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Regarding Validation Error on a 837P Claim.. RRS feed

  • Question

  • Hello

    I have a 837P HIPAA file where like 3000 claims are under one ST and SE Transaction. In this 1 claim has a validation issue.

    I have enabled routing on failure messages on the receive port, EDI Dissembler did create 3000 instances but suspended all of them with error message as some validation error description of that particular one claim.

    I thought the BizTalk would suspend only the particular instance where there was an error, which is not happening. Can anybody explain this is happening in this way...

     

    I appreciate any help..

     

     


    Rick
    • Edited by Rick85 Tuesday, October 4, 2011 2:39 PM
    Tuesday, October 4, 2011 2:27 PM

Answers

  • I had the same problem too, and here is what I was told. Biztalk will suspend based on the ST-SE envelop per HIPAA. This is done because when you send the 997 back to the trade partner, then your report reflects the ST-SE enevelope. Since the 997 can not break down the transaction inside the ST-SE, BT will fail all transactions based on the envelope.

    I ended up developing a solution that will route failed transactions to one directory. At that point, given that you are using the correct schema, biztalk will break the message into multiple files. Next you can pick them up and run them again through biztalk. However, I strongly encourage to use a custom report and stay away from the 997.


    Please Indicate "Mark as Answer" if this Post has Answered the Question
    • Marked as answer by Rick85 Tuesday, October 4, 2011 6:50 PM
    Tuesday, October 4, 2011 3:15 PM

All replies

  • I had the same problem too, and here is what I was told. Biztalk will suspend based on the ST-SE envelop per HIPAA. This is done because when you send the 997 back to the trade partner, then your report reflects the ST-SE enevelope. Since the 997 can not break down the transaction inside the ST-SE, BT will fail all transactions based on the envelope.

    I ended up developing a solution that will route failed transactions to one directory. At that point, given that you are using the correct schema, biztalk will break the message into multiple files. Next you can pick them up and run them again through biztalk. However, I strongly encourage to use a custom report and stay away from the 997.


    Please Indicate "Mark as Answer" if this Post has Answered the Question
    • Marked as answer by Rick85 Tuesday, October 4, 2011 6:50 PM
    Tuesday, October 4, 2011 3:15 PM
  • Thanks carlos...For the reply..

     

    So is this a problem only when we use 997 Acknowledgement?...

    Or Is it problem even when we dont generate 997 for the transaction..?

     

     


    Rick
    Tuesday, October 4, 2011 3:21 PM
  • It is a HIPAA rule. The 997 is a reflection of an ST-SE envelope. BT was designed based on that rule. Regardless if you want the 997 or not, that is how BT works.

    However, that is why I used my custom orchestration to ensure that I process claims regardless of the envelope. My sugestion, if you want to process the claims regardless of how they come, is to draw out what you want to do. Once you have it on paper or Visio the flow of how you want the flow to work, develop the orchestration or just ports to handle this. I used an orchestration because I only wanted to continue processing a certain TP's instead of everyone, so I developed a function that checks the NPI on an xref table. However, if you dont care, then just use the ports, but I encourage you to draw it first. It can get complex if you are not careful.


    Please Indicate "Mark as Answer" if this Post has Answered the Question
    Tuesday, October 4, 2011 4:32 PM