The IBM WebSphere Transformation Extender (WTX) is a universal transformation engine that can validate and transform any data, work directly in any architecture, and can be used for transformations across the enterprise.
WTX supports specific industry packs such as healthcare services, which provide capabilities to perform following:
- Transform, validate, and enrich any data
- Deliver trustworthy information for critical business initiatives
- Meet regulatory compliance requirements
- Support universal reuse and development
IBM WTX HIPAA EDI pack is healthcare industry pack which supports following transactions:
- Eligibility Inquiry (270)
- Eligibility Response (271)
- Claim (837)
- Claim Status Inquiry (276)
- Claim Status Response (277)
- Claim Payment (835)
- Health Care Services Delivery (278)
- Enrollment (834)
- Payment Order (820)
The Pack for HIPAA EDI contains type trees, maps, sample data, and utility modules. These predefined, industry specific objects provide flexibility to implement wide variety of integration applications and boost the development effort by reusing standard components.
The pack provides type trees for HIPAA EDI Compliance reporting. They provide Types 1 through Type 7 as described below.
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Type 1 (EDI Standard Integrity Testing) testing validates the basic syntactical integrity of the EDI submission. Type 1 testing conducts a test of EDI file for valid segments, segment order, element attributes, numeric values in numeric data elements, validation of x12 or NCPDP syntax, and compliance with X12 rules.
Type 2 (HIPAA Implementation Guide Requirement Testing) testing involves testing for HIPAA implementation guide-specific syntax requirements, like limits on repeat counts, used and not used qualifiers, codes, elements and segments
Type 3 (HIPAA Balance Testing) checks transaction balanced field totals, financial balancing of claims or remittance advice, balancing summary fields etc.
Type 4 (HIPAA Inter-Segment Situation Testing) involves testing of specific inter-segment situations described in the HIPAA implementation guides, such that if A occurs then B must be populated etc.
Type 5 (HIPAA External Code Set Testing) involves testing for valid implementation guide-specific code set values and other code sets adopted as HIPAA standards such as ICD-9-CM or NDC code sets.
Type 6 (Product Type/ Type of Service Testing) testing ensures that the segments of data that differ based on certain healthcare services are properly created and processed into claims data formats. For example such services as ambulance, chiropractic, podiatry, home health etc. have specific requirements in the Implementation guides.
Type 7 (Trading Partner-Specific Testing) testing is specific to Medicare, Medicaid, and Indian Health, which have specific requirements. Only if you are dealing with these special payers, you may use this validation.
The compliance check application can validate HIPAA X12 data against the compliance rules using the type trees provided by the PACK and generates one or more acknowledgement responses that explicitly identifies the nature and the location of all exceptions within the transmission.
With the help of HIPAA pack, Healthcare IT Integrators can give boost to their Integration development timeline and comply with government regulations and mandates on time.
