The Strategic National Implementation Process (SNIP) is a WEDI-sponsored program that helps health care communities identify and resolve HIPAA implementation issues. WEDI, the Workgroup for Electronic Data Interchange, is a health care industry group that lobbied for HIPAA Administrative Simplification and has a formal consultative role under the HIPAA legislation. See Table 1-1 for the WEDI/SNIP testing types that Sybase HIPAA Accelerator 6.0 supports.
Testing type |
Description |
|---|---|
Type 1: EDI syntax integrity testing |
Validates basic syntactical integrity of EDI submission: segments, order, element attributes, testing numeric values in data elements, validation of X12 syntax, and compliance with X12 rules. |
Type 2: HIPAA syntactical requirement testing |
Testing for HIPAA IG-specific syntax requirements, such as limits on repeat counts, used/not used qualifiers, codes, elements and segments. Also, testing for HIPAA required or intra-segment situational data elements, testing for nonmedical code sets, and values and codes noted in the IG via an X12 code list or table. |
Type 3: Balancing |
Testing the transaction for balanced field totals, financial balancing of claims or remittance advice, and balancing of summary fields. For example, all claim line item amounts equal the total claim amount. |
Type 4: Situation testing |
Testing of specific inter-segment situations described in the IG, such that: If A occurs then B must be populated. This is considered to include the validation of situational fields given values or situations present elsewhere in the file. Example: if the claim is for an accident, the accident date must be present. |
Type 5: External code set testing |
Testing for valid IG-specific code set values and other code sets adopted as HIPAA standards. This level of testing validates the code sets and ensures the usage is appropriate for any particular transaction and appropriate with the coding guidelines that apply to the specific code set. Validates external code sets and tables, status codes, adjustment reason codes, and their appropriate use for the transaction. Sybase HIPAA Accelerator supports type 5 validation for some situations. For example, Sybase HIPAA Accelerator does not support validation of U.S. zip codes. Sybase supports medical external code sets. |
Testing type |
Description |
|---|---|
Type 6: Product types or line of services |
Testing type is required to ensure that the segments/records of data that differ based on certain health care services are properly created and processed into claims data formats. These specific requirements are described in the IGs for different product types or lines of service. For example, ambulance, chiropractic, podiatry, home health, parenteral and enteral nutrition, durable medical equipment (DME), psychiatry, and other specialized services have specific requirements in the IG that must be tested before putting the transaction in production. This type of testing applies only to a trading partner candidate that conducts transactions for the specific line of business or product type. |
Type 7: Implementation Guide-specific trading partners |
The IGs contain some HIPAA requirements that are specific to Medicare, Medicaid, and Indian Health. Compliance or testing with these payer-specific requirements is not required from all trading partners. If the trading partner candidate intends to exchange transactions with one of these IG special payers, Type 7 testing is required. When a certification service certifies a trading partner for compliance, the certification service must indicate whether these payer-specific requirements were met during the certification process. Other payers and trading partners may have their own specific business requirements. Unless, however, they are listed in the HIPAA IGs, they are not HIPAA requirements. These non-HIPAA trading partner specific requirements must be tested as part of the business-to-business testing. |
For additional information, see the Workgroup for Electronic Data Interchange Web site
