is at depth 2. A segment in a loop that is within a loop has a depth of 3. In the first figure above: The ST, BPR, TRN, CUR, REF, and DTM segments are all at depth 1 since they are not in a loop. The N1 segment is at depth 1 because it is the trigger segment in a non-nested loop. The N3 segment is at depth 2 since it is a non-trigger segment within the N1 loop. In the nested loop graphic above: The CLP segment is at depth 2 because it is the trigger segment of a nested loop within the LX loop. The NM1 segment is at depth 3 because it is a non-trigger segment within a nested loop. Validator Validating data 17

22 Occur The Occur column in the Counts, Depth, and Position report shows how many instances of each segment and loop has occurred so far. In the Nested Loop example above, there are four consecutive SVC loops (at Rcd 19, 22, 25, and 28) with occurrences of 1, 2, and 3. Loc The Loc column in the Counts, Depth, and Position report shows the table followed by a hyphen and then the X12 segment position ID means Table 1 (the heading table) and segment with position 005. Library shows segment position numbers: Rcd The Rcd column in the Counts, Depth, and Position report shows the record number in the EDI file. Examples: 1 is the ISA segment. 3 is the ST segment. Validator Validating data 18

23 Debug To request debug messages, turn on debug before validating: This menu choice is a toggle. Your current setting will stick until you change it. The green debug messages show the steps Validator takes to enforce your business rules: To prevent some business rules from displaying debug messages, use a text editor to edit BusinessRules.properties in the Bin directory. Set rules to 0 if you don t want them to show debug messages: Validator Validating data 19

24 Correcting validated data To correct data that has been validated: 1. Unlock the file: The bottom pane turns yellow and the bottom pane s title bar shows Segments - UNLOCKED! to show that you are in edit mode. 2. Right-click on a segment that you want to change and select Edit Segment, Delete Segment, or Insert Segment: Edit Segment Delete Segment Make the change in the edit box and click OK. The edited segment is blue. The segment is preceded with (Deleted). The deleted segment is red. Validator Validating data 20

25 Insert Segment A new line appears. Right-click on it and choose Edit Segment. Type the segment and click OK. The inserted segment is green. 3. Choose File Save Data File or File Save Data File As and choose the filename and location for the saved file: 4. Choose File Open and revalidate the new file. 5. When finished making changes, lock the bottom pane to prevent accidental editing: Validator Validating data 21

26 4 Customizing your validation Options overview The Options menu lets you customize the way your files are validated. Customization Use See Select which conditions to check Suppress the display of certain diagnostics Change diagnostic colors Change diagnostic type or severity Save and reuse settings Set up an automatic profile Options Validator Profile Analysis tab Options Validator Profile Filter tab Options Validator Profile Colors tab Options Validator Profile Messages tab or right-click on the message in the top pane Save Profile and Load Profile Save Profile See General options on page 23. Filtering diagnostic messages on page 29. Diagnostic colors on page 28. Changing individual diagnostic messages on page 30 Saving a profile on page 33 or Loading a saved profile on page 33. Loading a saved profile on page 33 or Standard-specific profiles on page 35. Validator Customizing your validation 22

27 General options To modify how Desktop processes your data file, use the Options Validator Profile menu or the Options button on your toolbar: The Analysis tab has general options, segment-related options, and element-related options: General Options Ignore standard specific profiles You can set up profiles that automatically activate when you use specific standards or guidelines (see Standard-specific profiles on page 35). If selected, standard-specific profiles are suppressed. If not selected, standard-specific profiles are used if they exist. This is the default. Validator Customizing your validation 23

28 Use One Standard This affects validation of EDI files with multiple functional groups. If selected, the entire file is validated against the same standard or guideline. If not selected, you are asked for a new standard or guideline whenever Desktop finds a new functional group. This is the default. The guideline used depends on the state of the Ask for Standard Names option (see below). Ask for Standard Name This option controls whether Desktop asks you to select the guideline. If selected, you will be asked to select a guideline. This is the default. If not selected, Desktop picks a guideline based on the contents of the GS08 in the file. For these documents, Desktop uses use both the GS08 and then the ST01 to select a guideline: 270, 271, 276, and 277. For 278s, Desktop uses the GS08 and then the BHT02. Regardless of this setting, the same guideline will be used throughout the file if you chose Use One Standard. Allow Decimal in ICD9 (HIPAA guidelines only) If selected, decimals will be allowed in HIPAA ICD9 codes. For guidance on HIPAA requirements for the ICD9, see Allow Leading Zeroes in DRG (HIPAA guidelines only) If selected, leading zeros will be allowed in HIPAA DRG codes. For guidance on HIPAA requirements for the DRG, see Check CCI Edits (HIPAA guidelines only) If selected, Correct Coding Initiatives (CCI) rules will be enforced by Desktop. This slows down validation. Guidelines that have CCI rules are marked in ForesightHIPAAguidelinelist.pdf in the Doc directory of Desktop or Instream. Check CAQH Core III Edits ( std only) If selected and you are validating with a guideline that incorporates it, the Phase III CORE 360 Uniform Use of Claim Adjustment Reason Codes and Remittance Advice Remark Codes ( ) Rule is enforced by Desktop. Validator Customizing your validation 24

29 Allow Trailing Delimiter If selected, trailing delimiters are permitted at: the end of a segment the end of a composite the end of a flat file record This is primarily for flat files since EDI does not allow trailing delimiters. Padding between Interchanges Sometimes padding characters (blanks, for example) appear after the IEA to fill it out to a certain length. If so, type it here. This can be a hex or a keyboard character. The default is empty. Segment Terminator Desktop will usually read the segment terminator from the ISA. However, if the ISA is abnormal, include the terminator here. If it is a keyboard character, type the character. If it is a hex value, type the value preceded by a lower-case x. Example: x0d. The default is empty. X12 ST Control Number Unique in Interchange Checkbox A Transaction Set Control (ST) number must be unique within a transaction (ISA-IEA structure), as well as within a functional group (the GS-GE structure). If your transaction contains multiple functional groups, you must specify that the ST number will be unique within the interchange rather than just the functional group. Unchecked(default) Checked The Transaction Set Control number is unique within the functional group. The Transaction Set Control number is unique within the interchange. Segment-related options Check Unused Segments Present If selected, Desktop warns if a segment is present in the data but the guideline says it is unused. The default is on. Check Envelopes Only If selected, Desktop only checks interchange enveloping, transaction set headers and trailers. The transaction sets are not checked. The default is off. Check Segment Placement If selected, Desktop checks each segment as defined at a particular location within a transaction set. Otherwise, it only checks segments against the generic dictionary definitions. The default is on. Validator Customizing your validation 25

30 Element-related options Check Relationals If selected, Desktop checks for X12 syntax rules such as "If you use this element, you must also use that element." The default is on. User-defined business rules are always checked, regardless of this option's setting. Check Element Values If selected, Desktop checks element values to be sure they are the correct type and length. The default is on. Check Code Values If selected, Desktop checks the data's X12-based code values to be sure they are on the list of allowed values. The default is on. HIPAA s external code lists are checked by Foresight-supplied business rules, which always run. Check App. Data Values If selected, Desktop checks data for elements that have application values placed in the guideline by Standards Editor and ensures those values are on the list. The default is on. Application values are case sensitive. Check Leading Zeroes If selected, Desktop flags leading zeros in numeric elements. The default is on. Check Blanks in Numerics If selected, Desktop flags leading blanks in real or numeric elements. The default is on. Check Leading Blanks in Alpha If selected, Desktop flags leading blanks in alphanumeric elements. The default is off. Check Trailing Blanks If selected, Desktop flags trailing blanks in alphanumeric elements. The default is on. Check Unused Elements If selected, Desktop issues diagnostics when data is present for elements that the standard says are unused. The default is on. Validator Customizing your validation 26

31 Use X12 Character Set Specifies which character sets should be allowed in X12 alphanumeric elements: Unchecked (default) Checked Allows characters defined in the X12 basic and extended character sets. Please see Restricts the character set to those defined in the HIPAA implementation guides. This includes: Allow Delimiters within data A-Z a-z 0-9! \"& <>#$" and spaces Not allowed: ^ and ` This setting applies only to HL7 data. If selected, validation will not present errors when delimiters are present in data fields. X12 R Type Strict (X12 only) If selected, Desktop enforces strict processing and does not allow insignificant (meaningless) leading and trailing zeroes. Note: When this option is selected, zeroes used to pad to a field s minimum length requirement are considered significant and are allowed. Examples: Value X12 R Type Strict checked X12 R Type Strict unchecked.01, which contains a significant (meaningful) zero 0.010, which contains both an insignificant leading and trailing zero , which contains both an insignificant leading and trailing zero , which contains an insignificant leading zero and two trailing zeroes, which are used to pad the value to its minimum length. Allowed Not Allowed Not Allowed Leading zero not allowed, trailing zeroes allowed. Allowed Allowed Allowed Allowed Validator Customizing your validation 27

32 Diagnostic colors Choose Options Validator Profile Colors to see or change the colors for each type of diagnostic. Default Colors for Diagnostic Types Type Color Meaning Ignore Light gray Messages you consider unimportant Informational Dark gray Identifies segments, cancellations, etc. Warning Olive Minor errors, such as leading zeros in numerics or assumptions made due to ambiguity. Error Blue Errors such as wrong codes, violation of rules, etc. Fatal Red Error that stops the validation from continuing. User #1 Dark green For your use. User #2 Light green For your use. Using the Colors Tab To do this Change colors for a particular type Reset colors to the default Set all colors to black Do this Click the color next to the type Click Default Colors Click No Colors Validator Customizing your validation 28

33 Filtering diagnostic messages Choose Options Validator Profile Filter to change which severities or HIPAA types you d like to display. Uncheck any of the severities and types you no longer want to see. The default is to have all types displayed. Alternative Choose View Severity Level or View HIPAA Type and click on the selection that you want to filter. To stop filtering, repeat the process. Validator Customizing your validation 29

34 Changing individual diagnostic messages Pop-up Menu To determine a message s number, right-click on it in the top pane. In addition to seeing the message number, you can change its severity and type on this menu. Messages Tab To see a list of all diagnostic messages, choose Options Validator Profile Messages. You will see a list of all messages created by Foresight or by your own business rules. Validator Customizing your validation 30

35 You can change individual messages as follows. To do this Change the severity or HIPAA type. Do this Click on the message. Use the Severity or HIPAA Type drop-down lists at the bottom left. Load a previously saved profile. Save the current settings for loading later. Click Load. See Saving and loading a profile on page 33. Click Save As. See Saving and loading a profile on page 33. The AK3, AK4, TED1, TED2, and Data fields do not affect Desktop. They are used by Instream. Since Desktop and Instream can both share the same profile, these fields are available here. Specify a value that appears in Response Generator s 997 AK3-04 as a result of this message. Type the value in the AK3 field. You can use Library to see acceptable codes. Specify a value that appears in Response Generator s 997 AK4-03 as a result of this message. Type the value in the AK4 field. You can use Library to see acceptable codes. Validator Customizing your validation 31

36 To do this Specify a value that appears in Response Generator s 999 IK3-04 as a result of this message. Do this Type the value in the IK3 field. You can use Library to see acceptable codes. Specify a value that appears in Response Generator s 999 IK4-03 as a result of this message. Type the value in the IK4 field. You can use Library to see acceptable codes. Specify a value that appears in Response Generator s 824 TED-01 as a result of this message. Type the value in the TED1 field. You can use Library to see acceptable codes. Specify a value that appears at the beginning of Response Generator s 824 TED-02 as a result of this message. Type the value in the TED2 field. This element has no code values. If you specify a TED2 value here, Response Generator will insert it in front of the error message text in the TED-02. Specify your own information to appear in the DTL record that Instream writes as a result of this error. Type up to 20 characters in the Data field. This goes in the Application Data field at the end of the DTL record. See the DTL file layout in InstreamValidationTechnicalManual.pdf in Instream s Doc directory. Disable this validation message so it will not be displayed. This is the same as putting a minus sign in front of this error s severity in the APF file. Select Disable Error. Validator Customizing your validation 32

37 Saving and loading a profile Saving a profile Save a profile if you want to use it again after exiting Desktop, or if you want to give it to other Desktop users. You do not have to save a profile to use it for validation. When you click OK in the Validator Options Profile box, your selections will be used for all validations until you exit, change the options, or load a saved profile. To save a profile: 1. Choose Options Validator Profile. 2. Make your selections on the four tabs. 3. Choose Save As on any tab. 4. Navigate to the directory where you want to store it. 5. Type a filename. Use file type.apf. Alternative: Choose Options Save Profile Loading a saved profile To load a saved profile and use it for validation: 1. Choose Options Validator Profile. 2. Click the Load button. 3. Choose the directory and file containing the profile. 4. Validate. Alternative: Choose Options Load Profile It will be used for all validations until you load another profile or close Desktop. Validator Customizing your validation 33

38 Default profiles Loading the default profile 1. Choose Options Validator Profile Load. 2. Select $fsdeflt.apf in Desktop s Bin directory. Saving a default profile 1. Choose Options Validator Profile. 2. Make your selections on the four tabs. 3. Click Save As from any tab. 4. Select the directory and filename. 5. Select Save as the Default Profile for Analyzer at the bottom. The profile will be automatically loaded each time you open Desktop. Restoring $fsdeflt.apf as the default profile If you have saved a default profile, it will automatically load each time you open Desktop. To stop this and return to using $fsdeflt.apf as the default profile: 1. Choose Options Validator Profile. 2. Click Load. 3. Choose $fsdeflt.apf in Desktop s Bin directory. 4. Click Save As. 5. Save it with Save as the Default Profile for Analyzer selected. Validator Customizing your validation 34

39 Standard-specific profiles You can save a profile to be automatically used only with a specific standard or guideline. To do so: 1. Look in the first column of the Select Standard dialog box and note the guideline name that is to trigger the use of the profile. Example: For the guideline highlighted above, this is is B41A837I 2. Choose Options Validator Profile. 3. Choose the profile setting that you want to use with the guideline or standard. 4. Choose Save As. 5. Go to Desktop s Bin directory. 6. Save it to the same name as the standard or guideline, and use file type.apf. Use all capital letters in the filename. Example: B41A837I.apf To override this automatic profile during a particular validation, choose Options Validator Profile Ignore standard-specific profiles. You can modify and re-save standard-specific profiles as with any other profile. Validator Customizing your validation 35

40 CCI edits Desktop will enforce Correct Coding Initiatives (CCI) for Part B Medicare Carriers from the Centers for Medicare and Medicaid Services (CMS): Certain Foresight guidelines will enforce CCI when you validate with them or use GuideMerge to merge your own guidelines with them. These are flagged in ForesightHIPAAguidelinelist.pdf with a CCI to remind you. To have CCI rules enforced during validation, set CheckCCIEdits=1 in your APF. This is set to 0 by default. You can create your own business rules that enforce CCI if you have EDISIM 5.14 or later (see BusinessRules.pdf) CCI checking slows down validation. Saving a validation To save a validation for later review: 1. Validate your data. 2. Choose File Save Analysis. 3. Navigate to the directory where you want to save it. You may want to save validations in a distinct or temporary folder so you'll be able to easily locate them and delete them when they're no longer needed. 4. Name your file and use SAF for file type. To load a saved validation: 1. Choose File Open Saved Analysis. 2. Open the SAF file you previously saved. Validator Customizing your validation 36

41 5 Appendices Data types AN B DT (X12) Alphanumeric, a sequence of any printable characters. Significant characters should be left justified. Leading spaces, when they occur, are assumed to be significant. Trailing spaces should not be included unless needed to meet the minimum length. (X12) Binary. A sequence of octets ranging in value from binary to binary This type has no defined length, but the length is specified with the preceding element. This type only occurs in the BIN segment. (X12) Date, in YYMMDD or CCYYMMDD format. CC is century. ID (X12) Code values taken from a predefined list distributed by X12. N or Nn (X12). Numeric data with implied decimal. The decimal is not included in the EDI file (this is what distinguishes it from R types). If included, n shows the number of digits to the right of the implied decimal. Leading zeros are suppressed unless needed to satisfy the minimum length of the element. If the value is negative, include a minus sign, which does not count toward the length. N and N0 are equivalent (it is not necessary to include the zero). This means the implied decimal is at the end of the number. Validator Appendices 37

42 N1 means there is one digit to the right of the implied decimal. Example: The element contains the value -123, which is to be interpreted as N2 means there are two digits to the right of the implied decimal. Examples: R or Rn (X12 ) The element contains the value and the type is N9. This is to be interpreted as The element contains the value and the type is N9. This is to be interpreted as If the value to be represented is , and the type is N2, the transmitted data is If the value is , and the type is N2, the transmitted data would be If the value is to be interpreted as.01 and N2, the transmitted data is 1. Decimal numeric data where the decimal is required in the transmitted data if the number contains a fraction, but is optional for integers. Do not include the decimal for whole numbers and do not include leading zeros. Do not include commas in the number (use 1000 rather than 1,000). The minus sign is included if it is negative. Do not include commas or plus signs. Leading zeros should be suppressed unless needed to satisfy the minimum length. Trailing zeros at the end should be omitted if the value includes a decimal point unless they show the level of precision. Signs and decimal points do not count toward length. Examples: The data in the EDI file is and the type is R. The value being represented is also The EDI data contains but the type is R1. The value being represented would be TM (X12) Time, in 24-hour clock time as follows: HHMM, HHMMSS, or HHMMSSD, or HHMMSSDD, where H = hours (00-23), M = minutes (00-59), S = integer seconds (00-59) and DD = decimal seconds; decimal seconds are expressed as follows: D = tenths (0-9) and DD = hundredths (00-99). Validator Appendices 38

43 Diagnostic messages Error Number Purpose Basic EDI error messages to Error messages generated by Foresightsupplied business rules. Error messages generated by user-created business rules Error messages generated by public companion guidelines Error messages generated by CCI rules. Listed in FSAnErrs.txt and Options Validator Profile Messages tab. FSBRErrs.txt and Options Validator Profile Messages tab. Filename of your choice. See BusinessRules.pdf in Desktop s Doc directory. Also listed in Options Validator Profile Messages tab. CompanionFSBRERRS.txt CCI error numbers Validator Appendices 39

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45 6 Index customizing the validation 22 $ $fsdeflt.apf 34 A activating a pane 7 AK AK Allow Decimal in ICD9 24 Allow Leading Zeros in DRG 24 Analysis tab 23 application values 26 Ask for Standard Name 9, 24 B blanks 2, 25, 26 business rules 2 C CCI Edits 24 choosing a guideline 9 code values 2, 26 colors 22, 28 control numbers 2 copying 13 correcting data 20 counts 2 Counts Depths and Positions 14 CR/LF 2 D data requirements 2 data types 37 dates 2 debug 19 default profiles 34 delimiters 2 demo data 4 diagnostics 30 Disable Error 32 DTL record 32 E EDI - wrapped data 2 EDI data requirements 2 element errors 11 element length 26 element type 26 enveloping 2, 25 F filtering 22, 29 G guideline - choosing 9 guideline - selecting 23 guideline selection 24 Validator Index 41

46 H HL loops 2 I IK IK industry codes 2 ISA 25 items checked by Desktop 2 K keyboard keys 7 L leading zeroes 26 Library 6 Library Link 12 loops 3 M message numbers 30, 39 N navigating 7 O opening Desktop 4 Options menu 22 options overview 22 P padding 25 pane - sizing 7 printing 13 printing to a file 14 segment errors 10 segment terminator 2, 25 Select Standard box 9 severity 22, 29, 31 sizing a pane 7 standard - choosing 9 standard - selecting 23 standard specific profiles 23 standard-specific profiles 35 starting 4 syntax rules 26 T TED TED toolbar 7 tutorial 4 types 29, 31 U unprintable data 2 unused elements 26 unused segments 25 Use One Standard 24 V validation 9 viewing results 5 Z zoom 7 R results - understanding 10 results - viewing 5 S saved profile 31, 33 saving a validation 36 Validator Index 42