Guidance is requested for handling of 278x217 Request and Response data. In developing a solution for mapping X12 to FHIR back to X12, we have identified that some data populated at Loop 2000E of the X12 request translates to the equivalent of 2000F in the FHIR request. The UMO processes the FHIR request and generates FHIR responses at the 2000F level. This causes the translation back to X12 to:
- Populate Loop 2000F data in the response when the data was not present in the request at this level, and/or
- Duplicate data in Loop 2000F that is already returned in Loop 2000E.
Is it non-compliant with the standard if an X12 278 response (BHT02=11) returns data at the 2000F level when i) 2000F was not present in the original 278 request (BHT02=13), or ii) the response duplicates data from Loop 2000E in Loop 2000F when the data is not different? Depending on the data, situational rules exist (i.e., "required when valued on the request" or "required when different from 2000E").
Example 1: 2000F UM segment was not present/valued in the request. Response returns 2000F UM segment with UM02, UM03, and UM04 data that replicates the UM values from 2000E.
- Loop 2000F UM Situational Rule: "Required when valued on the request and used by the UMO to render a medical decision. If not required by this implementation guide, do not send."
- Does the "required when valued on the request" only apply to this 2000F Loop level, or does it imply valued "anywhere" in the request (e.g., 2000E)?
Example 2: Request 2000F UM segment does not contain certain data element(s) (i.e., UM04). Response returns a 2000F UM04 value copied from 2000E.
- UM04 Situational Rule: "Required when different from the UM04 value at the Patient Event level (Loop 2000E). If not required by this implementation guide, do not send."
- UM04 DE Note: "Values entered at the Service Level override the value at the Patient Event Level for this service."
- The UM04 is not different from Loop 2000E. Is it compliant if the same value is returned in both 2000E and 2000F?
The situational rule to return the data in the 2000F is only allowed if the 2000F was sent in the request.
If the situational rule in the response indicates to return if submitted in the request, then that would be applicable for both 2000E and 2000F loops, if those loops are being returned in the response.
The UM04 value at the 2000F must only be reported if different from the UM04 value reported in 2000E.