TIBCO Foresight HIPAA Validator Manual de usuario
TIBCO Foresight® HIPAA Validator®
Desktop
Standards and Guidelines Reference
Manual
Version 9.2.0
February 2022
Copyright © 2001-2022. TIBCO Software Inc. All Rights Reserved.
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,
28
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
Tabla de contenidos
