Selecting a Code Set

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EDI relies on transaction code sets. A transaction code is a basic EDI message type. The HIPAA Claim Payment Master translates HIPAA code sets into meaningful words (a corresponding longer explanation or description). For example, facility code "25" means a Birthing Center, gender code "M" means Male.

At the onset of EDI one of the main design ideas was to make the EDI files as short as possible and to allow different languages to use the same descriptions by reducing long verbose explanations to 2-3 byte long codes. Computer storage was incredibly expensive and making any file larger than it absolutely had to was considered wasteful.

The code sets are stored in the file codesets.xml in the Configuration subdirectory:

Windows XP: C:\Documents and Settings\All Users\Application Data\HIPAAsuite\HIPAA Claim Payment Master\Configuration\
Windows 7, Vista: C:\ProgramData\HIPAAsuite\HIPAA Claim Payment Master\Configuration\

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The Configuration folder in Windows XP

Tip: The folder is hidden.

 

To view/edit transaction code sets in HIPAA Claim Payment Master, follow the instructions below.

1.Go to the "Code Sets" item in the main menu.
 
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The "Code Sets" menu
2.From the sub-menu, select a code set name. The following menu items are available via the "Code Sets" menu:

A to E

AdjustmentReason
AdjustmentReasonCode
AdjustmentReasonGroup
AmountQualifier
ClaimStatusCategoryCode
ClaimStatusCode
CommCode
DateQualifier
EntityCode

F to P

FacilityTypes
Filing
Frequency
GenderCode
ID
PaymentMethod
PlaceOfService

Q to Z

Quantity Qualifier
RDMCode
REFCode
RemarkCodes
ServiceID
Status
TransType

 

The following screen-shot illustrates how to select the "PaymentMethod" code set for display.
 
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The "PaymentMethod" sub-menu

3. The Code Set configuration window will be displayed. Double-click the field to edit it and type in the new value.
 
Below you can see such window for PaymentMethod.
 
The window provides the following information:

Number of records in codeset — The total number of codes. For example, for PaymentMethod it is equal to 5.
Codes and their corresponding descriptions. The codes are indicated in the source EDI files. The descriptions are  displayed instead of codes in the result easy-to-read files. For example, for PaymentMethod there are the following codes and corresponding descriptions:
ACH — Automated Clearing House
BOP — Financial Institution Option
CHK — Check
FWT — Federal Reserve Funds
NON — Non Payment Data

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The "PaymentMethod" code set configuration window

4. Click on the "Save" button to save the changes.

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The "Save" button