Resolution:
On April 2, 2007, CMS announced a contingency plan for those covered entities (other than small health plans) who will not meet the May 23, 2007 deadline for National
Provider Identification (NPI) compliance. “Covered entities that have been making a good faith effort to comply with the NPI provisions may, for up to 12 months, implement contingency plans that could include accepting legacy provider numbers on HIPAA transactions in order to maintain operations and cash flows.”

The intention of this Late Breaking News article is to help our customers to relax validation edits for NPI related errors which will begin occurring on May 23, 2007 for those transactions where National Provider Identifiers are not used as mandated.  If the severity of these validation edits are not relaxed, transactions, which do not properly use the NPI beginning on May 23, 2007, will be rejected.

TIBCO customers using TIBCO BusinessConnect EDI Protocol HIPAA Edition v2.8.x or TIBCO BusinessConnect EDI Protocol HIPAA Edition v5.x can use Error Severity Files (ESF files) to relax the severity of the NPI related validation edits. Error Severity Files are explained in the following documents:

    TIBCO BusinessConnect EDI Protocol HIPAA Edition v2.8.x
            TIBCO BusinessConnect EDI Protocol - EDI-X12 Configuration Guide
                  Chapter 8, Section Titled: HIPAA Validation Error Severity

    TIBCO BusinessConnect EDI Protocol HIPAA Edition v5.0.0
            TIBCO BusinessConnect EDI Protocol HIPAA Edition Configuration
                     Chapter 1, Section Titled: HIPAA Validation Error Severity

With ESF files, the severity of an error can be relaxed for a particular error ID. This feature can be used to relax the error severity for the following error IDs relating to the use of the NPI:

    TIBCO BusinessConnect EDI Protocol HIPAA Edition v2.8.x
    NPI Related Error IDs

        60001141
        60003230
        60003232
        60003308
        60003352

    TIBCO BusinessConnect EDI Protocol HIPAA Edition v5.0.0

    NPI Related Error IDs
        0x3938B75
        0x393939E
        0x39393A0
        0x39393EC
        0x3939418

In future releases of TIBCO BusinessConnect EDI Protocol HIPAA Edition, all NPI related errors will have a severity of “Informational”. Attached are example ESF files
which can be used as-is or integrated with your existing ESF files for all HIPAA and X12N transaction guidelines for those trading partners who will not be complaint in their usage of NPI identifiers by May 23, 2007.

Contents to add to your .esf file for HIPAA 5.0:

<?xml version="1.0" encoding="UTF-8"?>

&ltSeverityConfigFile Version="2.0" Mode="override" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xsi:noNamespaceSchemaLocation="SeverityConfig.xsd">
    &ltSeverityDefinition/>
    &ltSeverityUsage>
        &ltApplyTo>
            &ltCriteria Name="emp.snip" Value="4"/>
            &ltCriteria Name="emp.id" Value="0x3938B75"/>
            &ltSetSeverity SeverityID="3000"/>
        </ApplyTo>
        &ltApplyTo>
            &ltCriteria Name="emp.snip" Value="4"/>
            &ltCriteria Name="emp.id" Value="0x393939E"/>
            &ltSetSeverity SeverityID="3000"/>
        </ApplyTo>
        &ltApplyTo>
            &ltCriteria Name="emp.snip" Value="2"/>
            &ltCriteria Name="emp.id" Value="0x39393A0"/>
            &ltSetSeverity SeverityID="3000"/>
        </ApplyTo>
        &ltApplyTo>
            &ltCriteria Name="emp.snip" Value="4"/>
            &ltCriteria Name="emp.id" Value="0x39393EC"/>
            &ltSetSeverity SeverityID="3000"/>
        </ApplyTo>
        &ltApplyTo>
            &ltCriteria Name="emp.snip" Value="4"/>
            &ltCriteria Name="emp.id" Value="0x3939418"/>
            &ltSetSeverity SeverityID="3000"/>
        </ApplyTo>
        &ltApplyTo Type="System">
            &ltCompoundCriteria>
                &ltCriteria Name="ecSGroup" Value="3"/>
            </CompoundCriteria>
            &ltSetSeverity SeverityID="0"/>
        </ApplyTo>
        &ltApplyTo Type="System">
            &ltCompoundCriteria>
                &ltCriteria Name="ecSGroup" Value="2"/>
            </CompoundCriteria>
            &ltSetSeverity SeverityID="1001"/>
        </ApplyTo>
        &ltApplyTo Type="System">
            &ltCompoundCriteria>
                &ltCriteria Name="ecSGroup" Value="1"/>
            </CompoundCriteria>
            &ltSetSeverity SeverityID="2000"/>
        </ApplyTo>
        &ltApplyTo Type="System">
            &ltCompoundCriteria>
                &ltCriteria Name="ecSGroup" Value="0"/>
            </CompoundCriteria>
            &ltSetSeverity SeverityID="3000"/>
        </ApplyTo>
    </SeverityUsage>
</SeverityConfigFile>

Contents to add to your .esf file for HIPAA 2.8:

<?xml version="1.0" encoding="UTF-8"?>

&ltSeverityConfigFile Version="1.0" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xsi:noNamespaceSchemaLocation="ErrorSeverityConfig.xsd">
    &ltSeverityDefinition/>
    &ltSeverityUsage>
        &ltApplyTo Type="System">
            &ltCompoundCriteria>
                &ltCriteria Name="ecSGroup" Value="1"/>
            </CompoundCriteria>
            &ltSetSeverity SeverityID="2000"/>
        </ApplyTo>
        &ltApplyTo Type="System">
            &ltCompoundCriteria>
                &ltCriteria Name="ecSGroup" Value="0"/>
            </CompoundCriteria>
            &ltSetSeverity SeverityID="3000"/>
        </ApplyTo>
        &ltApplyTo>
            &ltCriteria Name="ErrorLevel" Value="4"/>
            &ltCriteria Name="ErrorID" Value="60001141"/>
            &ltSetSeverity SeverityID="3000"/>
        </ApplyTo>
        &ltApplyTo>
            &ltCriteria Name="ErrorLevel" Value="4"/>
            &ltCriteria Name="ErrorID" Value="60003230"/>
            &ltSetSeverity SeverityID="3000"/>
        </ApplyTo>
        &ltApplyTo>
            &ltCriteria Name="ErrorLevel" Value="2"/>
            &ltCriteria Name="ErrorID" Value="60003232"/>
            &ltSetSeverity SeverityID="3000"/>
        </ApplyTo>
        &ltApplyTo>
            &ltCriteria Name="ErrorLevel" Value="4"/>
            &ltCriteria Name="ErrorID" Value="60003308"/>
            &ltSetSeverity SeverityID="3000"/>
        </ApplyTo>
        &ltApplyTo>
            &ltCriteria Name="ErrorLevel" Value="4"/>
            &ltCriteria Name="ErrorID" Value="60003352"/>
            &ltSetSeverity SeverityID="3000"/>
        </ApplyTo>
    </SeverityUsage>
</SeverityConfigFile>

HIPAA NPI Acceptance Extension and impact on BC EDI HIPAA 2.8.X and 5.0