TIBCO Foresight HIPAA Validator Bedienungsanleitung

TIBCO Foresight® HIPAA Validator®

Desktop

Standards and Guidelines Reference

Manual

Version 9.2.0

February 2022

TIBCO Foresight® HIPAA Validator® Desktop Standards and Guidelines Reference

Manual

2 | Contents

Contents

Contents 2

Introduction 4

Basic Concepts 4

XML and Flat-File Guidelines 4

Guideline Management with TIBCO Foresight Products 5

Guideline Merging with GuideMerge 6

Standards Overview 8

Supported Standards 9

Pre-X12 Standards 9

X12 Standards 10

X12 Derivatives 12

Medical Standards 13

EDIFACT Standards 14

EDIFACT Derivatives 16

Other Standards 16

XML Standards 17

Flat-File Standards 17

Guideline Overview 18

Life Cycle of a Guideline 18

Using a Merged Guideline 19

Anatomy of a Guideline 23

Explanation for Segment Table Example 24

Explanation for Segment Detail Page Example 26

Supported Guidelines 29

TIBCO Foresight® HIPAA Validator® Desktop Standards and Guidelines Reference

Manual

3 | Contents

HIPAA Guidelines 30

Healthcare Guidelines Non-HIPAA Mandated 35

Healthcare Guidelines for TIBCO Foresight® Community Manager® 37

General Guidelines 38

Appendix A: HL7 Standards 39

HL7 in TIBCO Foresight Products 39

Sample Data and Instream Scripts 40

Big Picture 40

HL7 Specific Information 41

HL7 Data Types 45

Appendix B: NCPDP Standards 49

NCPDP in TIBCO Foresight Products 49

Sample Data and Instream Scripts 50

Terminology 50

Big Picture 51

Codes 52

Elements 52

Segments 55

Example Batch 57

Data with no 1.1 “Enveloping” 58

TIBCO Documentation and Support Services 60

Legal and Third-Party Notices 61

TIBCO Foresight® HIPAA Validator® Desktop Standards and Guidelines Reference

Manual

4 | Introduction

Introduction

This document is intended as a reference for those who use EDI industry standards and

guidelines or develop customized guidelines using TIBCO Foresight® products.

Basic Concepts

Standards

Standards ensure that electronic data conforms to formatting rules for sending business

documents between companies using delimited, variable-length fields.

Some well-known standards are X12, EDIFACT, and NCPDP.

Industry Guidelines

Industry guidelines further define rules for specific industries.

Examples of types of industry guidelines are those related to healthcare, pharmacies, and

transportation logistics.

Customized Guidelines

Customized guidelines are those you develop using a published standard or guideline as a

starting point. They further define rules in places where the standard or industry guideline

is not specific enough or you need specialized behavior. Customized guidelines are also

referred to as companion guidelines.

Production Guidelines

Production guidelines are guidelines for TIBCO Foresight® Instream® and TIBCO Foresight®

HIPAA Validator Desktop® that you create by merging a user guideline with a TIBCO

Foresight guideline.

XML and Flat-File Guidelines

Unlike EDI, XML and flat-file guidelines are not firmly based on standards. Therefore, you

will notice differences in how they are implemented in TIBCO Foresight products. For more

TIBCO Foresight® HIPAA Validator® Desktop Standards and Guidelines Reference

Manual

5 | Introduction

information refer to the following documents:

lUsing XML (XMLatForesight.pdf)

lUsing Flat Files (FlatFilesAtForesight.pdf)

Guideline Management with TIBCO Foresight Products

All TIBCO Foresight products

lRead guidelines from their databases (.STD files)

lList guidelines so that you can select one.

Foresight products also have specific roles when working with guidelines:

Foresight

Product

Role of Product Role of Guideline

TIBCO

Foresight®

EDISIM®

Allows you to build, publish, and

test companion guidelines for

use during EDI transaction

processing and validation.

Create company guidelines

Uses guidelines to print documentation,

make test data, validate types 1, 2, and

8, migrate guidelines to new version,

view parts of guideline

HIPAA

Validator

Desktop®



lValidates data according to

industry standards, custom

guidelines, and specific

business rules.

lProvides the ability to

correct data.

Uses guidelines to validate data types 1-

8 (one file at a time)

Instream® lValidates data according to

industry standards, custom

guidelines, and specific

business rules.

Use guidelines to validate data types 1-8

(production)

TIBCO

Foresight®

Transaction

lEnterprise-wide, partner-

specific, and detailed

transaction reporting and

Uses guidelines to collect statistics,

view, and correct EDI errors.

TIBCO Foresight® HIPAA Validator® Desktop Standards and Guidelines Reference

Manual

6 | Introduction

Foresight

Product

Role of Product Role of Guideline

Insight® alerts

lAdvanced search and

transaction matching

capabilities

lAbility to view, share, and

correct transactions.

TIBCO

Foresight®

Community

Manager®

lAbility to check data

against guidelines supplied

by the Community

Manager administrator.

lAbility to view and

download analysis results.

Uses guidelines to allow partners to

validate their own EDI – types 1-8.

Guideline Merging with GuideMerge



Production guidelines are guidelines for Instream and HIPAA Validator Desktop that you

create by merging a user guideline with a TIBCO Foresight guideline. HIPAA-based

Production guidelines contain type 1-7 edits.

GuideMerge installs with HIPAA Validator® Desktop, EDISIM®, and Windows versions of

Instream.

Guideline Merge lets you merge the changes that you have made to your guideline in

EDISIM Standards Editor with:

lTIBCO Foresight-supplied guidelines containing other HIPAA rules

lAnother EDI or flat file guideline with the same structure.

This lets you have a “master” guideline and then separate guidelines with additional

rules for specific partners, for example.

The parties in a merge are:

TIBCO Foresight® HIPAA Validator® Desktop Standards and Guidelines Reference

Manual

7 | Introduction



TIBCO Foresight® HIPAA Validator® Desktop Standards and Guidelines Reference

Manual

8 | Standards Overview

Standards Overview

Standards ensure that electronic data conforms to formatting rules for sending business

documents between companies using delimited, variable-length fields.

Standards can contain many different transaction types. For example X12 standards

provide rules for hundreds of different transactions, often known by their numbers, like

these common ones:

810 Invoice

850 Purchase Order

856 Shipping Notice

997 Functional Acknowledgment

999 Acceptance/ Rejection Advice

Supported Standards provides a detailed list of the standards and guidelines that TIBCO

Foresight products support at some level.



TIBCO Foresight® HIPAA Validator® Desktop Standards and Guidelines Reference

Manual

9 | Supported Standards

Supported Standards

This section provides a listing of the standards:

lSupported by EDISIM, Instream, and HIPAA Validator Desktop. (A note may indicate

partial support.)

lShipped with EDISIM, Instream, and HIPAA Validator Desktop.

Additionally, these TIBCO Foresight products support general XML schema and flat-file

definitions, although they do not currently ship with organization schemas (e.g., MISMO).

Please see XML Standards and Flat-File Standards for more information.

Pre-X12 Standards

Version Shipped with

EDISIM?

Shipped with Instream/HIPAA Validator

Desktop?

AIR-24, 25, 26, 27 Yes No

FREIG-26, 27 Yes No

MOTOR-23, 24, 25, 26, 27,

Yes No

OCEAN-24, 25, 26, 27, 29 Yes No

RAIL-23, 24, 25, 26, 27, 28 Yes No

TARIF-27 Yes No

UCS-23, 24, 25, 26, 30, 31,

32, 33

Yes No

TIBCO Foresight® HIPAA Validator® Desktop Standards and Guidelines Reference

Manual

10 | Supported Standards

X12 Standards

Version Shipped with

EDISIM?

Shipped with Instream/HIPAA Validator

Desktop?

2000 Yes No

2001 Yes No

2002 Yes No

2003 Yes No

2040 Yes No

3010 Yes No

3020 Yes No

3030, 3031, 3032 Yes No

3040, 3041, 3042 Yes No

3050, 3051, 3052 Yes No

3060, 3061, 3062 Yes No

3070, 3071, 3072 Yes No

4010, 4011, 4012 Yes 4010 only

4020, 4021, 4022 Yes No

4030, 4031, 4032 Yes No

4040, 4041, 4042 Yes No

4050, 4051, 4052 Yes 4050 only

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