Can we safely say most of the 834 functionalities (with respect to HIPAA guidelines /compliance/regulations) are supported by the Connect for XML Converter (HIPAA spec)?

The driver supports the same situational syntax rules that the HIPAA TR3 documents use, such as “P0809” or “C1011”. The repository includes these rules sets for standard HIPAA messages, such as 834-005010X220 and 834-005010X307. These and other rules can be altered by using the EDI standards editor to create a .sef file, and then by using that .sef file during the execution of the conversion.

There are seven levels of compliance given by the Strategic National Implementation Process (SNIP) group of the Workgroup for Electronic Data Interchange (WEDI).
They are as follows:
1. Integrity Testing
2. Requirement Testing
3. Balancing
4. Situational Testing
5. Code Set Testing
6. Line of Business Testing
7. Trading Partner Testing

What do they mean, and how does the current implementation of the XML Converters (DDXC 6.2) support them?

Level 1: Integrity Testing
Tests for valid segments, segment order, element attributes, verifying that numeric data elements have a numeric value, validation of X12 syntax and compliance with X12 rules. We handle all of that transparently and completely.

Level 2: Requirement Testing
Tests for HIPAA Implementation Guide specific requirements like repeat counts, used vs. unused codes, elements and segments, and required or intra-segment situational
data elements. We support all of this.

Level 3: Balancing
Tests the transaction for balanced field totals, record or segment counts, financial balancing of claims or remittance advice and balancing of summary fields. We automatically do these calculations. We do allow the user to override the totals if for some reason they should feel the need, but the default is to calculate everything, including sums, totals, and hashes. Other users want errors to appear if the sums are incorrect; we allow autofill to be disabled for these cases.

Level 4: Situational Testing
Tests specific inter-segment situations described in the HIPAA implementation guides (i.e. if A occurs then B must be present) This is fully supported and enabled when the user specifies the intra=yes URI option.

Level 5: Code Set Testing
Tests for valid Implementation Guide specific code set values. Accepted code set values are: ICD-9-CM (International Classification of Diseases, 9th Edition, Clinical Modification), volumes 1-3, HCPCS (Health Care Financing Administration Common Procedure Coding System) except for level III or local codes and CPT-4 (Current Procedural Terminology, 4th Edition) We check automatically for all of the code lists that are included in the WPC-EDI guides. Because different locations will use different subsets of ICD-9, ICD-10, HCPCS, etc., we have not bundled those codelists (some of them run into the tens-of-thousands of items, or more). The user can specify these either by the SEF editor, an XQuery program, or using the unknownCodelistValue callout in the EDIConverterListener and providing an external lookup source, such as a database. unknownCodelistValue(String segment, int pos, int sub, int tri, int rep, String element, String item) is called if the normal code list validation fails for an item. Returning null will cause the caller to force an exception if tbl=yes is set. Returning a non-null value will indicate that the passed code should be accepted as valid.

Level 6: Line of Business Testing
Specialized testing required by certain health care specialties. For example, hospice care, home oxygen treatment and ambulance service have unique data requirements for submitting claims to a payer. This is where the specific line-of-business details are handled, and will be specific to each customer. XQuery or some other mechanism is ideal for this, since it deals with rules that span the document but are localized to the type of service (e.g. ambulance, chiropractic, podiatry, home health, psychiatry, etc.). A prepackaged application cannot supply this.

Level 7: Trading Partner Testing
Specialized testing between trading partners to ensure that data specific to conducting business between trading partners will process correctly. The Companion Guides deal with the specific requirements for transacting business between partners. Because each vendor will have different requirements for source data and documents, this will be localized to each combination of line-of-business and health care agent.