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 Enrollment Master\Configuration\
Windows 7, Vista: C:\DrogramData\HIPAAsuite\HIPAA Enrollment Master\Configuration\

windows_codeset
The Configuration folder in Windows XP

Tip: The folder is hidden.

 

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

1.Go to the "Code Sets" item in the main menu.
 
codsets_menu
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

ActionCode
AmountQualifierCode
BenefitStatusCode
CardAction
CardType
CitizenShipStatusCode
COBCode
CobraEvent
CoordinationBenefitsCode
ContactCode
CoverageLevelCode
DisabilityTypeCode
DTPCode
EmployeeStatusCode
EntityIdentifierCode

F to P

FileTypeCode
FrequencyCode
GenderCode
IDCode
InsuranceLineCode
HealthRelatedCauses
LanguageUse
LocationQualifier
MaintenanceTypeCode
MaintenanceReasonCode
MaritalStatusCode
MedicarePlanCode
PayerSequenceCode
ProviderRelationship
ProviderTypeCode
Purpose

Q to Z

RaceCode
REFCode
RelationshipCode
StudentStatusCode
YesNo

 

The following screen-shot illustrates how to select the "InsuranceLineCode" code set for display.
 
18
The "InsurenceLineCode" sub-menu

3. The Code Set configuration window will be displayed. Below you can see the window for InsuranceLineCode. The window displays the following fields:

Record Count — The total number of codes. For example, for InsuranceLineCode it is equal to 22.
Codes and their corresponding descriptions. The codes are indicated in the source EDI files. The descriptions are displayed instead of codes in the resultant easy-to-read files. For example, for InsuranceLineCode there are the following codes and corresponding descriptions:
AG — Preventitive Care
AH — 24 Hour Care
AJ — Medicare Risk

inslinecode_window
The "EnsuranceLineCode" code set configuration window

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

inslinecode_save
The "Save" button