private void btnGenerate_Click(object sender, EventArgs e)
{
// Generates 275 Patient Information - Additional Information to Support a Health Care Claim or Encounter
ediDocument oEdiDoc;
ediSchema oSchema;
ediSchemas oSchemas;
ediInterchange oInterchange;
ediGroup oGroup;
ediTransactionSet oTransactionSet;
ediDataSegment oSegment;
string sEdiFileName = "";
string sSefFileName = "";
string sPath = AppDomain.CurrentDomain.BaseDirectory;
// Create the top-level application object "ediDocument".
oEdiDoc = new ediDocument();
// This makes certain that Framework EDI only uses the SEF file provided,
// and that it does not use its built-in Standard Reference table to generate
// the EDI document
oSchemas = (ediSchemas)oEdiDoc.GetSchemas();
oSchemas.EnableStandardReference = false;
// The FORWARD-WRITE cursor increases the performance of processing the EDI
// document (see Technical Note 3 below).
oEdiDoc.CursorType = DocumentCursorTypeConstants.Cursor_ForwardWrite;
// Terminators have to be specified.
oEdiDoc.SegmentTerminator = "~{13:10}";
oEdiDoc.ElementTerminator = "*";
oEdiDoc.CompositeTerminator = "!";
sEdiFileName = "275_5010X210.X12";
sSefFileName = "275_005010X210.SemRef.SEF"; //evaluation SEF file
// Specify SEF file to load.
oSchema = (ediSchema)oEdiDoc.LoadSchema(sSefFileName, SchemaTypeIDConstants.Schema_Standard_Exchange_Format);
// Creates the Interchange Control Header segment (ISA).
oInterchange = (ediInterchange)oEdiDoc.CreateInterchange("X", "005010");
oSegment = (ediDataSegment)oInterchange.GetDataSegmentHeader();
oSegment.set_DataElementValue(1, 0, "00"); // Authorization Information Qualifier (I01)
oSegment.set_DataElementValue(2, 0, " "); // Authorization Information (I02)
oSegment.set_DataElementValue(3, 0, "00"); // Security Information Qualifier (I03)
oSegment.set_DataElementValue(4, 0, " "); // Security Information (I04)
oSegment.set_DataElementValue(5, 0, "ZZ"); // Interchange ID Qualifier (I05)
oSegment.set_DataElementValue(6, 0, "SENDER ID "); // Interchange Sender ID (I06)
oSegment.set_DataElementValue(7, 0, "ZZ"); // Interchange ID Qualifier (I05)
oSegment.set_DataElementValue(8, 0, "RECEIVER ID "); // Interchange Receiver ID (I07)
oSegment.set_DataElementValue(9, 0, "010101"); // Interchange Date (I08)
oSegment.set_DataElementValue(10, 0, "0101"); // Interchange Time (I09)
oSegment.set_DataElementValue(11, 0, ":"); // Repetition Separator (I65)
oSegment.set_DataElementValue(12, 0, "00501"); // Interchange Control Version Number (I11)
oSegment.set_DataElementValue(13, 0, "000000001"); // Interchange Control Number (I12)
oSegment.set_DataElementValue(14, 0, "0"); // Acknowledgment Requested (I13)
oSegment.set_DataElementValue(15, 0, "T"); // Usage Indicator (I14)
oSegment.set_DataElementValue(16, 0, "!"); // Component Element Separator (I15)
// Creates the Functional Group Header segment (GS).
oGroup = (ediGroup)oInterchange.CreateGroup("005010X210");
ediDataSegment.Set(ref oSegment, (ediDataSegment)oGroup.GetDataSegmentHeader());
oSegment.set_DataElementValue(1, 0, "PI"); // Functional Identifier Code (479)
oSegment.set_DataElementValue(2, 0, "APP SENDER"); // Application Sender's Code (142)
oSegment.set_DataElementValue(3, 0, "APP RECEIVER"); // Application Receiver's Code (124)
oSegment.set_DataElementValue(4, 0, "01010101"); // Date (373)
oSegment.set_DataElementValue(5, 0, "01010101"); // Time (337)
oSegment.set_DataElementValue(6, 0, "1"); // Group Control Number (28)
oSegment.set_DataElementValue(7, 0, "X"); // Responsible Agency Code (455)
oSegment.set_DataElementValue(8, 0, "005010X210"); // Version / Release / Industry Identifier Code (480)
// TRANSACTION SET ID 275 - Patient Information
// Creates the Transaction Set header segment (ST).
oTransactionSet = (ediTransactionSet)oGroup.CreateTransactionSet("275");
ediDataSegment.Set(ref oSegment, (ediDataSegment)oTransactionSet.GetDataSegmentHeader());
oSegment.set_DataElementValue(1, 0, "275"); // Transaction Set Identifier Code (143)
oSegment.set_DataElementValue(2, 0, "0001"); // Transaction Set Control Number (329)
oSegment.set_DataElementValue(3, 0, "005010X210"); // Implementation Convention Reference (1705)
// Beginning Segment (BGN)
oSegment = oTransactionSet.CreateDataSegment("BGN");
oSegment.set_DataElementValue(1, 0, "11"); // Transaction Set Purpose Code (353)
oSegment.set_DataElementValue(2, 0, "0001"); // Reference Identification (127)
oSegment.set_DataElementValue(3, 0, "20060915"); // Date (373)
// LOOP ID - 1000A PAYER NAME
oSegment = oTransactionSet.CreateDataSegment(@"NM1\NM1");
oSegment.set_DataElementValue(1, 0, "PR"); // Entity Identifier Code (98)
oSegment.set_DataElementValue(2, 0, "2"); // Entity Type Qualifier (1065)
oSegment.set_DataElementValue(3, 0, "ABC INSURANCE COMPANY"); // Name Last or Organization Name (1035)
oSegment.set_DataElementValue(8, 0, "XV"); // Identification Code Qualifier (66)
oSegment.set_DataElementValue(9, 0, "12345"); // Identification Code (67)
// LOOP ID - 1000B SUBMITTER INFORMATION
oSegment = oTransactionSet.CreateDataSegment(@"NM1\NM1");
oSegment.set_DataElementValue(1, 0, "41"); // Entity Identifier Code (98)
oSegment.set_DataElementValue(2, 0, "2"); // Entity Type Qualifier (1065)
oSegment.set_DataElementValue(3, 0, "XYZ SERVICES"); // Name Last or Organization Name (1035)
oSegment.set_DataElementValue(8, 0, "46"); // Identification Code Qualifier (66)
oSegment.set_DataElementValue(9, 0, "A222222221"); // Identification Code (67)
// LOOP ID - 1000C PROVIDER NAME INFORMATION
oSegment = oTransactionSet.CreateDataSegment(@"NM1\NM1");
oSegment.set_DataElementValue(1, 0, "1P"); // Entity Identifier Code (98)
oSegment.set_DataElementValue(2, 0, "2"); // Entity Type Qualifier (1065)
oSegment.set_DataElementValue(3, 0, "ST HOLY HILLS HOSPITAL"); // Name Last or Organization Name (1035)
oSegment.set_DataElementValue(8, 0, "XX"); // Identification Code Qualifier (66)
oSegment.set_DataElementValue(9, 0, "3999000B01"); // Identification Code (67)
// LOOP ID - 1100C PROVIDER IDENTIFICATION
oSegment = oTransactionSet.CreateDataSegment(@"NM1\NX1\NX1");
oSegment.set_DataElementValue(1, 0, "1P"); // Entity Identifier Code (98)
// Provider Address
ediDataSegment.Set(ref oSegment, oTransactionSet.CreateDataSegment(@"NM1\NX1\N3"));
oSegment.set_DataElementValue(1, 0, "2345 Winter Blvd"); // Address Information (166)
// Provider City, State, ZIP Code
ediDataSegment.Set(ref oSegment, oTransactionSet.CreateDataSegment(@"NM1\NX1\N4"));
oSegment.set_DataElementValue(1, 0, "Miami"); // City Name (19)
oSegment.set_DataElementValue(2, 0, "FL"); // State or Province Code (156)
oSegment.set_DataElementValue(3, 0, "33132"); // Postal Code (116)
// LOOP ID - 1000D PATIENT NAME
oSegment = oTransactionSet.CreateDataSegment(@"NM1\NM1");
oSegment.set_DataElementValue(1, 0, "QC"); // Entity Identifier Code (98)
oSegment.set_DataElementValue(2, 0, "1"); // Entity Type Qualifier (1065)
oSegment.set_DataElementValue(3, 0, "JACKSON"); // Name Last or Organization Name (1035)
oSegment.set_DataElementValue(4, 0, "JACK"); // Name First (1036)
oSegment.set_DataElementValue(5, 0, "J"); // Name Middle (1037)
oSegment.set_DataElementValue(8, 0, "MI"); // Identification Code Qualifier (66)
oSegment.set_DataElementValue(9, 0, "987654320~"); // Identification Code (67)
// REF - PATIENT CONTROL NUMBER
ediDataSegment.Set(ref oSegment, oTransactionSet.CreateDataSegment(@"NM1\REF"));
oSegment.set_DataElementValue(1, 0, "EJ"); // Reference Identification Qualifier (128)
oSegment.set_DataElementValue(2, 0, "JACKSON123"); // Reference Identification (127)
// REF - MEDICAL RECORD IDENTIFICATION NUMBER
ediDataSegment.Set(ref oSegment, oTransactionSet.CreateDataSegment(@"NM1\REF"));
oSegment.set_DataElementValue(1, 0, "EA"); // Reference Identification Qualifier (128)
oSegment.set_DataElementValue(2, 0, "STHHL12345"); // Reference Identification (127)
// DTP - CLAIM SERVICE DATE
ediDataSegment.Set(ref oSegment, oTransactionSet.CreateDataSegment(@"NM1\DTP"));
oSegment.set_DataElementValue(1, 0, "472"); // Date/Time Qualifier (374)
oSegment.set_DataElementValue(2, 0, "D8"); // Date Time Period Format Qualifier (1250)
oSegment.set_DataElementValue(3, 0, "20060812"); // Date Time Period (1251)
// LX - ASSIGNED NUMBER
oSegment = oTransactionSet.CreateDataSegment(@"LX\LX");
oSegment.set_DataElementValue(1, 0, "1"); // Assigned Number (554)
// TRN - PAYER CLAIM CONTROLNUMBER/PROVIDER ATTACHMENT CONTROL NUMBER
ediDataSegment.Set(ref oSegment, oTransactionSet.CreateDataSegment(@"LX\TRN"));
oSegment.set_DataElementValue(1, 0, "2"); // Trace Type Code (481)
oSegment.set_DataElementValue(2, 0, "1822634840"); // Reference Identification (127)
// STC - STATUS INFORMATION
ediDataSegment.Set(ref oSegment, oTransactionSet.CreateDataSegment(@"LX\STC"));
oSegment.set_DataElementValue(1, 1, "R4"); // Industry Code (1271)
oSegment.set_DataElementValue(1, 2, "18626-2"); // Industry Code (1271)
oSegment.set_DataElementValue(1, 4, "LOI"); // Code List Qualifier Code (1270)
// DTP - ADDITIONAL INFORMATION SUBMISSION DATE
oSegment = oTransactionSet.CreateDataSegment(@"LX\DTP\DTP");
oSegment.set_DataElementValue(1, 0, "368"); // Date/Time Qualifier (374)
oSegment.set_DataElementValue(2, 0, "D8"); // Date Time Period Format Qualifier (1250)
oSegment.set_DataElementValue(3, 0, "20060915"); // Date Time Period (1251)
// CAT - CATEGORY OF PATIENT INFORMATION SERVICE
ediDataSegment.Set(ref oSegment, oTransactionSet.CreateDataSegment(@"LX\DTP\CAT"));
oSegment.set_DataElementValue(1, 0, "AE"); // Report Type Code (755)
oSegment.set_DataElementValue(2, 0, "TX"); // Report Transmission Code (756)
// EFI - ELECTRONIC FORMAT IDENTIFICATION
oSegment = oTransactionSet.CreateDataSegment(@"LX\DTP\EFI\EFI");
oSegment.set_DataElementValue(1, 0, "05"); // Security Level Code (786)
// BIN - BINARY DATA SEGMENT
ediDataSegment.Set(ref oSegment, oTransactionSet.CreateDataSegment(@"LX\DTP\EFI\BIN"));
//oSegment.set_DataElementValue(1, 0, ""); // ' Length of Binary Data (784) automatically calculated and entered by FREDI
oSegment.get_DataElement(2).ImportValue(sPath + @"\import\edidevpic.gif"); //sample binary file
// LX - ASSIGNED NUMBER
oSegment = oTransactionSet.CreateDataSegment(@"LX\LX");
oSegment.set_DataElementValue(1, 0, "2"); // Assigned Number (554)
// TRN - PAYER CLAIM CONTROLNUMBER/PROVIDER ATTACHMENT CONTROL NUMBER
ediDataSegment.Set(ref oSegment, oTransactionSet.CreateDataSegment(@"LX\TRN"));
oSegment.set_DataElementValue(1, 0, "2"); // Trace Type Code (481)
oSegment.set_DataElementValue(2, 0, "1822634840"); // Reference Identification (127)
// STC - STATUS INFORMATION
ediDataSegment.Set(ref oSegment, oTransactionSet.CreateDataSegment(@"LX\STC"));
oSegment.set_DataElementValue(1, 1, "R4"); // Industry Code (1271)
oSegment.set_DataElementValue(1, 2, "18647-8"); // Industry Code (1271)
oSegment.set_DataElementValue(1, 4, "LOI"); // Code List Qualifier Code (1270)
// DTP - ADDITIONAL INFORMATION SUBMISSION DATE
oSegment = oTransactionSet.CreateDataSegment(@"LX\DTP\DTP");
oSegment.set_DataElementValue(1, 0, "368"); // Date/Time Qualifier (374)
oSegment.set_DataElementValue(2, 0, "D8"); // Date Time Period Format Qualifier (1250)
oSegment.set_DataElementValue(3, 0, "20060915"); // Date Time Period (1251)
// CAT - CATEGORY OF PATIENT INFORMATION SERVICE
ediDataSegment.Set(ref oSegment, oTransactionSet.CreateDataSegment(@"LX\DTP\CAT"));
oSegment.set_DataElementValue(1, 0, "AE"); // Report Type Code (755)
oSegment.set_DataElementValue(2, 0, "TX"); // Report Transmission Code (756)
// EFI - ELECTRONIC FORMAT IDENTIFICATION
oSegment = oTransactionSet.CreateDataSegment(@"LX\DTP\EFI\EFI");
oSegment.set_DataElementValue(1, 0, "05"); // Security Level Code (786)
// BIN - BINARY DATA SEGMENT
ediDataSegment.Set(ref oSegment, oTransactionSet.CreateDataSegment(@"LX\DTP\EFI\BIN"));
//oSegment.set_DataElementValue(1, 0, ""); // ' Length of Binary Data (784) automatically calculated and entered by FREDI
oSegment.get_DataElement(2).ImportValue(sPath + @"\import\sampleText.txt"); //sample binary file
// Trailing segments are automatically created when Framework EDI commits
// (saves) the instance of "oEdiDoc" object into an EDI file.
oEdiDoc.Save(sEdiFileName, 0);
//Display EDI file
frmViewEdi oViewEdi = new frmViewEdi();
oViewEdi.sEdiFile = oEdiDoc.GetEdiString();
oViewEdi.Show();
//destroy objects
oSegment.Dispose();
oTransactionSet.Dispose();
oGroup.Dispose();
oInterchange.Dispose();
oSchema.Dispose();
oSchemas.Dispose();
oEdiDoc.Dispose();
}
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