Why do some of the coded values differ across file types? Why do some code values not have a value to represent unknown?
Although the HIPAA standard coding schema was adopted for the coding structure within the state’s claims requirements, the HIPAA electronic transmission coding standards are not standard across the different file types. Therefore, the prescription drug specifications call for gender codes of 1, 2, or 3, while the medical and eligibility specifications require a gender code of M, F, or U. This follows the HIPAA requirements for these data sets. Please use caution when setting up your extract to code all of these fields appropriately. Similarly, if a coded field does not have a value to indicate “unknown,” it is because HIPAA did not allow for an unknown value to be reported. In a few instances, only a subset of the HIPAA codes are allowed in the extract. This was done to restrict the use of nonspecific codes.
