1. What are the different levels of testing within transaction compliance checking? 

  Level 1: Integrity testing – Testing of the EDI file for valid segments, segment order, element attributes, testing for numeric values in numeric data elements, validation of X12 syntax, and compliance with X12 rules. This will validate the basic level integrity of the EDI submission. 

 Level 2: Requirement testing – Testing for HIPAA implementation-guide-specific syntax requirements, such as repeat counts, used and not used codes, elements and segments, required or intra-segment situational data elements. Testing for non-medical code sets as laid out in the implementation guide. Values noted in the implementation guide via an X12 code list or table.

 Level 3: Balancing – Testing the transaction for balanced field totals, financial balancing of claims or remittance advice, and balancing of summary fields, if appropriate.

 Level 4: Situation testing – The testing of specific inter segment situations described in the HIPAA implementation guides, such that: If A occurs then B must be populated. This is considered to include the validation of situational fields given values or situations present elsewhere in the file. Example: if the claim is for an accident, the accident date must be present. 

 Level 5: External Code Set testing – Testing for valid implementation-guide-specific code set values. This level of testing will not only validate the code sets but also make sure the usage is appropriate for any particular transaction. Validates external code sets and tables such as CPT, ICD9, CDT, NDC, status codes, adjustment reason codes, and their appropriate use for the transaction. 

 Level 6: Product Types or Line of Services: The testing is required to ensure that the segments / records of data that differ based on certain healthcare services are properly created and processed into claims data formats. For example, ambulance, chiropractic, podiatry, home health, parenteral and enteral nutrition, durable medical equipment, psychiatry, and other specialized services have specific requirements in the implementation guide that must be tested before putting the transaction in production.

 2. Which levels of transaction compliance testing are minimal acceptable? 

 All trading partners should test their transactions at levels 1 and 2 as a minimum before attempting to exchange data with another trading partner. A transaction that does not meet these requirements should not be transmitted, even as a test, to a trading partner. 

 3. Which levels of testing does STC Compliance Checker perform?

 STC Compliance Checker tests documents on the 1, 2 and 4 levels described above. That's quite enough for the most purposes.