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Release Notes for TIBCO Foresight® Instream® Release 8.5.0

1. Change 9532 and 9533 Guideline s 5010 837X300 std Originally contained in an earlier Guideline Release Yes 8 4 0 8 Interim Update to Guidelines May 2015 Issue The edits based around Rendering Provider Name Loop 2310B NM1 being required when it is different from the Billing Provider Loop 2010AA NM1 should be revisited The sender can send the information at their discretion but the receiver cannot require it Solution Edit 42063 should not have been included in the 5010 837X300 std and has been removed Edit 47765 remains valid but the severity has been changed from Severity 3 Error to Severity 1 Informational The claim will not fail but a message will be produced allowing customer to determine how to handle this situation when it occurs Related errors 42063 The Rendering Provider Name Loop 2310B NM1 is only required when it is different from the Billing Provider Loop 2010AA NM1 otherwise do not send 47765 The Rendering Provider Name Loop 2310B NM1 is only required when it is different from the Billing Provider Loop 2010AA NM1 otherwise do not send Instream Release Notes 36 7 10 2015 Change 9534 Guideline s 5010 8371 std Originally contained in an earlier Guideline Release Yes 8 4 0 8 Interim Update to Guidelines May 2015 Issue The business rule checking for an Occurrence Code of 55 when the Patient Discharge status was equal to 20 40 41 or 42 was received correctl
2. Instream Release Notes 10 7 10 2015 Change 9412 and 9573 Guideline s 5010 837P std Originally contained in an earlier Guideline Release No Issue There is ambiguity regarding whether or not Place of Service POS 31 should be considered an inpatient code Solution It was determined that POS 31 should no longer be considered an inpatient code in the 837P guideline Change and Guideline 9434 5010 837X299 std 9440 5010 837X300 std 9441 5010 837X298 std Originally contained in an earlier Guideline Release Yes 8 4 0 2 Interim Update to Guidelines August 2014 Issue The ICD 10 cutover date has been moved from October 1 2014 to October 1 2015 Solution The ICD 10 cutover rule has been updated with the date October 1 2015 Change 9448 Guideline s 5010 837D std Originally contained in an earlier Guideline Release Yes 8 4 0 1 Interim Update to Guidelines July 2014 Issue The FS_ICD9_ICD10_CutoverDate variable supports the ICD 9 to ICD 10 conversion cutover Existing functionality does not verify that that ICD10 code date in the 2300 HI is less than the date in the FS_ICD9_ICD10_CutoverDate variable Solution Rules were added to check the ICD10 code date in the 2300 HI Error 42211 will be generated if the ICD10 code date is less than or equal to the date set in the variable FS_ICD9_ICD10_CutoverDate Note For more information on this variable see BusinessRules pdf Appendix A Var
3. BusinessRules pdf Business Rules Reference chapter DBQuery section has been updated to make a distinction between the ReturnCode parameter which returns a success failure code for the database connection and the var1 1 var2 2 parameter which returns information about the database query When the exceed max count error occurs Instream now produces an error for every line that exceeds the count Previously only the first line that exceeded the count produced an error For example if the max count is 100 and 105 lines are sent lines 101 through 105 each produce an error Beginning with Instream Version 8 3 0 Hotfix 3 installation instructions are Hotfix 3 included in the Hotfix Readme file Instream validation has been updated to produce an error when the ISA11 does not match the ISA16 Novell has discontinued support of Novell SUSE Linux Enterprise Server 11 2 Therefore the system requirements information for Instream 8 4 0 now specifies Novell SUSE Linux Enterprise Server 11 3 64 bit on x86 64 as the minimum requirement for the platform For AK9 TA1 IK3 IK4 and IK5 overrides Response Generator now ignores No any records that have less than 6 fields Instream Release Notes 52 7 10 2015 Originally a contained n f apg Summary in a Release Request ID 8 3 0 Hotfix FINS 606 Response Generator now generates error code 018 f
4. Issue Edit 40817 was missing from the 2420C N403 field Solution The 40817 edit was added to the 2420C N403 element in the subscriber loop Related error 40817 Zip codes are not to contain any special characters Change 9391 Guideline s 5010 277X212 std Originally contained in an earlier Guideline Release Yes 8 4 0 3 Interim Update to Guidelines September 2014 Issue The Information Receiver Claim Status Category Code listing STC0101 List did not include E3 and E4 as valid codes Solution The STC0101List now considers the following codes to be valid DO E0 E1 E2 E3 and E4 Updated errors 43371 The Information Receiver Claim Status Category Code 2200B STC01 01 must be either DO E0 E1 E2 E3 or E4 43412 The Information Receiver Claim Status Category Code 2200C STC10 01 must be either DO EO E1 E2 E3 or E4 43413 The Information Receiver Claim Status Category Code 2200C STC11 01 must be either DO E0 E1 E2 E3 or E4 43414 The Information Receiver Claim Status Category Code 2200B STC10 01 must be either DO E0 E1 ES E3 or E4 43415 The Information Receiver Claim Status Category Code 2200B STC11 01 must be either DO E0 E1 E2 E3 or E4 43416 The Information Receiver Claim Status Category Code 2200C STC01 01 must be either DO EO E1 E2 E3 or E4 Instream Release Notes 9 7 10 2015 Change 9393 Guideline s 5010 837X229 std Originally contained in an ea
5. Originally contained in an earlier Guideline Release Yes 8 4 0 5 Interim Update to Guidelines December 2014 Issue Edit 40958 currently runs at the end of the HL Loop It is preferable to have the error referenced on the 999 DTP Solution The edit was removed from ST segment and added to the to the DTP 096 segments in both the Subscriber and Patient loops Related error 40958 The Discharge Date 2300 DTP is only required on inpatient claims when discharge date is known Otherwise do not send Instream Release Notes 27 7 10 2015 Change 9505 Guideline s 5010 820X306 std Originally contained in an earlier Guideline Release Yes 8 4 0 5 Interim Update to Guidelines December 2014 Issue Loop 1000C N101 is generating Error 46623 when the code value is equal to TV This error should only be thrown for FFM Individual markets The companion guideline states FFM User Interface will transmit the TPA Broker ID as the National Producer Number NPN and data element N101 shall be BO Solution The business rule was revised to generate the error only when the 834 is for FFM Individual markets and the N101 is not equal to BO Updated error 46623 HIX The TPA Broker Name Entity Identifier Code 1000C N101 must be BO Broker or Sales Office for FFM Individual markets Change 9506 Guideline s 5010 820X306 std Originally contained in an earlier Guideline Release Yes 8 4 0 5 Interim Update
6. 8 4 0 1 Interim Update to Guidelines July 2014 Issue The business rules checking for the Member Supplemental Identifier Qualifier 2000 REFO1 17 23 or ZZ when the INS04 59 OR 24are too restrictive Solution The business rules now reviews all iterations of the Member Supplemental Identifier Qualifier 2000 REF01 being equal to 17 23 or ZZ As long as one iteration has the required qualifier the error messages are not generated Related errors 46568 HIX The Member Supplemental Identifier Qualifier 2000 REFO1 must be 17 23 or ZZ for cancellations 46588 HIX The Member Supplemental Identifier Qualifier 2000 REF01 must be 17 23 or ZZ when the Maintenance Type Code 2000 INSO3 equals 024 Change 9457 Guideline s 5010 8371 std Originally contained in an earlier Guideline Release Yes 8 4 0 2 Interim Update to Guidelines August 2014 Issue The 2010CA N404 business rule was looking at the incorrect zip code list when checking for non USA zip codes Solution The business rule was updated to point to the correct zip code list when checking for non USA zip codes Instream Release Notes 13 7 10 2015 Change 9458 Guideline s 5010 835 std Originally contained in an earlier Guideline Release Yes 8 4 0 2 Interim Update to Guidelines August 2014 Issue When the BPR12 01 was present there was no checking for a valid 9 digit number in the BPR13 Solution Created a business rule to verify
7. fno_AlS When present turns off GenerateAlsS flag fno_ung When present turns off functional group UNG data in EDIFACT CONTRL responses fUseShortGS05 If present GSO5 is set to 4 characters HHMM instead of the default HHMMSS Refer ResponseGeneratorTechnicalManual pdf for more information Instream Release Notes 2 7 10 2015 Change Details Custom Reports were added for 278x215 and 278x216 transactions Refer ResponseGeneratorTechnicalManual pdf for more information Trading Partner Automation Instream Trading Partner Administration has been updated with default Flat File values for various elements Refer InstreamTPAutomation pdf for information on creating trading partner lookup csv files to define custom default values Demo Changes This section describes changes and additions to the demos provided with Instream Refer to Demo_Index pdf for more information Nothing at this time Instream Release Notes 3 7 10 2015 CCI Table Changes Important CCI Tables apply only to Instream Healthcare Edition Note Instream Release 8 5 0 includes changes originally contained in the following interim CCI Table Updates 8 4 0 1 through 8 4 0 5 Table Updated to this Version Date CCI Tables CMS Version 21 2 of the CCI Tables through the period ending September 30 2015 CMS Version 21 1 of the CCI Tables through the period ending June 30 2015 CMS Version 21 0 of the
8. 2100B DMG segment must be present New error 42831 The Incorrect Member Demographics 2100B DMG is required when the Member Name Entity ID 2100A NM101 equals IL and the Incorrect Member Name 2100B loop is used Instream Release Notes 34 7 10 2015 Change 9528 Guideline s APF file change only Originally contained in an earlier Guideline Release Yes 8 4 0 7 Interim Update to Guidelines March 2015 Issue The 5010837D std 5010837I std and 5010837P std contain edits for the same issue but have different values in the default APF file fsdeflt apf Values in fsdeflt apf should be the same for all three Solution fsdeflt apf was updated as follows 1 For 5010837I std edit 41231 was found to have the correct values no changes were made 41231 3 4 8 7 024 X1 21 8 7 2 For 5010837D std edit 42020 was changed as follows Previous entry 42020 3 4 8 7 024 X1 21 8 19 Changed IK403 from I9 to 7 New entry 42020 3 4 8 7 024 X1 21 8 7 3 For 5010837P std edit 40846 was changed as follows Previous entry 40846 3 5 8 7 024 X7 8 12 Changed HIPAA type from 5 to 4 and IK403 from 12 to 7 New entry 40846 3 4 8 7 024 X7 8 7 Related errors 40846 Within a given claim the various values for the Payer Responsibility Sequence Number Code other than value U may occur no more than once 41231 Within a given claim the various values for the Payer Responsibility Sequence Number Code other than value U m
9. 44 Instream Release Notes 1 7 10 2015 New and Changed Features Change Details Additional Guidelines Supported See New and Changed Healthcare Guidelines Non HIPAA Mandated APF File Options You can now add or remove characters from the default character set for a transaction set using a new parameter in the APF Validation Profile file Analyzer Options section UserCharacterSet lt hexcharacter gt Refer APF pdf for more information Business Rules Business Rules ValidateDateTimeX12 and ValidateTimeUN now include an option to set a lt falseRule gt to be executed if the time check fails Refer to BusinessRules pdf for more information Instream Structure ID information was added for the newly supported guidelines See New and Changed Healthcare Guidelines Non HIPAA Mandated and InstreamValidationTechnicalManual pdf Instream API A new call has been added to the Java API updateMessage is used to write Document Splitter and Data Exchange values output to memory Refer to InStreamAPI pdf for more information ISIServer ISIServer has a new logging format ISIServer can now be installed as a service Refer ISlserver pdf for more information Response Generator The following parameters were added to Response Generator diq lt on off gt Sets a flag in the ISA14 element to notify the receiver that the sender is expecting a TA1 to be returned for the document
10. 9V or 9X 46616 HIX The Reporting Category Date 2750 DTP must be present when submitting defined Reporting Category 2750 NM1 codes per section 9 6 of the companion guideline Change 9509 Guideline s 5010 HIX 834X220 std Originally contained in an earlier Guideline Release Yes 8 4 0 6 Interim Update to Guidelines January 2015 Issue Errors 4615 and 46616 refer to NM1 instead of N1 Solution Errors 4615 and 46616 were updated to refer to N1 Updated errors 46615 HIX The Reporting Category Reference 2750 REF must be present when submitting defined Reporting Category 2750 N1 codes per section 9 6 of the companion guideline 46616 HIX The Reporting Category Date 2750 DTP must be present when submitting defined Reporting Category 2750 N1 codes per section 9 6 of the companion guideline Instream Release Notes 29 7 10 2015 Change 9510 Guideline s 5010 HIX 834X220 std Originally contained in an earlier Guideline Release Yes 8 4 0 6 Interim Update to Guidelines January 2015 Issue Error 46622 is being generated for Individual when the QTY is not sent with the QTY01 ET According to the CMS HIX 834_Companion_Guide_DRAFT_FFM_1 7 Pre Clearance_June_1_ 2014 _v1 7 pdf section 10 1 page 33 SHOP needs to send the QTY01 ET only when there is an INSO1 Y QTY01 ET FF SHOP only transmit to indicate that the value conveyed in QTY02 represents the total number of INS segments in this ST S
11. A more verbose Instream return code is needed when running Instream in No TIBCO ActiveMatrix BusinessWorks Plug in for HL7 FINS 773 TPA Router is not routing TA1 Files No FINS 776 HL7 callback error message appears to be incorrect No FINS 777 An installer issue related to Instream permissions on Linux was corrected No FINS 778 A validation error caused by invalid EDIFACT data was not reported by Instream Hotfix 8 causing a problem with Translator This has been corrected FINS 783 The DocSplitter user manual was updated to note that recalculation of BPRO2 is No for both 820s and 835s FINS 784 A note was added to ResponseGeneratorTechnicalManual pdf Appendix A No Return codes 300 and 400 level return codes indicate serious or unusual Response Generator execution errors If you receive a return code in this range make note of the error number and contact TIBCO Foresight Technical Support FINS 786 The default EDIFACT release character was not applied during validation No FINS 788 Remove TPAConfig exe from the Instream install No FINS 798 Installation of Instream 64 bit causes issues with custom build site for ISIServer No FINS 799 CTX records appearing despite APF file being set to 0 No FINS 800 DocSplitter is not handling the splitting of the 278X216N transaction as expected No FINS 801 Issues related to unexpected testing results have been resolved No FINS 804 FINS 805 FINS 808 FINS 809 Instream Release Notes 48 7 10
12. Intermediaries had an incorrect code value of LX It should be D9 Solution The REFO1 was corrected to be code value D9 Change 9468 Guideline s 5010 HIX 834X220 std Originally contained in an earlier Guideline Release Yes 8 4 0 2 Interim Update to Guidelines August 2014 Issue A business rule on the 2750 REF was incorrectly generating error number 46617 Solution The business rule was corrected and error 46617 is no longer generating in error Related error 46617 HIX One iteration of the Reporting Category Name 2750 N102 must be equal to ADDL MAINT REASON with a Reporting Category Reference ID 2750 REFO2 equal to either CANCEL CANCEL FLC CANCEL MDC CANCEL CHP CANCEL NLE CANCEL MEC CANCELCIC TERM TERM FRD TERM FLC TERM MCD TERM CHP TERM NLE TERM MEC TERM DCT or TERMCIC for all terminations and cancellations Instream Release Notes 16 7 10 2015 Change 9469 Guideline s 5010 837P std Originally contained in an earlier Guideline Release Yes 8 4 0 3 Interim Update to Guidelines September 2014 Issue The 2420E PERO2 should be required for both the Subscriber and Patient loops Solution The 2420E PERO2 user attributes were changed from Dependent to Required for both the Subscriber and Patient loops Change 9470 Guideline s 5010 837D std Originally contained in an earlier Guideline Release Yes 8 4 0 3 Interim Update to Guidelines September 2014 Issu
13. Line Check or Remittance Date Current_Element 47872 The Service Line Adjustment Reason Code FS_FindCodeValue was not valid on the Service Line Check or Remittance Date Current_Element 47873 The Service Line Adjustment Reason Code FS_FindCodeValue was not valid on the Service Line Check or Remittance Date Current_Element 47874 The Service Line Adjustment Reason Code FS_FindCodeValue was not valid on the Service Line Check or Remittance Date Current_Element 47875 The Service Line Adjustment Reason Code FS_FindCodeValue was not valid on the Service Line Check or Remittance Date Current_Element 47794 The Remark Code 2320MOA03RemarkCode was not valid on Claim Check or Remittance Date of Current_Element 47795 The Remark Code 2320MOA04RemarkCode was not valid on Claim Check or Remittance Date of Current_Element 47796 The Remark Code 2320MOA05RemarkCode was not valid on Claim Check or Remittance Date of Current_Element 47797 The Remark Code 2320MOA06RemarkCode was not valid on Claim Check or Remittance Date of Current_Element 47798 The Remark Code 2320MOA07RemarkCode was not valid on Claim Check or Remittance Date of Current_Element Instream Release Notes 42 7 10 2015 Change 9569 Guideline s 5010 835 Originally contained in an earlier Guideline Release No Issue The business rule that is throwing error 42558 is considered too restrictive based on the X12 interpretation RFI 14
14. Policy Number Reference ID Qualifier 2300 REFO1 must be CE E8 or 1L when the Maintenance Reason Code 2000 INS04 equals EC or 41 Change 9513 Guideline s 5010837D std Originally contained in an earlier Guideline Release Yes 8 4 0 6 Interim Update to Guidelines January 2015 Issue Error 42056 triggers incorrectly in the Patient Loop The edit should consider if the SV3 being used is for Subscriber or Patient loop Solution The edit was updated to specify the location Subscriber 2000B loop or Patient 2000C loop of 2400 DTP in question Related error 42056 The Date Prior Placement segment Loop 2400 DTP should not be used when the Prosthesis Crown or Inlay Code Loop 2400 SV305 is not equal to R replacement Instream Release Notes 31 7 10 2015 Change 9513 Guideline s 5010837D std Originally contained in an earlier Guideline Release Yes 8 4 0 7 Interim Update to Guidelines March 2015 Issue Error 42056 continues to trigger incorrectly The edit should consider if the SV3 being used is for Subscriber or Patient loop This issue originally appeared in 8 4 0 6 Interim Update to Guidelines dated January 2015 Solution The SetVar PHAve2400SV3 and SHave2400SV3 are now set to OFF in both the Subscriber and Patient LX segment Related error 42056 The Date Prior Placement segment Loop 2400 DTP should not be used when the Prosthesis Crown or Inlay Code Loop 2400 SV305 is not equa
15. that when the BPR12 01 the BPR13 was a 9 digit number New error 42677 The DFI Identification Number BPR13 must be a nine digit number when the DFI ID Number Qualifier BPR12 equals 01 Change 9459 Guideline s 5010 837D std Originally contained in an earlier Guideline Release Yes 8 4 0 2 Interim Update to Guidelines August 2014 Issue When the 2300 DTP02 RD8 the date used in the FindCodeWithDate rules should be the Through date not the From date Solution Business rules for the 2300 DN201 FindCodeWithDate ToothNumber rule were updated to validate first using the Statement Date then the Service Date This was also implemented for the 2300 HI segment ICD10 and ICD9 codes along with the Cutover rule Change 9460 Guideline s 5010 835 std Originally contained in an earlier Guideline Release Yes 8 4 0 2 Interim Update to Guidelines August 2014 Issue The 2100 CAS and 2110 CAS 02 05 08 11 14 17 CARC codes were missing a business rules for date checking validation Solution A new rule was added to check the CAS02 05 08 11 14 and 17 CARC codes at both the 2100 ad 2110 levels New error 42676 The Claim Adjustment Reason Code Current_Element was not valid for date BPR16TransactionDate Instream Release Notes 14 7 10 2015 Change and Guidelines 9463 278X215l std and 278X215R std 9465 5010 278X216N std and 5010 278X216A std Originally contained in an earlier G
16. to pass validation Instream Release Notes 24 7 10 2015 Change 9496 Guideline s 5010 837X298 std Originally contained in an earlier Guideline Release Yes 8 4 0 5 Interim Update to Guidelines December 2014 Issue Edit 47314 is no longer needed because the 2330B DTP and 2430DTP are both required per the associated TR3 Solution Removed all 47314 edits from the guideline and retired error 47314 Retired error 47314 The Claim Check or Remittance Date Loop 2330B DTP is only required when the Line Adjudication Information Loop 2430 SVD is not used and the claim has been previously adjudicated by the provider in loop 2330B Change 9497 Guideline s HDMA DSCSA 4010856 std Originally contained in an earlier Guideline Release Yes 8 4 0 5 Interim Update to Guidelines December 2014 Issue A new Healthcare Distribution Management Association HDMA Guideline for the 856 Advance Ship Notice to Support Implementation of Drug Supply Chain and Security Act DSCSA is needed The HDMA issues these guidelines based on interpretation of compliance requirements for DCSCA as of July 2014 Solution The HDMA DSCSA 4010856 std guideline is now available based on the July 2014 specifications provided by HDMA Change 9498 Guideline s 5010 HIX 834X220 std Originally contained in an earlier Guideline Release Yes 8 4 0 5 Interim Update to Guidelines December 2014 Issues 1 Error 46641 is be
17. when a previous claim also has a 2310A Solution Edits were added to the to the CLM segments to clear variable S2310NM101 The error is now generating as expected Related error 47182 The value DN must precede the value of P3 when both are present or only one iteration of the Referring Provider Name Loop 2310A is used Change 9502 Guideline s 5010 837X298 Originally contained in an earlier Guideline Release Yes 8 4 0 5 Interim Update to Guidelines December 2014 Issue Edit 47236 is not required on the 2400 SV105 element according to the 5010 837X298 TR3 Solution Edit 47236 was removed from the 2400 SV105 element and the error was retired Retired error 47236 The Facility Code Value 2400 SV105 is only required when it is different than the value carried in the Facility Code Value 2300 CLM05 01 Instream Release Notes 26 7 10 2015 Change 9503 Guideline s 5010 837x299 Originally contained in an earlier Guideline Release Yes 8 4 0 5 Interim Update to Guidelines December 2014 Issue Edit 47635 on Line Hem Control Number Loop 2400 REF is not required by the 5010 837x299 TR3 Solution Edit 47635 was removed from the guideline Related error 47635 The Line Item Control Number Loop 2400 REF is strongly encouraged to routinely be sent on all service lines particularly if the submitter automatically posts their remittance advice Change 9504 Guideline s 5010837P std
18. 047 Solution The business rule has been removed Retired error s 42558 The Other Claim Related ID Qualifier Loop 2100 REF01 CE is only required when there is a Contractual Obligation on the claim Loop 2100 CAS0O1 CO or 2110 CASO1 CO otherwise do not send Change 9574 Originally contained in an earlier Guideline Release No Guideline s 5010 271 Issue Edit 43807 not triggering reliably The local variable on the 2100C REF01 is capturing only the last qualifier of the up to 9 repeats of the segment Resolution Rules were added to generat an error when any iteration total 9 of the REF segment in the 2100C REFO1 SY and the EB04 12 13 14 15 16 41 42 43 47 CP HN MA MB MC MH MI or MP The same issue was found in the 2100B REF segment and the rule was modified to trigger for every iteration of the 2100B REF Total 9 when the REF01 SY and the EB04 12 13 14 15 16 41 42 43 47 CP HN MA MB MC MH MI or MP Related Error s 43806 The Reference Identification Qualifier SY 2100B REFO1 must not be used when the Insurance Type Code 2110C EB04 is 12 13 14 16 41 42 and 43 CP HN MA MB MC MH MI or MP 43807 The Reference Identification Qualifier SY 2100C REF01 must not be used when the Insurance Type Code 2110C EB04 is 12 13 14 16 41 42 and 43 CP HN MA MB MC MH MI or MP Instream Release Notes 43 7 10 2015 Error Message File Changes Note If you are using your own profiles
19. 2015 Originally a contained n f ange Summary in a Release Request ID 8 4 0 Hotfix FINS 811 An issue occurring when Instream validates large ST elements containing Hotfix 9 special characters has been corrected FINS 812 A Doc plitter issue causing fatal errors has been resolved No Instream Release Notes 49 7 10 2015 Appendix A Closed Issues for Previous Releases Closed Issues for Previous Releases are retained in this document for one year These tables are for reference only and contain no new or updated information Instream Release 8 4 0 Note Instream Release 8 4 0 includes changes originally contained in Release 8 3 0 Hotfix 1 Hotfix 2 Hotfix 3 Hotfix 4 and Hotfix 5 Originally E contained n f ad Summary in a Release Request ID 8 3 0 Hotfix FINS 226 TPARouter now skips any TA1 found between an ISA and GS thereby ensuring No that it does not route data files with a TA1 in the envelope FINS 422 A Response Generator issue with UTF 16 encoding has been resolved No FINS 478 New flag X12RTypeStrict 0 was added to the default APF file This can be No FINS 519 used to toggle on off strict X12 processing of insignificant leading trailing zeros See APF pdf for more information FINS 479 Response Generator was updated to better handle leading and trailing zeros in Hotfix 1 fields containing monetary amounts FINS 509 A Response Generator perfor
20. 24 The Claim Adjustment Reason Code FS_FindCodeValue was not valid on the Claim Check or Remittance Date Current_Element 47625 The Claim Adjustment Reason Code FS_FindCodeValue was not valid on the Claim Check or Remittance Date Current_Element 47626 The Claim Adjustment Reason Code FS_FindCodeValue was not valid on the Claim Check or Remittance Date Current_Element Instream Release Notes 41 7 10 2015 5010X300 47864 The Claim Adjustment Reason Code FS_FindCodeValue was not valid on the Claim Check or Remittance Date Current_Element 47865 The Claim Adjustment Reason Code FS_FindCodeValue was not valid on the Claim Check or Remittance Date Current_Element 47866 The Claim Adjustment Reason Code FS_FindCodeValue was not valid on the Claim Check or Remittance Date Current_Element 47867 The Claim Adjustment Reason Code FS_FindCodeValue was not valid on the Claim Check or Remittance Date Current_Element 47868 The Claim Adjustment Reason Code FS_FindCodeValue was not valid on the Claim Check or Remittance Date Current_Element 47869 The Claim Adjustment Reason Code FS_FindCodeValue was not valid on the Claim Check or Remittance Date Current_Element 47870 The Service Line Adjustment Reason Code FS_FindCodeValue was not valid on the Service Line Check or Remittance Date Current_Element 47871 The Service Line Adjustment Reason Code FS_FindCodeValue was not valid on the Service
21. CCI Tables through the period ending March 31 2015 CMS Version 20 3 of the CCI Tables through the period ending December 30 2014 Code Table Changes Important Code Tables apply only to Instream Healthcare Edition Note Instream Release 8 5 0 includes changes originally contained in the following interim Code Table Updates 8 4 0 1 through 8 4 0 15 Code Table Updated to this Version Date Adjustment Reason Codes Jan 2014 Jun 2014 Jul 2014 November 2014 Jul 2015 Mar 2015 July 2015 CDT Codes 2015 Condition Codes Apr 2015 CPT Codes January 2015 Category IIl codes Category Il code updates amp MAAA codes added CPT Modifiers January 2015 DRG codes October 2015 HCPCS October 2014 including MM8764 pdf January 2015 Apr 2015 Jul 2015 April 2015 HCPCS Modifiers MM8764 pdf January 2015 April 2015 Jul 2015 1CD10Procedures 2016 Instream Release Notes 4 7 10 2015 Code Table Updated to this Version Date InsAppErrorCodes Insurance Application Error Codes May be viewed on WPC website Language Codes Updated NISO Z39 53 Language Code List Language Names Updated ISO 639 1 ISO 639 2 ISO 639 6 Added ISO 639 3 and ISO 639 5 Removed duplicates as needed LOINC Codes Jan 2015 NAIC July 2014 December 2014 Payment Codes October 2014 May 2015 Remark Codes March 2014 Jul 2014 November 2014 Mar 2015
22. E set with INSO1 Y This number will represent the number of Employee Subscribers contained in the transaction Set Solution The error was updated to generate for FF SHOP only when INS segments contain INS01 Y for Employee Subscribers Retired error 46622 HIX At least one Transaction Set Control Totals QTY segment must be sent with the qualifier of ET Employee Total for FFM and FF SHOP New error 46650 HIX At least one Transaction Set Control Totals QTY segment must be sent with the qualifier of ET Employee Total when the number exceeds zero for SHOP Change 9511 Guideline s 5010 HIX 834X220 std Originally contained in an earlier Guideline Release Yes 8 4 0 6 Interim Update to Guidelines January 2015 Issue The QTY segment with a value of QTY01 TO is required for both FFM and SHOP However the edit requiring the QTY01 TO is being generated for SHOP only Solution The business rule was updated to require the QTY segment with a value of QTY01 TO for both FFM and SHOP Instream Release Notes 30 7 10 2015 Change 9512 Guideline s 5010 HIX 834X220 std Originally contained in an earlier Guideline Release Yes 8 4 0 6 Interim Update to Guidelines January 2015 Issue Error 46537 is set to severity 2 Warning when it should be severity 3 Error Solution The default APF file fsdeflt apf was updated to set Error 46537 to severity 3 Error Related error 46537 HIX The Health Coverage
23. Hotfix 1 and 5010 HIX 834x307 Response Generator populated the GS08 and ST03 with 005010 instead of 005010X231A1999 This issue has been corrected FINS 541 A new Options parameter for Docsplitter allows recalculation of the TS2 element No values in the valid invalid output files to be turned on or off FINS 551 Validation engine changes were made to better handle supported Payment No Initiation PAIN standards e g pain 001 001 03 FINS 552 Response Generator produced a 277CA with empty dollar values when the Hotfix 1 original EDI data contained a zero 0 dollar amount e g CLM02 0 This issue has been corrected FINS 554 Validation engine changes were made to better handle Amadeus guidelines Hotfix 1 FINS 570 Instream was updated to better handle missing delimiters in source data Hotfix 1 FINS 571 ResponseGeneratorTechnicalManual pdf was updated to state that TA104 No can be generated only as A Accept or R Reject Suspend It cannot be generated as E Accepted with Errors Chapter 4 Enveloping Format gt TA1 Appendix E Response Document Contents gt 997 Structure and Data Sources FINS 574 An issue causing Docsplitter to fail without creating valid or invalid files after No encountering poorly structured has been corrected FINS 575 Instream now recognizes as the EDIFACT default release character Hotfix 1 FINS 579 A Response Generator issue that occurred when generating a 277CA Custom No Report has been corrected FIN
24. July 2015 Report Type Codes May 2015 Status Codes Jan 2014 Jun 2014 November 2014 Taxonomy Codes January 2014 July 2015 See wpc edi website for details Zip codes Jun 2014 Jul 2014 Aug 2014 Sept 2014 October 2014 November 2014 December 2014 Feb 2015 Mar 2015 Apr 2015 Jun 2015 Jul 2015 Instream Release Notes 5 7 10 2015 Guideline Changes This section describes changes and additions to the HIPAA and Non HIPAA guidelines provided with Instream Refer to the documents ForesightHIPAAguidelinelist pdf and ForesightGeneralGuidelinelist pdf New and Changed HIPAA Guidelines Guideline Change HIPAA Guidelines 5010 Types 1 2 Errata None at this time HIPAA Guidelines 5010 Types 1 7 Errata None at this time HIPAA Guidelines PLUS 5010 Errata The changes to the HIPAA guidelines listed in HIPAA Guidelines 5010 Types 1 7 Errata are also included in the corresponding HIPAA Guideline Plus listed in this section X12 5010 before June 2010 Errata Although still supported these guidelines are no longer shipped with TIBCO Foresight products New and Changed Healthcare Guidelines Non HIPAA Mandated Guideline Change 275 X314 Health Care Claim or Encounter This guideline has been added 275 X314 std 275 X316 Health Care Services Review This guideline has been added 275 X316 std 277 X313 Health Care Claim Reques
25. REFO1 17 for Individual must be 10 numeric characters Change 9479 Guideline s 5010 837D std Originally contained in an earlier Guideline Release Yes 8 4 0 4 Interim Update to Guidelines October 2014 Issue Edits are needed for Referring Provider 2310A when Referral Number is used 2300 REF01 9F Solution Edit 42212 was added and now generates when the 2300 REF01 9F exists and the 2310A Referring Provider is missing New error 42212 When the Referral Number 2300 REFO1 9F is present the Referring Provider 2310A must be used Instream Release Notes 20 7 10 2015 Change 9480 Guideline s 5010 837X298 std Originally contained in an earlier Guideline Release Yes 8 4 0 4 Interim Update to Guidelines October 2014 Issue Variables were not clearing for Edits 47147 47148 and 47223 Solution Edits were updated to clear variables and are working as expected Related errors 47147 The Previous Claim does not balance Formula used CLM02 SLoop2300CLM02 sum of SV102 SLoop2400SV102 47148 The Previous Claim does not balance Formula used CLM02 PLoop2300CLM02 sum of SV102 PLoop2400SV102 47223 The LX Service Line Number is not incrementing by one Change 9481 Guideline s 5010 8371 std Originally contained in an earlier Guideline Release Yes 8 4 0 4 Interim Update to Guidelines October 2014 Issue A business rule on elements HI02 04 through HI012 04 refers bac
26. Reason Code FS_FindCodeValue was not valid on the Claim Check or Remittance Date Current_Element 41532 The Claim Adjustment Reason Code FS_FindCodeValue was not valid on the Claim Check or Remittance Date Current_Element 41533 The Claim Adjustment Reason Code FS_FindCodeValue was not valid on the Claim Check or Remittance Date Current_Element 41534 The Claim Adjustment Reason Code FS_FindCodeValue was not valid on the Claim Check or Instream Release Notes 40 7 10 2015 Remittance Date Current_Element 41535 The Claim Adjustment Reason Code FS_FindCodeValue was not valid on the Claim Check or Remittance Date Current_Element 41542 The Remark Code Current_Element was not valid on Claim Statement Date of SStatementDate2 41543 The Remark Code Current_Element was not valid on Claim Statement Date of PStatementDate2 41547 The Remark Code Current_Element was not valid on Claim Statement Date of SStatementDate2 41548 The Remark Code Current_Element was not valid on Claim Statement Date of PStatementDate2 5010 837D 42110 The Claim Adjustment Reason Code FS_FindCodeValue was not valid on the Claim Check or Remittance Date Current_Element 42111 The Claim Adjustment Reason Code FS_FindCodeValue was not valid on the Claim Check or Remittance Date Current_Element 42112 The Claim Adjustment Reason Code FS_FindCodeValue was not valid on the Claim Check or Remittance Date Curre
27. S 580 Validation rules needed to handle the new CAQH Core III requirements have Hotfix 3 been added FINS 581 Instream no longer ends processing when it encounters a hex value of 1A No Instream Release Notes 7 10 2015 Change Request ID FINS 584 FINS 586 FINS 589 FINS 594 FINS 595 FINS 596 FINS 597 FINS 598 FINS 600 FINS 601 FINS 602 FINS 603 FINS 604 FINS 605 Originally contained Summary in a Release 8 3 0 Hotfix Instream was updated to better handle ISA Loops that do not contain an ISA1 No Response Generator Custom Report GS claim amount totals are now being No cleared as expected Flat files with incorrect structures sometimes caused Instream to go into an Hotfix 1 infinite loop This has been corrected Custom reporting variables for the 820 X218 std and 820 X306 std have been No added to ResponseGeneratorTechnicalManual pdf Chapter 5 Custom Output An issue which caused Instream to include release characters erroneously as Hotfix 2 part of the element length count has been resolved An SlServer thread issue has been resolved Windows platforms only Hotfix 2 A validation issue which caused an error to be reported for a valid EDIFACT Hotfix 2 segment that included a release character has been corrected Instream s HL7 OBX structure has been updated to reflect that validation of the Hotfix 3 OBX05 depends on the contents of the OBX02
28. TED IN NEW EDITIONS OF THIS DOCUMENT TIBCO SOFTWARE INC MAY MAKE IMPROVEMENTS AND OR CHANGES IN THE PRODUCT S AND OR THE PROGRAM S DESCRIBED IN THIS DOCUMENT AT ANY TIME THE CONTENTS OF THIS DOCUMENT MAY BE MODIFIED AND OR QUALIFIED DIRECTLY OR INDIRECTLY BY OTHER DOCUMENTATION WHICH ACCOMPANIES THIS SOFTWARE INCLUDING BUT NOT LIMITED TO ANY RELEASE NOTES AND READ ME FILES Copyright 2010 2015 TIBCO Software Inc ALL RIGHTS RESERVED TIBCO Software Inc Confidential Information General Contact Information TIBCO Software Inc Foresight Group 655 Metro Place South Suite 900 Dublin OH 43017 Phone 614 791 1600 Fax 614 791 1609 Technical Support E mail support tibco com Web https support tibco com Note Entry to this site requires a username and password If you do not have one you can request one You must have a valid maintenance or support contract to use this site Contents Important Information about Instream Release 8 5 0 ooo eee eeeeneeeeeenneeeeeeeneeeeeeaeeeeeeaeeeeeeaeeeeeeaeeeeeeaeeeeneaa 1 EL E e eges eegenen Aegeeegee ennen eenegen enee egen Deaessdgedaunedieasindd E A 1 Download DOCUMENTATION 2 euu eieregd aeersereegee eteuee reiege eer eener dine dene ceneddes de duueneesdiviacacdoands 1 License File Information ssn S 1 G de Tables eege ellie hee i std dA ee ei ie ieee 1 New and Changed Features ccccceesceceeeeecceeeeaae scence cae eeeaaeseaeecaeeeseaesseaaesaeeeseaees
29. TIBCO Foresight Instream Release Notes Software Release 8 5 0 July 2015 Two second advantage TIBC Important Information SOME TIBCO SOFTWARE EMBEDS OR BUNDLES OTHER TIBCO SOFTWARE USE OF SUCH EMBEDDED OR BUNDLED TIBCO SOFTWARE IS SOLELY TO ENABLE THE FUNCTIONALITY OR PROVIDE LIMITED ADD ON FUNCTIONALITY OF THE LICENSED TIBCO SOFTWARE THE EMBEDDED OR BUNDLED SOFTWARE IS NOT LICENSED TO BE USED OR ACCESSED BY ANY OTHER TIBCO SOFTWARE OR FOR ANY OTHER PURPOSE USE OF TIBCO SOFTWARE AND THIS DOCUMENT IS SUBJECT TO THE TERMS AND CONDITIONS OF A LICENSE AGREEMENT FOUND IN EITHER A SEPARATELY EXECUTED SOFTWARE LICENSE AGREEMENT OR IF THERE IS NO SUCH SEPARATE AGREEMENT THE CLICKWRAP END USER LICENSE AGREEMENT WHICH IS DISPLAYED DURING DOWNLOAD OR INSTALLATION OF THE SOFTWARE AND WHICH IS DUPLICATED IN THE LICENSE FILE OR IF THERE IS NO SUCH SOFTWARE LICENSE AGREEMENT OR CLICKWRAP END USER LICENSE AGREEMENT THE LICENSE S LOCATED IN THE LICENSE FILE S OF THE SOFTWARE USE OF THIS DOCUMENT IS SUBJECT TO THOSE TERMS AND CONDITIONS AND YOUR USE HEREOF SHALL CONSTITUTE ACCEPTANCE OF AND AN AGREEMENT TO BE BOUND BY THE SAME This document contains confidential information that is subject to U S and international copyright laws and treaties No part of this document may be reproduced in any form without the written authorization of TIBCO Software Inc TIBCO Two Second Advantage TIBCO ActiveMatrix BusinessWorks TIBCO ActiveMat
30. ay occur no more than once 42020 Within a given claim the various values for the Payer Responsibility Sequence Number Code other than value U may occur no more than once Change 9530 Guideline s 5010 835 std Originally contained in an earlier Guideline Release Yes 8 4 0 7 Interim Update to Guidelines March 2015 Issue A business rule was missing an end quotation mark causing error 42583 not to trigger as expected Solution The business rule now generate when the modifier code Loop 2110 SVC01 03 is not valid for the service date Related error 42583 The Modifier Code FS_FindCodeValue was not valid on service line date 2110DTMO02ServiceDate Instream Release Notes 35 7 10 2015 Change 9531 Guideline s 5010 MEDICAREB std no guideline change error text change only Originally contained in an earlier Guideline Release Yes 8 4 0 7 Interim Update to Guidelines March 2015 Issue Error 91070 used in 5010 MEDICAREB std Loop 2400 PS102 element when there are more than two digits to the right of the decimal does not accurately describe the issue The error previously stated The dollar amount 2300 CLM02 cannot be less than zero and cannot be greater than 99 999 99 with only two digits to the right of the decimal Solution The text for error 91070 was updated Updated error 91070 MedicareB The dollar amount 2400 PS102 can only have up to two digits to the right of the decimal
31. e 8 4 0 2 Interim Update to Guidelines Change 9459 required an updated business rule involving statement and service dates The updated edit unintentionally allowed the inclusion of a dash with the date e g 20140812 which caused an error be generated Solution The rule was updated and now captures the date without a dash Instream Release Notes 17 7 10 2015 Change 9471 Guideline s 5010 HIX 834X220 std Originally contained in an earlier Guideline Release Yes 8 4 0 3 Interim Update to Guidelines September 2014 Issue Only one iteration of the 2300 DTP Health Coverage Date need be present with a value of DTP01 348 when the INS04 41 or the INSO4 EC This was updated in the CMS Companion Guideline dated June 2014 Currently validation rules check for two iterations where one is 2300 DTP01 348 and one DTP01 349 Solution The rules were updated to check for one iteration of the 2300 DTP Health Coverage Date being equal to DTP01 348 when the INSO4 EC or when the INS04 41 Updated errors 46614 HIX One iteration of the Health Coverage Dates 2300 DTP segment must be present with one DTP01 348 when the Maintenance Reason Code 2000 INS04 equals 41 46612 HIX One iteration of the Health Coverage Dates 2300 DTP segment must be present with one DTP01 348 when the Maintenance Reason Code 2000 INS04 equals EC Change 9472 Guideline s 5010 HIX 834X220 std Originally contained in an earli
32. e guideline 47189 47190 47291 and 47304 Related errors 47189 The Referring Provider Secondary Identification 2310A REF information may not be used when the Identification Code 2310A NM109 is present 47190 The Rendering Provider Secondary Identification 2310B REF information may not be used when the Identification Code 2310B NM109 is present 47291 The Rendering Provider Secondary Identification 2420A REF information may not be used when the Rendering Provider Identification Code 2420A NM109 is present 47304 The Individual or Organizational Name Secondary Identification 2420F REF information may not be used when the Ordering Provider Identification Code 2420F NM109 is present Change 9494 Guideline s 5010 8371X299 std Originally contained in an earlier Guideline Release Yes 8 4 0 5 Interim Update to Guidelines December 2014 Issue The ST03 contains the text 005010X223A2 instead of 005010X299 This is causing the PDSA5010 837X299 std and the PDSX5010 837X299 std to be incorrect as well Solution The text in the ST03 was corrected to read 005010X299 Change 9495 Guideline s 5010 837X299 std and 837 X299 std Originally contained in an earlier Guideline Release Yes 8 4 0 6 Interim Update to Guidelines January 2015 Issue In the 2000C 2300 and 2400 DTP Service Line Date code value RD8 is failing Solution In the 2000C 2300 and 2400 DTP Service Line Date code value RD8 has been added
33. eaaeseeaeesseeesaeseeaeesenees 2 Ban RE GETT 3 CGI WEE ue CTT 4 Code Table Changes ieisccd secs sccepseceesiec innana iiaa aiaa Eaa aa aa aaa aa S 4 G ideline CHANGES TEE 6 New and Changed HIPAA Guidelines ccccceeececeeeeeceneeeeeeeceeeeecaeeesaaeeeeeeeseeeeeseaeeseaaeseneeeseaeeesaeeneneeee 6 New and Changed Healthcare Guidelines Non HIPAA Mandated cceccceceeeeeeseseeeeeseeeeseaeeseneeees 6 No Future Guideline Changes essesssesssesssesssesssesssnssnttnntttnntnattnnttnntnnstnnsennsttnsetnssensenastnssnnssennsnennn nne 7 Ee ET 8 Error Message File Change ives seccevseretens eden serene ersat ee edd dreckege eege gek 44 Other Installations and Miscellaneous sssssessesssesssesssesssesssesssnssnttsntssnttsnttnnnttnnetnnetnnetnnonn nennen nnen nn nnn 44 Separate Code Table Updates isviececesccdescachiecavesechestanevacteaeedes chancues vaveetestanevtes catecgessnandei LaEEddEeE Sege 44 TIBCO Foresight Transaction Insight Customers eee eeeeaeeeeaeeseeeeeseaeeesaeeeeeeeee 44 le E 45 Instream Release 8 5 0 se cciscccschs ctencdh ceded aeagedsreseith a aee EEE EAE SALE ATEENA aE A E NEES EEN 45 Appendix A Closed Issues for Previous Heleases nenn net 50 Instream Release 8 A0 50 Appendix B No Future Guideline Changes Listing cceccceceeeeeeeeeeeeeeceeeeecaeeeseaeeeeneeseaeeesaeeeeaaeeenees 54 Release Notes for TIBCO Foresight Instream Release 8 5 0 Instream auto
34. er Guideline Release Yes 8 4 0 3 Interim Update to Guidelines September 2014 Issue Based on the CMS Companion Guideline dated June 2014 the guideline checks for a generic 10 numeric characters regardless of whether the transaction is for Individual or FF SHOP On September 2 2014 CMS released new information regarding formatting based on Individual or FF SHOP Note For the FFM Individual market 10 numeric characters are placed in the Alphanumeric field No check digits no intelligence is found in the characters Note For the FF SHOP market 15 numeric characters are placed in the Alphanumeric field This begins with the HIOS ID of the Issuer and is concatenated with 10 numeric characters No check digits no intelligence is found in the last 10 characters of the Id Solution Rules were updated to verify that Individual is 10 numeric characters A new rule was added to verify that FF SHOP is 15 numeric characters Updated error 46620 HIX The Subscriber Number 2000 REF where REFO1 OF for Individual must be 10 numeric characters New error 46646 HIX The Subscriber Number 2000 REF where REFO1 OF for FF SHOP must be 15 numeric characters Instream Release Notes 18 7 10 2015 Change 9473 Guideline s 837X224 std 5010 837D std and PDSA5010837D std Originally contained in an earlier Guideline Release Yes 8 4 0 4 Interim Update to Guidelines October 2014 Issue A situational rule on the 2320 SBRO9 ma
35. es document Please contact TIBCO Foresight Support for details TIBCO Foresight Transaction Insight Customers Transaction Insight customers who update Instream need to run one of the scripts below to get their new error definitions into TI Tl_ErrorUpdate_For_Instream_8 5 0 0_MSSQL sq Tl_ErrorUpdate_For_Instream_8 5 0 0_ORACLE sq These scripts are available in Instream s Scripts directory Scripts T1 Instream Release Notes 44 7 10 2015 Closed Issues Instream Release 8 5 0 Note Instream Release 8 5 0 includes changes originally contained in Release 8 4 0 Hotfix 1 through Hotfix 9 Originally EH contained g Summary in a Release Request ID 8 4 0 Hotfix FINS 478 Update to leading and trailing zeros in monetary fields No FINS 572 Instream was updated to better handle unsupported formatting in the DTL file Hotfix 5 FINS 638 ValidateDateTimeX12 and ValidateDateTimeUN are missing the ability to have No else clauses FINS 647 Response Generator provides new flag fno_ung which can be used to turn off Hotfix 1 functional group UNG data in EDIFACT CONTRL responses FINS 651 Instream missing errors when Debugging is on No FINS 653 You can now add or remove characters from the default character set for a Hotfix 1 transaction set using a new parameter in the APF Validation Profile file Analyzer Options section See New and Changed Features FINS 656 A new ret
36. f HIPAA Type 5 Solution The default APF file fsdeflt apf was updated to set errors 43601 and 43610 to HIPAA Type 5 Related errors 43601 The Interchange Receiver ID ISA08 code FS_FindCodeValue was not found in Code Table FS_FindCodeList 43610 The Information Source Identification Code Loop 2100A NM109 FS_FindCodeValue was not found in Code Table FS_FindCodeList Change 9490 Guideline s 5010 837I std Originally contained in an earlier Guideline Release Yes 8 4 0 5 Interim Update to Guidelines December 2014 Issue Per the NUBC when the Patient Discharge Status is equal to 20 41 42 or 43 then Occurrence Code 55 must be present Solution A new rule was added to check for the Patient Discharge Status being equal to 20 41 42 or 43 and the presence of at least one Occurrence Code equal to 55 If Occurrence Code 55 is not present error 41695 is generated New error 41695 The Occurrence Code 55 2300 HIOX 2 must be present when the Patient Discharge status 2300 CL103 equals 20 40 41 or 42 Instream Release Notes 23 7 10 2015 Change 9491 Guideline s 5010 837X298 std Originally contained in an earlier Guideline Release Yes 8 4 0 5 Interim Update to Guidelines December 2014 Issue Several edits should be removed from the guideline because there are no notes on the REF segments for the edits Solution The following edits and their associated errors were removed from th
37. ge 820X306 are needed 8 4 0 2 and 8 4 0 4 A new CMS Companion Guideline FM_HIX820_CompanionGuide_v2_5CR_100714 October G 2014 oct was received and reviewed for required changes 8 4 0 4 Solution 8 4 0 2 The guideline was updated with companion guideline editsedits as needed and 8 4 0 4 The 5010 HIX 820X306 std and PDSA5010HIX 820X306 std guidelines were updated with changes found in the FM_HIX820_CompanionGuide_v2_5CR_100714 October_6_2014 pdf Instream Release Notes 12 7 10 2015 Change 9455 Guideline s 5010 835 std Originally contained in an earlier Guideline Release Yes 8 4 0 1 Interim Update to Guidelines July 2014 Issue Edit 42501 requires the Claim Adjustment reason code of 101 to be present when the CLP02 25 for predetermination Based on X12N RFI 1941 this rule is too restrictive The usage of CARC 101 only applies when there is a future payment to be reported and is not in conflict with the requirement to not report zero adjustments Since there is no future payment there is no CAS with CASO2 101 Solution The edit requiring this condition has been removed Retired error 42501 The Claim Adjustment Group code OA Loop 2100 CAS01 must be used with a Claim Adjustment Reason code of 101 when the Claim Status Code Loop 2100 CLP02 equals 25 for predetermination Change 9456 Guideline s 5010 HIX 834 std Originally contained in an earlier Guideline Release Yes
38. iables the section TIBCO Foresight Defined Variables New error 42211 The Health Care Diagnosis Code 2300 HI ABK ABF qualifier for ICD 10 code may not be used prior to the effective date of FS_ICD9_ICD10 CutoverDate Instream Release Notes 11 7 10 2015 Change 9450 Guideline s 5010 834X220 std Originally contained in an earlier Guideline Release Yes 8 4 0 1 Interim Update to Guidelines July 2014 Issue 834 X220 std must support new 834 Federally Facilitated Exchange FFE guideline as detailed in the updated CMS companion guideline Solution The guideline has been updated to include all changes edits from the CMS companion guideline Version Number 1 7 June 1 2014 Change 9451 Guideline s NCPDP_PAH42 std Originally contained in an earlier Guideline Release Yes 8 4 0 5 Interim Update to Guidelines December 2014 Issue Support is needed for the NCPDP Post Adjudication Standard Version 4 2 Solution Support for NCPDP Post Adjudication 4 2 was added NCPDP_PAH42 sid NOTE To use this guideline Instream 8 4 0 Hotfix 4 and EDISIM 6 14 0 Hotfix 3 are required Change 9452 Guideline s 5010 HIX 820X306 std and PDSA501 OHIX 820X306 std Originally contained in an earlier Guideline Release Yes 8 4 0 2 Interim Update to Guidelines August 2014 and 8 4 0 4 Interim Update to Guidelines October 2014 Issue 8 4 0 2 CMS companion guideline edits for the Health Care Exchan
39. iggering Errors 47315 and 47317 incorrectly Solution Variable flags used in the balancing edits were updated for both the Subscriber and Patient loops and Errors 47315 and 47317 are now triggering as expected Related errors 47315 The Claim Payment Amounts do not balance for SOtherPayerCOBID1 The Sum of Loop 2430 SVD02 amounts SSVD02PayerAmt1 sum of loop 2320 CAS adjustment amounts S2320CASPayer1 Loop 2320 AMT Payer Paid amount S2320PayerPaidAmt1 47317 The Claim Payment Amounts do not balance for SOtherPayerCOBID2 The Sum of Loop 2430 SVD02 amounts SSVD02PayerAmt2 sum of loop 2320 CAS adjustment amounts S2320CASPayer2 Loop 2320 AMT Payer Paid amount S2320PayerPaidAmt2 Change 9527 Guideline s 5010 834 std Originally contained in an earlier Guideline Release Yes 8 4 0 7 Interim Update to Guidelines March 2015 Issue An edit is needed to consider the TR3 requirement on the value in 2100A NM101 IL or 74 and its relationship to the 2100B DMG segment The TR3 document states Required if a corrected name is being sent in loop 2100A or if previously supplied demographics are being changed If only the demographics are being changed the code in NM101 in loop 2100A will be IL and the code in NM101 in this loop will be 70 If not required by this implementation guide do not send Solution Edit 42831 was added to the guideline stating that if the 2100A NM101 IL and the 2100B loop is present the
40. ing generated incorrectly for termination and cancellations for Individual Markets 2 The edit for error 46642 is not checking for FF SHOP correctly Solutions 1 The business rule was corrected to look for Individual Markets Subscriber status and non termination cancellations before making this rule required and generating error 46641 2 The business rule was corrected to check for FF Shop before generating error 46642 Related errors 46641 HIX The Marital Status Code 2100A DMG04 will be transmitted for Individual Markets for the subscriber 46642 HIX The Marital Status Code 2100A DMG04 must not be used for FF SHOP markets Instream Release Notes 25 7 10 2015 Change 9499 Guideline s 5010837I std Originally contained in an earlier Guideline Release Yes 8 4 0 5 Interim Update to Guidelines December 2014 Issue When data is received for the HI Value Code and the composites are not sent in order the claim passes instead of generating Error 41329 Solution A variable was not resetting properly This has been corrected and the edit now generates the expected response Related error 41329 The Value Code HIOX 01 cannot be sent because the preceding Value Code HIOX 01 data element was not sent Change 9500 Guideline s 5010 837X298 std Originally contained in an earlier Guideline Release Yes 8 4 0 5 Interim Update to Guidelines December 2014 Issue Edit 47182 is triggering incorrectly
41. issue which caused DocSplitter to drop the last line of a processed HL7 Hotfix 4 document has been resolved FINS 726 Instream error when EDI ends with two IEA segments No FINS 727 Response Generator fails when ISA segment is missing No Instream Release Notes 46 7 10 2015 Originally a contained n f apg Summary in a Release Request ID 8 4 0 Hotfix FINS 729 Compare Numeric does not call DisplayErrorByNumber unless all parameters for No DisplayErrorByNumber are filled out FINS 730 In instances where message 11214 contains UNA and the UNAO5 is empty Hotfix 4 Instream retains a space in the empty element to prevent a Response Generator crash FINS 731 Instream was updated to better handle cases when the data contains a value Hotfix 4 that matches the default repeat delimiter FINS 736 The DocSplitter user manual was updated with additional 5010 split point No information See DocumentSplitterTechnicalManual pdf FINS 738 The DocSplitter user manual was updated with information about the 278X216N No 278X216A 278X215l and 278X215R guidelines See DocumentSplitterTechnicalManual pdf FINS 739 Instream was updated to better handle UTF 16BE encoded TEXT data Hotfix 4 FINS 740 DocSplitter splitting information at 2000D on the 278 is incorrect No FINS 741 DocSplitter was enhanced to improve performance for splitting of large files Hotfix 4 FINS 742 HL7 standard does not a
42. k to the associated HIOX 01 to verify the element is equal to BBQ If it is and the date is prior to the ICD 10 cutover date then Error 41687 is generated It was discovered that each of these elements was referring to the HI01 01 instead of their respective composite variable For example HI01 04 should refer to HI01 01 HI02 04 should refer to HI02 01 etc Therefore the error was generated based on the wrong element Solution The rules on elements HI02 04 through HI12 04 have been updated to refer to the correct composite variables Change 9482 Guideline s PDSA5010 837X298 std and PDSX5010 837X298 std Originally contained in an earlier Guideline Release Yes 8 4 0 4 Interim Update to Guidelines October 2014 Issue The GS08 contains the text 005010X222A1 instead of 005010X298 Solution The text in the GS08 was corrected to read 005010X298 Instream Release Notes 21 7 10 2015 Change 9483 Guideline s 5010 837X298 std Originally contained in an earlier Guideline Release Yes 8 4 0 5 Interim Update to Guidelines December 2014 and 8 4 0 6 Interim Update to Guidelines January 2015 Issue The 2300 CLMO9 in the patient loop is set to M U Must Be Used when it should be Optional Solution 8 4 0 5 The user attribute on the 2300 CLMO9 in the patient loop was changed to Optional 8 4 0 6 The user attribute on the 2300 CLMO9 in both the Patient andSubscriber loops was changed to Optional Cha
43. kes it required prior to mandated use of the HIPAA National Plan ID The user attribute was set to M U which cannot be turned off by location for validation Solution The user attribute M U was removed from guideline 837X224 std Types 1 2 and a new Business Rule was added to enforce this condition in the 5010 837D std New error 42213 The Claim Filing Indicator Code Loop 2320 SBRO9 is required prior to mandated use of PlanID Change 9475 Guideline s 5010 HIX 834X220 std Originally contained in an earlier Guideline Release Yes 8 4 0 4 Interim Update to Guidelines October 2014 Issues The QTY segment is required for FFM and FF SHOP only Edit 46518 is not checking for the FFM or FF SHOP condition before requiring QTY QTY01 ET is required for FFM and FF SHOP only Edit 46622 is not checking for the FFM or FF SHOP condition before requiring QTY01 ET QTY01 DT is required for FFM and FF SHOP only when the number exceeds zero Edit 46622 is not checking for the FFM or FF SHOP condition before requiring QTY01 DT Solutions Business Rules were updated and new edit 46647 was added in order to check for FFM FF SHOP before requiring the QTY segment check for FFM FF SHOP before requiring QTY01 ET check for FFM FF Shop and ensure that the number exceeds zero before requiring QTY01 DT New error 46647 HIX At least one Transaction Set Control Totals QTY segment must be sent with the qualifier of DT Dependent Total
44. l be generated if the 2110C REFO1 and REF02 match the 2100C REFO1 and REFO2 Related errors 45749 The Subscriber Additional Information REF segment in both the 2100C and 2110C loop cannot have more than one occurrence of the same Reference ID REF02 and Qualifier REFO1 pair Change and Guideline 9537 5010 837D 9538 5010 8371 9539 5010 837P 9540 837X298 9541 837X299 9542 837X300 9543 5010 270X279 and 5010 271X279 9544 276X212 and 277X212 9546 5010 834 9547 5010 835 9548 5010 278X217Q and 278X217R 9549 5010 820 9551 5010 834X307 9558 5010 275X210 9563 5010 278X215R and 5010 278X215l 9564 5010 278X216N Originally contained in an earlier Guideline Release No Issue Checking is needed for spaces in International Postal Codes Solution Business rules were updated to check for spaces in International Postal Codes New errors 5010 278X215R and 5010 278X215l 48167 Zip codes are not to contain any special characters 5010 278X216N 48513 Zip codes are not to contain any special characters Instream Release Notes 38 7 10 2015 Change 9562 Guideline s 5010 820X306 std PDSA5010 820X306 std 5010 HIX 820X306 std and PDSA5010HIX 820X306 sid Originally contained in an earlier Guideline Release No Issue The 5010 820X306 needs to have a new business rule added to the loop 2300 REF Exchange Report Document Control Number A new code table called Re
45. l to R replacement Change 9515 Guideline s 5010 837X300 std Originally contained in an earlier Guideline Release Yes 8 4 0 6 Interim Update to Guidelines January 2015 Issue Error 47806 triggers incorrectly because the variable used to count the LX is not being cleared at the 2300 CLM segment Solution The edit was updated to clear the variable at the 2300 CLM segment and the error now generates as expected Related error 47806 The LX Service Line Number is not incrementing by one Change 9516 Guideline s 5010 837X300 std Originally contained in an earlier Guideline Release Yes 8 4 0 6 Interim Update to Guidelines January 2015 Issue Error 47915 triggers incorrectly because the associated edit does not specify Subscriber or Patient loop Solution The edit was updated to specify the location subscriber or patient loop of the 2320 AMT in question Related error 47915 The Coordination of Benefits COB Payer Paid Amount 2320 AMT is required when the Line Adjudication Information 2430 Loop is present Instream Release Notes 32 7 10 2015 Change 9518 Guideline s 50108371 std Originally contained in an earlier Guideline Release Yes 8 4 0 6 Interim Update to Guidelines January 2015 Issue The business rule on the Dependent 2000C 2300 HI Admitting Diagnosis pointed to a variable on the Subscriber 2000B 2300 HI Admitting Diagnosis code This caused Error 41692 to trigger incor
46. llow the TAB Character No FINS 744 Documentation was updated with information on new guidelines including how No to use them with partner automation FINS 747 Max element repeat count error due to data matching default repeat delimiter on No AIX platform FINS 748 New guidelines added 275 X314 275 X316 277 X313 No FINS 749 FINS 751 ISIServer installation information was updated No FINS 754 HDMA 4010856 std types 1 amp 2 guideline was added for EDISIM users No FINS 755 Instream documentation was updated to reflect the addition of HDMA No 4010856 std Types 1 amp 2 guideline FINS 758 Docsplitter creates only valid files with results file containing a severity 3 error No FINS 759 New parameters were added to Response Generator to allow greater control of Hotfix 5 the X12 segments ISA14 and GS05 See New and Changed Features FINS 762 An issue with the Business Rule TrimWhitespace has been corrected Hotfix 6 Instream Release Notes 47 7 10 2015 Originally a contained n f apg Summary in a Release Request ID 8 4 0 Hotfix FINS 763 An issue with Instream creating temp file names has been corrected Hotfix 7 FINS 765 The 275 X211 guideline was removed from the Instream install No FINS 768 A thread issue on Sun Solaris SPARC platforms has been resolved Hotfix 8 FINS 769 NCPDP_PAH42 and NCPDP_PAU42 incorrectly recognize 00000000 as valid No date FINS 772
47. mance issue related to a Lock file used for No generating Unique IC Control numbers has been corrected FINS 520 Response Generator Custom 835 report template variable SvcProcCode No now populates as expected FINS 523 Response Generator now skips the IK4 if the element position is set to 0 No FINS 524 Response Generator Custom 837 report template variables for 2010BB No Secondary Payer were added FINS 527 The following tables were added to InstreamValidationTechnicalManual pdf No Appendix C SVALU Record Structure IDs 820 Premium Payments PDSA5010820X218 820 Premium Payments PDSA5010820X306 FINS 528 Settings for the Response Generator parameter No PartialTransactionSetAcceptance824 were updated to accept only true or false Instream Release Notes 50 7 10 2015 Originally a contained n f apg Summary in a Release Request ID 8 3 0 Hotfix FINS 529 System requirements information for Instream 8 4 0 has been updated to specify No minimum hardware requirements for both Windows and UNIX as CPU of 2 5 GHz processor or better RAM of at least 4GB and Disk Space of at least 20GB FINS 533 A problem with Instream validation of EDI with UTF 16 encoding has been No resolved FINS 535 An issue causing the Response Generator Overrides file to not override values in No the IK502 has been corrected FINS 538 When generating a 999 from data validated with guidelines 5010 HIX 820x306
48. mates transaction flow and validates transactions according to industry standards organizational guidelines and specific business rules We are pleased to offer you our newest version of Instream Instream is available in two versions Instream Standard Edition and Instream Healthcare Edition Some information in this document pertains only to Instream Healthcare Edition and is noted appropriately We welcome all feedback Please contact our Support Representatives by e E mail support tibco com e Web https support tipco com Note Entry to this site requires a username and password If you do not have one you can request one You must have a valid maintenance or support contract to use this site Important Information about Instream Release 8 5 0 This section lists important information about the newest release of this product API users API users must recompile their API code for Instream 8 5 0 Download Documentation The installation program no longer installs documentation Instream documentation is available on httos docs tiobco com When Instream is installed a Doc directory is provided You may wish to download your documentation to this directory for ease of access License File Information A license file is no longer required to use Instream Code Tables HIPAA code tables which apply to Instream Healthcare Edition only are updated with each release and as needed see Separate Code Table Updates on page
49. nda Types 1 7 B41A270 B41A271 B41A276 B41A277 41A278RQ 41A278RP B41A820 B41A834 B41A835 B41A837P CCl B41A837D B41A8371 Instream Release Notes 54 7 10 2015 Guideline type Guideline HIPAA GuidelinePlus 4010 Types 1 7 PDSA Types 1 2 PDSX PDSA270 PDSX270 PDSA271 PDSX271 PDSA276 PDSX276 PDSA277 PDSX277 PDSX277U PDA278RQ PDX278RQ PDA278RP PDX278RP PDSA820 PDSX820 PDSA834 PDSX834 PDSA835 PDSX835 PDSA837P CCl PDSX837P PDSA837D PDSX837D PDSA8371 PDSX8371 PDSA997 4010 997 HIPAA 4050 Addenda Types 1 7 4050 275 4050 277 HIPAA Guidelines 5010 Pre Errata pre June 2010 Types 1 7 NOTE Until April 1 2011 fixes required in the base guideline and NOT due to a June 2010 Errata change were updated After April 1 2011 no further maintenance of these guidelines will be done 5010 835 A0 std 5010837DA1 std 50108371A1 STD 5010837PA0 STD 5010 MEDICAREA A1 STD 5010 MEDICAREB A0 STD PDSA5010835 A0 STD PDSA5010837D A1 STD PDSA50108371 A1 STD PDSA5010837P A0 STD PDSA5010MEDICAREA A1 STD PDSA5010MEDICAREB A0 STD Instream Release Notes 55 7 10 2015
50. nge 9484 Guideline s 5010 837X298 std Originally contained in an earlier Guideline Release Yes 8 4 0 5 Interim Update to Guidelines December 2014 Issue Error 40834 is incorrectly triggering on AMT segments This requirement was carried over from the base 5010837P but is not required in the X298 IG Solution The edit that triggers error 40834 was removed from the 5010 837X298 std Related error 40834 AMT Remaining Patient Liability Loop 2320 AMT02 This segment is not used if the line level Loop 2430 Remaining Patient Liability AMT segment is used for this Other Payer Change 9485 Guideline s 5010 837X298 std Originally contained in an earlier Guideline Release Yes 8 4 0 5 Interim Update to Guidelines December 2014 Issue Error 47192 is incorrectly triggering on REF segments This requirement originally appeared in the base 5010837P but is not required in the X298 IG Solution Error 47192 was retired Retired error 47192 The Service Facility Location Secondary Identification 2310C REF information may not be used when the Service Facility Location Identification Code 2310C NM109 is present Instream Release Notes 22 7 10 2015 Change 9489 Guideline s N A Originally contained in an earlier Guideline Release Yes 8 4 0 5 Interim Update to Guidelines December 2014 Issue In the default APF file fsdeflt apf errors 43601 and 43610 are incorrectly set to HIPAA Type 4 instead o
51. nt_Element 42113 The Claim Adjustment Reason Code FS_FindCodeValue was not valid on the Claim Check or Remittance Date Current_Element 42114 The Claim Adjustment Reason Code FS_FindCodeValue was not valid on the Claim Check or Remittance Date Current_Element 5010X299 47615 The Claim Adjustment Reason Code FS_FindCodeValue was not valid on the Claim Check or Remittance Date Current_Element 47616 The Claim Adjustment Reason Code FS_FindCodeValue was not valid on the Claim Check or Remittance Date Current_Element 47617 The Claim Adjustment Reason Code FS_FindCodeValue was not valid on the Claim Check or Remittance Date Current_Element 47618 The Claim Adjustment Reason Code FS_FindCodeValue was not valid on the Claim Check or Remittance Date Current_Element 47619 The Claim Adjustment Reason Code FS_FindCodeValue was not valid on the Claim Check or Remittance Date Current_Element 47620 The Claim Adjustment Reason Code FS_FindCodeValue was not valid on the Claim Check or Remittance Date Current_Element 47621 The Claim Adjustment Reason Code FS_FindCodeValue was not valid on the Claim Check or Remittance Date Current_Element 47622 The Claim Adjustment Reason Code FS_FindCodeValue was not valid on the Claim Check or Remittance Date Current_Element 47623 The Claim Adjustment Reason Code FS_FindCodeValue was not valid on the Claim Check or Remittance Date Current_Element 476
52. or an IEA error It had No previously sent an invalid TA105 code FINS 607 Response Generator now allows multiple error codes for the 999 AK9 Previous No functionality limited the number of error codes to one FINS 608 Response Generator Custom 837 report template variables No otherpayercontrolnumber and otherpayernamesecid now populate as expected FINS 612 GS level errors that should cause TA1 rejection were not being caught by No Response Generator This issue has been resolved Added support for GS 10900 and 10911 errors FINS 623 Support for versions HL7 2 3 2 3 1 2 5 1 and 2 6 has been enhanced to include No additional elements and composites FINS 624 Instream s Diagnostic Related Grouping DRG code table has been updated to No FINS 629 include the most recent codes from the official HIPAA site Please note this adds 3 digit codes with leading zeros such as 001 004 010 etc which had not been included in the table previously FINS 626 CORE Phase III rules were deemed too restrictive and were revised to allow the No user more flexibility in validation FINS 628 The Instream HL7 OBX structure has been updated to reflect that validation of Hotfix 4 the OBX05 depends on the contents of the OBX02 FINS 630 Minimum length checks have been added for the following HL7 types TX SI Hotfix 4 FT TM DTM DT ST and NM FINS 631 5010 838P data that included the 2310B loop after the 2400 loop generated No Error 11323 in In
53. please make sure you run HVUpdate exe This will ensure that your profiles are updated with all the latest error numbers and latest parameters See APF pdf for details Some of these errors may apply to Instream Healthcare Edition only Beginning with Instream 8 3 0 error message additions and or changes resulting from guideline updates are now noted with the Guideline Updates for the release Other Installations and Miscellaneous Separate Code Table Updates The code table database is available for download separately from the product installation When possible TIBCO Foresight will make code table updates available between new versions of Instream This will make code table updates available without upgrading Instream To download code table updates Updates can be downloaded from the TIBCO Product Support file transfer server using your username and password for the TIBCO Support Web http mft tipco com cfcc login login jsp You can use FTP SFTP FTP or SFTP use requires an FTP SFTP client or command line FTP or your web browser at https mft tibco com requires JAVA applet support in your browser Note Code tables with version 7 3 and later require the actual Instream 7 3 or later program You can check the Instream version and the code table version by executing the Version bat file in Instream s Scripts directory TIBCO Foresight Studio Foresight Studio is a separate installation program with a separate Release Not
54. portType will need to be added to the code table list A new business rule will be added to point to this new table for validation Solution A new business rule was added to the loop 2300 REF Exchange Report Document Control Number to point to the new ReportType code list A new code table called ReportType was added to the code table list This change affects the following guidelines New error 46136 The Report Type Loop 2300 REFO2 Current_Element is not a valid Report Type code Change 9565 Guideline s 5010835 Originally contained in an earlier Guideline Release No Issue The business rule generating error number 42615 is considered too restrictive Reference X12 interpretation RFI 1324 Solution The business rule was removed Retired error s 42615 When the Claim Supplemental Information Loop 2100 AMT01 equals for Interest an Adjustment Reason Code in the Provider Adjustment PLB03 05 07 09 11 or 13 must be equal to L6 Interest Owed Instream Release Notes 39 7 10 2015 Change and Guideline s 9566 5010 837P 9567 5010 8371 9568 5010 837D 9570 5010X298 9571 5010X299 9572 5010X300 Originally contained in an earlier Guideline Release No Issue Date checking should be removed for the CARC and RARC codes Solution All date checking for CARC RARC codes should be removed since these codes are only being reported based on information from the 835 Refer
55. ream Release Notes 7 7 10 2015 Guideline Updates Important Note Instream Release 8 5 0 includes changes originally contained in Guideline Releases 8 4 0 1 through 8 4 0 8 Change 7048 Guideline s 5010 837P std Originally contained in an earlier Guideline Release Yes 8 4 0 4 Interim Update to Guidelines October 2014 Issue Error 40820 was generated when the State Code was missing but required in the 2010AA loop Solution The edit that generated Error 40820 was retired and replaced with edit 41174 New error 41174 The State or Province Code N402 is required when address is within the United States or Canada Retired error 40820 The State or Province Code Loop 2300 CLM11 04 is required when address is within the United States or Canada Change 9249 Guideline s 5010 834X307 Originally contained in an earlier Guideline Release No Issue The response generator was not outputting the CTX Segment Context IK3 loop and or the CTX Element Context IK4 loop as was appropriate based on the situational rules in the TRS Solution The guidelines were updated to output the CTX Segment Context IK3 loop and or the CTX Element Context IK4 loop as was appropriate based on the situational rules in the TR3 Instream Release Notes 8 7 10 2015 Change 9297 Guideline s 5010 837P std Originally contained in an earlier Guideline Release Yes 8 4 0 2 Interim Update to Guidelines August 2014
56. rectly Solution The business rule on the Dependent 2000C 2300 HI Admitting Diagnosis was updated to point to the correct variable Related error 41692 The Admitting Diagnosis 2300 HI01 02 does not allow External Cause of Injury codes that begin with V W X or Y Change 9519 Guideline s 5010 HIX 834X220 std Originally contained in an earlier Guideline Release Yes 8 4 0 6 Interim Update to Guidelines January 2015 Issue Information for Error 46632 was not included in the default APF file fsdeflt apf Solution The default APF file fsdeflt apf was updated with information for Error 46632 46632 3 2 8 7 8 7 Related error 46632 HIX The Employment Status Code 2000 INSO8 must be present and equal to TE AC or RT for FF SHOP Markets when the Maintenance Reason Code 2000 INS04 equals 59 or 14 for termination cancellation Change 9523 Guideline s HDMA 4010856 std Originally contained in an earlier Guideline Release Yes 8 4 0 7 Interim Update to Guidelines March 2015 Issue EDISIM only customers don t have access to HDMA 4010856 std Solution HDMA 4010856 std Types 1 2 has been added and is now available for EDISIM only customers Instream Release Notes 33 7 10 2015 Change 9524 Guideline s 5010 837X298 std Originally contained in an earlier Guideline Release Yes 8 4 0 6 Interim Update to Guidelines January 2015 Issue Balancing edits at the 2300 CLM are tr
57. rently supported platforms No FINS 692 278 X216 Notification guideline new TR3 No FINS 694 A memory leak discovered in the Instream API has been corrected Hotfix 2 FINS 695 Instream Trading Partner Automation has been updated with default Flat File Hotfix 3 values for various elements Refer to InstreamTPAutomation pdf for information on creating trading partner lookup csv files to define custom default values FINS 699 Instream was updated to accommodate validation of the NCPDP Post Hotfix 4 Adjudication 4 2 guideline FINS 701 Response Generator will not create an accepted 824 for an 834 with 2700 loops No FINS 704 Response Generator can t process files with invalid character Ctrl Z Ox1A No FINS 711 Invalid guideline in guideline only build No FINS 712 Response Generator now fails with an error if an 837 2100 CLP segment is No missing FINS 713 Instream was updated to accommodate validation of the 5010 278X215l std and Hotfix 4 5010 278X215R std which do not have a standard nested HL structure FINS 721 The Instream AIX full install overwrites the fsdir ini file No FINS 722 Response Generator was updated to support the 5010 278X215 std and 5010 Hotfix 4 278X216 std FINS 723 Response Generator Custom Reports were enhanced for the 5010 278X215 std No and 5010 278X216 std FINS 724 A Response Generator issue which caused TIBCO BusinessConnect Hotfix 4 customers to encounter an intermittent Error 201 has been corrected FINS 725 An
58. rix BusinessWorks Plug in for HL7 TIBCO BusinessConnect TIBCO Foresight Community Manager TIBCO Foresight EDISIM TIBCO Foresight HIPAA Validator Desktop TIBCO Foresight Instream TIBCO Foresight Studio TIBCO Foresight Transaction Insight and TIBCO Foresight Translator are either registered trademarks or trademarks of TIBCO Software Inc in the United States and or other countries Enterprise Java Beans EJB Java Platform Enterprise Edition Java EE Java 2 Platform Enterprise Edition J2EE and all Java based trademarks and logos are trademarks or registered trademarks of Oracle Corporation in the U S and other countries All other product and company names and marks mentioned in this document are the property of their respective owners and are mentioned for identification purposes only THIS SOFTWARE MAY BE AVAILABLE ON MULTIPLE OPERATING SYSTEMS HOWEVER NOT ALL OPERATING SYSTEM PLATFORMS FOR A SPECIFIC SOFTWARE VERSION ARE RELEASED AT THE SAME TIME SEE THE README FILE FOR THE AVAILABILITY OF THIS SOFTWARE VERSION ON A SPECIFIC OPERATING SYSTEM PLATFORM THIS DOCUMENT IS PROVIDED AS IS WITHOUT WARRANTY OF ANY KIND EITHER EXPRESS OR IMPLIED INCLUDING BUT NOT LIMITED TO THE IMPLIED WARRANTIES OF MERCHANTABILITY FITNESS FOR A PARTICULAR PURPOSE OR NON INFRINGEMENT THIS DOCUMENT COULD INCLUDE TECHNICAL INACCURACIES OR TYPOGRAPHICAL ERRORS CHANGES ARE PERIODICALLY ADDED TO THE INFORMATION HEREIN THESE CHANGES WILL BE INCORPORA
59. rlier Guideline Release Yes 8 4 0 2 Interim Update to Guidelines August 2014 Issue New 837Institutional Post Adjudication Claims Data Reporting 837 X299 guidelines Types 1 7 need to be created Solution Guideline edits were added for for the Post Adjudication 837 X299std Change 9394 Guideline s 5010 837X298 std Originally contained in an earlier Guideline Release Yes 8 4 0 2 Interim Update to Guidelines August 2014 Issue New 837Professional Post Adjudication Claims Data Reporting 837 X298 guidelines Types 1 7 need to be created Solution Guideline edits were added for the Post Adjudication 837 X298std Change 9395 Guideline s 5010 837X300 std Originally contained in an earlier Guideline Release Yes 8 4 0 2 Interim Update to Guidelines August 2014 Issue New 837 Dental Post Adjudication Claims Data Reporting 837 X300 guidelines Types 1 7 need to be created Solution Guideline edits were added for the Post Adjudication 837 X300std Change 9406 Guideline s APF file change only Originally contained in an earlier Guideline Release Yes 8 4 0 7 Interim Update to Guidelines March 2015 Issue Error 41090 is set to severity 2 Warning when it should be severity 4 Situational Solution The default APF file fsdeflt apf was updated to set Error 41090 to severity 4 Situational Related error 41090 The Subscriber Address 2010BA N3 is required when the subscriber is the patient
60. rmation Inquiry PDSX5010 278X215R Health Care Services Review Information Response PDSX5010 278X216A Health Care Services Review Information Acknowledgement PDSX5010 278X216N Health Care Services Review Information Notification NOTE To use these guidelines a minimum of Instream 8 4 0 Hotfix 4 is required Instream Release Notes 15 7 10 2015 Change 9466 Guideline s 5010 HIX 834X220 std Originally contained in an earlier Guideline Release Yes 8 4 0 3 Interim Update to Guidelines September 2014 Issue Edit 46641 which uses the following situational rule does not consider whether or not the individual is a subscriber SITUATIONAL RULE Required when such transmission is required under the insurance contract between the sponsor and payer and allowed by federal and state regulations This element is NOT USED when the member identified in the related INS segment is not the subscriber If not required by this implementation guide do not send Solution The situational rule for Edit 46641 now verifies that the individual is a subscriber before generating Error 46641 Updated error 46641 HIX The Marital Status Code 2100A DMG04 will be transmitted for Individual Markets for the subscriber Change 9467 Guideline s 5010 837X299 std Originally contained in an earlier Guideline Release Yes 8 4 0 2 Interim Update to Guidelines August 2014 Issue The 2300 REF Claim Identification For Transmission
61. stream 8 1 0 but did not produce any error in Instream 8 3 0 This issue has been resolved FINS 632 A TA1 contained between the ISA and GS for example a 99x with a TA1 is Hotfix 5 now ignored by Response Generator FINS 633 Response Generator custom template variable SvcProcCode now populates Hotfix 5 for 835 custom reports FINS 639 Certain conditions caused Instream to go into a looping error when validating No HL7 OBX This was corrected FINS 644 Instream has been updated to better handle validation of EDIFACT elements that No begin with a delimiter Instream Release Notes 53 7 10 2015 Appendix B No Future Guideline Changes Listing Changes are no longer being incorporated into these guidelines Guideline type Guideline HIPAA Guideline 4010 4010270 std Non Addenda 4010271 std Types 1 7 4010276 std 4010277 std 41 278RP std 41 278RQ std 4010 820 std 4010834 std 4010 835 std 4010837D std 4010837I std 4010837P std PDSA820 std removed from Document Splitter PDSX820 std removed from Document Splitter PDSA835 std removed from Document Splitter PDSX835 std removed from Document Splitter PDSA837D std removed from Document Splitter PDSX837D std removed from Document Splitter PDSA837I std removed from Document Splitter PDSX837I std removed from Document Splitter PDSX837P std removed from Document Splitter PDSX837P std removed from Document Splitter HIPAA Guideline 4010 Adde
62. t for Additional Information This guideline has been added 277 X313 std 278X215 Health Care Services Review Information Inquiry This guideline has been added 278X215l std 278X215R Health Care Services Review Information This guideline has been added Response 278X215R std 278X216A Health Care Services Review Information This guideline has been added Acknowledgement 278X216A std 278X216N Health Care Services Review Information Notification This guideline has been added 278X216N std 5010 837X300 Dental Post Adjudication Claims Data Reporting Guideline for Types 1 7 has been added 5010 837X300 std 5010 837X299 Institutional Post Adjudication Claims Data Reporting Guideline for Types 1 7 has been added 5010 837X299 std 5010 837X298 Professional Post Adjudication Claims Data Reporting Guideline for Types 1 7 has been added 5010 837X298 std Instream Release Notes 6 7 10 2015 Guideline Change HDMA 4010856 Healthcare Distribution Management Association HDMA 856 Advance Ship Notice This guideline has been added HDMA 4010856 std NCPDP_PAH42 NCPDP Post Adjudication 4 2 This guideline has been added NCPDP_PAH42 std Note To use this guideline a minimum of EDISIM 6 14 0 Hotfix 3 is required No Future Guideline Changes See Appendix B for a listing of guidelines for which changes are no longer being incorporated Inst
63. to Guidelines December 2014 Issue When the BPRO4 NON then the BPR0O2 must equal Zero The BPRO4 NON the BPRO2 was not equal to zero and no error was generated Solution A business rules was added to check for the following condition If the BPRO4 NON then the BPRO2 must equal 0 New error 46135 The Total Payment Amount BPRO2 must be equal to Zero when the Payment Method Code BPR04 is equal to NON Non payment Data Instream Release Notes 28 7 10 2015 Change 9508 Guideline s 5010 HIX 834X220 std Originally contained in an earlier Guideline Release Yes 8 4 0 6 Interim Update to Guidelines January 2015 Issue Error 46513 requiring the 2750 DTP is being generated for Individual when the 2750 N102 REQUEST SUBMIT TIMESTAMP and REF01 17 According to Section 9 6 1 of the CMS HIX 834_Companion_Guide_DRAFT_FFM_1 7 Pre Clearance_June_1_ 2014 _v1 7 pdf the 275 DTP is not required Solution Rules were corrected to no longer require the 2750 DTP for Individual when the 2750 N102 REQUEST SUBMIT TIMESTAMP and REF01 17 New errors 46648 HIX The Reporting Category Date 2750 DTP segment is required for Individual per section 9 6 1 46649 HIX The Reporting Category Date 2750 DTP segment is required for SHOP per section 9 6 1 Retired errors 46513 HIX The Reporting Category Date 2750 DTP segment is required when the Reporting Category Reference ID Qualifier 2750 REF01 is equal to 17
64. to the X12 interpretation RFI 1748 The deactivated code is usable in these derivative transactions because they are reporting on the valid usage pre deactivation of the code in a previously generated 835 transaction Solution Date checking for the CARC and RARC was removed Retired error s 5010 837P and 5010X298 41018 The Claim Adjustment Reason Code FS_FindCodeValue was not valid on the Claim Check or Remittance Date Current_Element 5010 8371 41518 The Claim Adjustment Reason Code CAS02 FS_FindCodeValue was not valid on the Claim Check or Remittance Date Current_Element 41519 The Claim Adjustment Reason Code CAS05 FS_FindCodeValue was not valid on the Claim Check or Remittance Date Current_Element 41520 The Claim Adjustment Reason Code CAS08 FS_FindCodeValue was not valid on the Claim Check or Remittance Date Current_Element 41521 The Claim Adjustment Reason Code CAS11 FS_FindCodeValue was not valid on the Claim Check or Remittance Date Current_Element 41522 The Claim Adjustment Reason Code CAS14 FS_FindCodeValue was not valid on the Claim Check or Remittance Date Current_Element 41523 The Claim Adjustment Reason Code CAS17 FS_FindCodeValue was not valid on the Claim Check or Remittance Date Current_Element 41530 The Claim Adjustment Reason Code FS_FindCodeValue was not valid on the Claim Check or Remittance Date Current_Element 41531 The Claim Adjustment
65. uideline Release Yes 8 4 0 5 Interim Update to Guidelines December 2014 Issue Support is needed for the following 278X215l Health Care Services Review Information Inquiry 278X215R Health Care Services Review Information Response 278X216A Health Care Services Review Information Acknowledgement 278X216N Health Care Services Review Information Notification Solution The following guidelines have been added types 1 2 278X215l Health Care Services Review Information Inquiry 278X215R Health Care Services Review Information Response 278X216A Health Care Services Review Information Acknowledgement 278X216N Health Care Services Review Information Notification The following guidelines have been added types 1 7 5010 278X215I Health Care Services Review Information Inquiry 5010 278X215R Health Care Services Review Information Response 5010 278X216A Health Care Services Review Information Acknowledgement 5010 278X216N Health Care Services Review Information Notification The following PDSA guidelines have been added PDSA5010 278X215I Health Care Services Review Information Inquiry PDSA5010 278X215R Health Care Services Review Information Response PDSA5010 278X216A Health Care Services Review Information Acknowledgement PDSA5010 278X216N Health Care Services Review Information Notification The following PDSX guidelines have been added PDSX5010 278X215l Health Care Services Review Info
66. urn code was added to Instream for TIBCO BusinessConnect Hotfix 1 10654 Guideline error on s when checking element relation Index d outside bounds of total elements FINS 658 Instream now accepts spaces in Stored Procedure SQL Statements See New Hotfix 1 and Changed Features FINS 661 Response Generator change FINS 535 included in Instream Release 8 4 0 was Hotfix 1 intended to override values in the IK502 The fix has been removed and pre release 8 4 0 functionality has been restored FINS 662 Instream now generates a validation error when the tab character hex Hotfix 1 character 0x09 appears at the end of segment FINS 664 HL7 only Instream now accommodates HL7 s expectation that an ORC Hotfix 2 segment must appear before every OBR if OBR was used previously in the transaction FINS 665 Response Generator 277CA Amounts STC04 and AMTO2 issue resolved No FINS 666 Fixed length flat files now validate as expected Hotfix 1 FINS 669 The Instream Readme ixt file now lists RHEL 5 9 as a supported platform No Instream Release Notes 45 7 10 2015 Originally a contained n f apg Summary in a Release Request ID 8 4 0 Hotfix FINS 673 Response Generator Custom Report listing incorrect total errors when No comparing against DTL FINS 675 The Instream License Files were updated in the install No FINS 676 The Instream Readme ixt file was updated to list cur
67. when the number exceeds zero for FFM and FF SHOP Updated errors 46518 HIX At least one Transaction Set Control Totals QTY segment must be sent with the qualifier of TO Total 46622 HIX At least one Transaction Set Control Totals QTY segment must be sent with the qualifier of ET Employee Total or DT Dependent Total Instream Release Notes 19 7 10 2015 Change 9476 Guideline s 5010 837P std Originally contained in an earlier Guideline Release Yes 8 4 0 4 Interim Update to Guidelines October 2014 Issue The 2400 HCP12 edit for Error 40991 on the Patient Loop should match the edit on the Subscriber Loop Solution The 2400 HCP12 edit on the Patient Loop was updated to match the edit on the Subscriber Loop Related error 40991 The maximum length for this field 2400 HCP12 is 8 digits excluding the decimal The maximum number of digits allowed to the right of the decimal is three Change 9478 Guideline s 5010 HIX 834X220 std Originally contained in an earlier Guideline Release Yes 8 4 0 4 Interim Update to Guidelines October 2014 Issue When Loop 2000 REF01 17 for Individual then the formatting must be 10 numeric characters Currently the business rule doesnot check for Individual before generating an error Solution The business rule was updated to check for Individual before generating Error 46621 Updated error 46621 HIX The Member Supplemental Identifier 2000 REF where
68. y on the first claim However error 41695 continued to be received incorrectly on all subsequent claims Solution The variable was not being cleared in all places This has been corrected Related errors 41695 The Occurrence Code 55 2300 HIOX 2 must be present when the Patient Discharge status 2300 CL103 equals 20 40 41 or 42 Change 9535 Guideline s N A Originally contained in an earlier Guideline Release Yes 8 4 0 8 Interim Update to Guidelines May 2015 Issue Error numbers 41170 and 47203 are assigned an invalid IK403 value X7 This value should be set to 2 Solution Edits 41170 and 47203 were updated with an IK403 value of 2 Related errors 41170 The Claim Adjustment Reason Code 23 can only be present when the Claim Adjustment Group Code CAS01 is OA 47203 The Claim Adjustment Reason Code 23 can only be present when the Claim Adjustment Group Code CAS01 is OA Instream Release Notes 37 7 10 2015 Change 9536 Guideline s 5010 271 std Originally contained in an earlier Guideline Release Yes 8 4 0 8 Interim Update to Guidelines May 2015 Issue Only one occurrence of each REF01 REF02 code value may be used in the 2110C loop You can however repeat the same REF01 REF02 if it is a new 2110C loop Edit 45749 does not allow for this Solution Edit 45749 was updated to collect the 2100C REF01 and REFO2 AppendSiring and compare it against each 2110C REFO1 plus REFO2 The error wil

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