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HIPAA EDI Support

  EDI Tool for Developers

Framework EDI is an EDI software tool that enables programmers to rapidly create HIPAA EDI solutions.  (Click here to download an evaluation copy.)  Below are example programs to show how one can easily create HIPAA solutions with the Framework EDI.

 

HIPAA 4010

Example Programs
To run some of the example programs, you may have to remove the old reference of the Framework EDI dll from the program, and then reference its new version back again.  Click here for details.

Visual Basic .NET example HIPAA EDI solutions using FREDI-NET Hybrid component to process outbound and inbound EDI files.

  • Gen835X091Net - Generates a HIPAA 835 4010X091 Health Care Claim Payment/Advice (VS2005 32-bit) view code
  • Tran835X091Net - Translates an HIPAA EDI X12 835 X091 (VS2005 32-bit) view code
  • Gen270 X092Net - Generates an HIPAA 270 4010X092 Health Care Eligibility, Coverage or Benefit (VS2005 64-bit)
  • Tran270 X092Net - Translates a HIPAA EDI X12 270 4010X092 (VS2005 64-bit)
  • Gen834X095NetDB - Generates an 834 4010X095 Benefit Enrollment and Maintenance from a database (VS2003view code
  • Tran834X095NetDB - Translates a HIPAA EDI X12 834 X095 into a database (VS2003 32-bitview code
  • 837 X098NetDB - Generates and translates an EDI 837 4010X098 Professional from/to a database (VS2003 32-bit)
  • Gen276_X093Net - Generates a HIPAA EDI 276 4010X093 Health Care Claim: Status Request (VS2010 64-bit)
  • Tran276_X093Net - Translates a HIPAA 276 X093 Health Care Claim: Status Request (VS2010 64-bit)
  • VbNetGen837X098ADO - VB.NET (VS2005) program that generates an 837 EDI file with data from a database. view code
  • VbNetTran837X098ADO - Translates an 837 X098 EDI file into an Access Database via an ADO.NET connection. view  code

C# .NET example HIPAA solutions using FREDI-NET Hybrid component to process outbound and inbound HIPAA EDI files.

Visual Basic 6 example HIPAA EDI solutions that generate and translate EDI files using Framework EDI.

Delphi 5 example programs that uses Framework EDI

FoxPro 6 example programs that uses Framework EDI

Visual C++ skeleton programs that uses Framework EDI 

  • 837X096VC.zip - Generates and translates 837 4010X096 HIPAA EDI file.

Access - sample programs to demonstrate how one can map EDI files to/from a database

Excel - example HIPAA EDI solutions using Excel spreadsheet



Translating an EDI file into an Excel spreadsheet

 


Framework EDI HIPAA EDI validation
Framework EDI validates a HIPAA EDI file by checking it against its corresponding SEF file.  Any discrepancy between them will be regarded as an error in the EDI file.  Framework EDI can check for any expression that can be entered into the SEF file.  Validation includes the following types of testing recommended by WEDI SNIP (please visit their website for more information http://www.wedi.org)

  • Type 1: EDI syntax integrity testing
  • Type 2: HIPAA syntactical requirement testing
  • Type 4: Situational testing
  • Type 5: External code set testing
    • (Please note that none of the SEF files provided by EDIdEv includes external codes)
  • Type 6: Product types or line of services

Framework EDI does not automatically test Type 3: Balancing.  This test type would have to be implemented by the programmer at the time of translation.

For test Type 7: Implementation Guide-Specific Trading partners, programmers would have to create separate SEF files specific to the trading partners.

Example Validation Programs
Below are example programs (with source code)  that validate and acknowledge HIPAA EDI files with a Functional Acknowledgment 997.

Visual Basic 6

  • Ack (Functional Acknowledgment 997 4010 sample program)
  • ValidateHipaa (Sample program that validates HIPAA EDI files)

ASP.NET 

C#

Delphi

  • DelphiAck - Creates a Functional Acknowledgment 997 EDI file to acknowledge receipt of an EDI file in Delphi.

Visual C++

  • X096AckVC - .Generates Functional Acknowledgment 997 4010 in C++

Access

  • AccessAckX091.zip - Generates Functional Acknowledgment 997 EDI file in Access VB script.

Note:  The correct version of the SEF files must be used in both the "ValidateHipaa" and "Ack" sample program to generate a correct report and Functional Acknowledgment 997 file respectively.

For more information about Framework EDI's validation capabilities, please read EDI Validation.


Standard Exchange Format (SEF) Files

The following SEF files are used by the sample programs. (What are they?)  Please note: The SEF files listed below do not contain any addenda, however SEF files with addenda can be purchased at our eShop for $90.00 each.

 SEF files in their actual format.

837 004010X098.SEF Health Care Claim: Professional
837 004010X097.SEF Health Care Claim: Dental
837 004010X096.SEF Health Care Claim: Institutional

Evaluation SEF files (encrypted and will only work with the evaluation copy of Framework EDI).  Please note that evaluation SEF files cannot be edited nor modified.  SEF files can be viewed with the SEF Manager.

270 004010X092.SEF Eligibility, Coverage or Benefit Inquiry
271 004010X092.SEF Eligibility, Coverage or Benefit Information
276 004010X093.SEF Health Care Claim Status Request
277 004010X093.SEF Health Care Claim Status Notification
278 004010X094Request.SEF Health Care Service Review -  Request for Review
278 004010X094Response.SEF Health Care Service Review - Response to Request for Review
820 004010X061.SEF Payment Order/Remittance Advice
834 004010X095.SEF Benefit Enrollment and Maintenance
835 004010X091.SEF Health Care Claim Payment/Advice

(Also note that none of our SEF files contain the .TEXT section, nor do they include external codes.)

 

HIPAA 5010

A feature introduced in the HIPAA 5010 guideline that may wreak havoc to existing EDI systems is the use of repeating elements.  EDI translators that do not support repeating elements will either miss data by disregarding consecutive data after the first repeating element; or obtain an invalid data value by capturing all multiple values of a repeating element as one value.  An example of a segment which has a repeating element is the EB segment of Transaction Set 271 version 5010 X279.  In the example below, the third data element is a repeating element that has been repeated 10 times (having distinct values of 1, 33, 35, 47, 86, 88, 98, AL, MH, UC).

EB*1**1^33^35^47^86^88^98^AL^MH^UC

Notice that repeating elements are separated by a character delimiter called Repetition Separator defined at ISA11 (data element I65).  In this example, the Repetition Separator is the "^" (carat).

ISA*00* *00* *14*0073268795005 *ZZ*RECEIVERISA *960807*1548*^*00501*000000020*0*T*:~

It is important to note that in previous versions (4010 and earlier), the position ISA11 was data element I10 (Interchange Control Standards Identifier), which always had a value "U".  If this difference is overlooked when upgrading from 4010 to 5010, all "U" characters in the EDI file will incorrectly be regarded as Repetition Separators, and cause erroneous parsing and loss of data during translation.

 

HIPAA 5010 SEF files and sample EDI files
Below are evaluation versions of the HIPAA 5010 SEF files along with sample EDI files. (Sample EDI files are structurally correct, but their data are nonsensical.).  Please note that evaluation SEF files cannot be edited nor modified, but they can be viewed with the SEF Manager.

270 005010X279A1 - Health Care Eligibility Benefit Inquiry
271 005010X279A1 - Eligibility, Coverage or Benefit Information
276 005010X212 - Health Care Claim Status Request
277 005010X212 - Health Care Claim Status Notification
278 005010X217Request - Health Care Service Review -  Request for Review
278 005010X217Response - Health Care Service Review - Response to Request for Review
820 005010X218 - Payment Order/Remittance Advice
834 005010X220A1 - Benefit Enrollment and Maintenance
835  005010X221A1 - Health Care Claim Payment/Advice
837 005010X222A1 - Health Care Claim: Professional
837 005010X223A2 - Health Care Claim: Institutional
837 005010X224A2 - Health Care Claim: Dental 
999 005010X231A1 - Implementation Acknowledgment

 

HIPAA 5010 Example programs
Below are example programs to demonstrate how to generate, translate and acknowledge HIPAA EDI files with repeating elements using Framework EDI component.

C#

  • CsharpGen271X279 - Generates Transaction Set 271 5010 X279 (VS2005 64-bit) view code
  • CsharpTran271X279 - Translates Transaction Set 271 5010 X279 (VS2005 64-bit) view code
  • CsharpAck5010 - Functional Acknowledgment Transaction Set 997 5010 X230 (VS2005 32-bit) view code
  • CsharpAck999 - Implementation Acknowledgment Transaction Set 999 5010 X231A1 (VS2005 32-bit) view code
  • CsharpValidate - A simple C# validation program view code
  • Multiple999Ack - Example program that acknowledges an 834 EDI (that has several Functional Groups) with a TA1 acknowledgment, and at the same time splits it into several smaller 834 EDI files by Functional Group.  They are then validated, and each are acknowledge with a separate 999 Implementation Acknowledgment.

Visual Basic 6

  • Vb6Gen271X279 - Generate Transaction Set 271 5010X279 HIPAA in VB6
  • Vb6Tran271X279 - Translate Transaction Set 271 5010X279 HIPAA in VB6
  • Vb6Ack5010 - Functional Acknowledgment Transaction Set 997 5010X230 in VB6
  • Vb6Ack999 - Implementation Acknowledgment Transaction Set 999 5010 X231A1 in VB6

Delphi

Visual Basic .NET

  • VbNetAck999 - Implementation Acknowledgment Transaction Set 999 5010X231A1 in VB.NET (VS2005 64-bit)
  • VbNet_Validate - A simple VB.NET validation program (VS2005 64-bit)

*** Below are more example programs (of similar style to above) that can be purchased from our eShop (in the Product Category field, select "Sourcecode Examples").  Please note that all example programs have only evaluation SEF files.

  • Generates and translates 270 5010X279A1 HIPAA EDI files (VB6, VB.NET)
  • Generates and translates 277 5010X212 HIPAA EDI files (C#, VB.NET)
  • Generates and translates 277 5010X214 EDI files (C#, VB.NET)
  • Generates and translates 278 5010X217 HIPAA EDI files (C#)
  • Generates and translates 278 5010X228 EDI files (C#)
  • Generates and translates 834 5010X220A1 HIPAA EDI files (C#, VB.NET)
  • Generates and translates 835 5010X221A1 EDI files (C#, VB.NET, VB6)
  • Generates and translates 837 5010X222A1 EDI files (C#, VB.NET)
  • Generates and translates 837 5010X223A2 HIPAA EDI files (C#)

 

Click here to download Framework EDI 

 

HIPAA EDI Guidelines
HIPAA EDI guidelines can be found on Washington Publishing Company website at www.wpc-edi.com.

 

The example programs provided in this article are for illustration only, and have no purpose other than to show software developers how to use the Framework EDI component in programming languages to process EDI files.  If you have any questions, don't hesitate to contact us:

 

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