EDIdEv - Electronic Data Interchange Development

HIPAA EDI Support

Creating solutions to process HIPAA EDI files can be a daunting task especially if you do not have the right EDI tool, which may be why many have resigned themselves to exorbitant EDI services that simply donít work.  So why settle for second rate services when you can create your own dream EDI solution?  The Framework EDI software not only simplifies the task of creating EDI applications, but enables you to create robust solutions that integrate with your legacy system seamlessly and accurately.  Its EDI component makes it easy to write programs that validate EDI files as well as generate and translate large EDI files quickly.  Oh, you're not sure how to acknowledge EDI files that you receive?  Well, that too is not a problem with an EDI component that can generate 997 and 999 acknowledgments automatically.  Below are example programs to show how one can easily create HIPAA EDI solutions with the Framework EDI.


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

Excel - EDI instructions for Excel example programs

  • ExcelTran837_5010X224A2.zip
    This Excel program translates an 837 5010X224A2 EDI file (Healh Care Claim: Dental) into an Excel spreadsheet.  The advantage of translating EDI files into Excel is that EDI data is converted into usable data on to a spreadsheet with ease.  You can also take advantage of Excelís export feature to output the data into other formats such as CSV.  In essence, this would be an easy way of converting EDI to CSV or delimited text or any other format that the Excel export feature supports.
  • ExcelGenTran834X095.zip
    In this example, the Excel program has one worksheet that can generate an 834 4010X095 EDI file (Benefit Enrollment and Maintenance), and another worksheet that can translate the same 834 EDI file.  To generate the EDI file, you would enter your data on to the worksheet, then click on the generate button to create the outbound 834 EDI file.  You could also, if your columns match, open your CSV or delimited text file on to the worksheet and then click on the generate button to create the EDI file basically making Excel a CSV to EDI, or delimited text to EDI convertor application.  view code generate translate


A rundown of steps that you have to take to run the Excel example programs

 


Translating an EDI file into an Excel spreadsheet

 

C# .NET - See how to convert a .NET 32-bit example program to a 64-bit in VS2013

  • CsharpGen271X279
    This is a C# program that generates a 271 5010X279 EDI file (Health Care Eligibility Benefit Inquiry and Response).  It shows how an EB segment with repeating elements is created.  view code
  • CsharpTran271X279
    This example program translates a 271 5010X279 HIPAA EDI file.  Pay special attention to how the EB segment with repeating elements is translated.  Note also that the Repetition Separator is defined in ISA11 (data element I65) of the ISA segment.  view code
  • CsharpAck999
    In this example, the program reads an 837 5010X221A1 EDI file, and then creates a 999 5010X231A1 and TA1 acknowledgment for the received 837 EDI file.  The program also shows how to read the TA1 and 999 EDI file it just created to check if the 837 EDI file was rejected or accepted.  view code
  • CsharpTranAck999
    This example shows how to translate a 999 5010X231A1 (Implementation Acknowledgment) EDI file that also has a TA1 (Interchange Acknowledgment) segment.  view code
  • CsharpAck997
    This C# program reads an 835 5010X221A1EDI file, and then creates a 997 5010X230 and TA1 acknowledgment for it.  The program also shows how to read the TA1 and 997 EDI file to check if the 835 EDI file was rejected or accepted.  view code
  • CsharpValidate
    This simple program shows how one can easily create an EDI validator with the Framework EDI (FREDI) component.  Note that FREDI validates EDI files by matching the EDI file against the schematics of the SEF file.  Any discrepancy found will be regarded as an error.  In this example, we are validating an 837 5010X222A1 EDI file so we have to use an 837 5010X222A1 SEF file.  view code
  • cSharp275X210
    This example shows how to generate a 275 5010X210 EDI file with a binary file and a text file embedded in it; and also shows how to read the same EDI file and extract the binary file and text file from it.  view translate view generate code

 

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)
  • VbNetTranGen837X098_SqlClient
    This is an example VB.NET program that reads and translates an 837P EDI file (837 4010X098) and stores the data into a SQL database.  It also generates an outbound 837P EDI files with data obtained from a SQL database.  (837 to SQL and vice-versa SQL to 837).  view Gen code view Tran code

 

Executable programs
Below are executable programs that will process HIPAA EDI files from/to a SQL database.  Their source codes can be purchased from our eShop.


Running the C# Translate 837 to SQL example program

 

Example program source codes that can be purchased
Below are more example source codes that can be purchased from our eShop (in the Product Category field, select "Source code Examples").  They are a little more comprehensive than the free examples and can considerably jump start your project.  Please note that all example programs have only evaluation SEF files.

  • Generates 270 5010X279A1 Health Care Eligibility Benefit Inquiry EDI files (VB6, VB.NET, C#)
  • Translates 270 5010X279A1 HIPAA EDI files (VB6, VB.NET, C#)
  • Generates 276 5010X212 Health Care Claim Status Request EDI files (C#)
  • Translates 276 5010X212 HIPAA EDI files (C#)
  • Generates 277 5010X212 Health Care Claim Status Notification EDI files (C#)
  • Translates 277 5010X212 HIPAA EDI files (C#)
  • Generates 277 5010X214 Health Care Claim Status Acknowledgment EDI files (VB.NET, C#)
  • Translates 277 5010X214 HIPAA EDI files (VB.NET, C#)
  • Generates 277 5010X228 Health Care Claim Status Pending Status Information EDI files (C#)
  • Translates 277 5010X228 HIPAA EDI files (C#)
  • Generates 278 5010X217 Health Care Services Review Information - Review EDI files (C#)
  • Translates 278 5010X217 Review HIPAA EDI files (C#)
  • Generates 820 5010X306 Health Insurance Exchange Related Payments EDI files (C#)
  • Translates 820 5010X306 HIPAA EDI files (C#)
  • Generates 834 5010X220A1 Benefit Enrollment and Maintenance EDI files (VB.NET, C#, Excel VBA)
  • Translates 834 5010X220A1 HIPAA EDI files (VB.NET, C#, Excel VBA)
  • Generates 834 5010X220A1 EDI files with data from SQL database (C#, SQL) Download executable copy
  • Translates 834 5010X220A1 HIPAA EDI files into SQL database (C#, SQL) Download executable copy
  • Generates 835 5010X221A1 HIPAA EDI files with data from SQL database / Excel (C#, Excel VBA) Download executable copy
  • Translates 835 5010X221A1 HIPAA EDI files into SQL database / Excel (C#, Excel VBA) Download executable copy
  • Generates 837 5010X222A1 Health Care Claim: Professional EDI files (VB.NET, C#)
  • Translates 837 5010X222A1 HIPAA EDI files (VB.NET, C#)
  • Generates 837 5010X222A1 HIPAA EDI files with data from SQL database (C#, SQL) Download executable copy
  • Translates 837 5010X222A1 HIPAA EDI files into SQL database (C#, SQL) Download executable copy
  • Generates 837 5010X223A2 Health Care Claim: Institutional EDI files (C#)
  • Translates 837 5010X223A2 HIPAA EDI files (C#)
  • Generates 837 5010X223A2 HIPAA EDI files with data from SQL database (C#, SQL) Download executable copy
  • Translates 837 5010X223A2 HIPAA EDI files into SQL database (C#, SQL) Download executable copy
  • Generates 837 5010X224A2 Health Care Claim: Dental EDI files (C#)
  • Translates 837 5010X224A2 HIPAA EDI files (C#)


Source code for the C# Gen835 5010X221A1 SQL program

 

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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: