HIPAA EDI Support

The purpose for this page is to provide support and assistance to users using EDIdEv Framework EDI with their HIPAA EDI X12 projects.  Please download, install and familiarize yourself with Framework EDI before downloading the sample programs on this web page.

• HIPAA 4010
  • Example programs
  • Validation
  • Guidelines
  • SEF file samples
• HIPAA 5010
  • Example programs
  • SEF and sample EDI files

HIPAA 4010

Example Programs
Below are example programs to demonstrate how one can easily use the Framework EDI component in a programming language to generate, translate and validate EDI files.

Visual Basic .NET sample programs using FREDI-NET Hybrid component to process outbound and inbound EDI files.

• Gen835X091Net - Generates a HIPAA EDI 835 X091 Health Care Claim Payment/Advice view code
• Tran835X091Net - Translates a HIPAA EDI 835 X091 Health Care Claim Payment/Advice view code
• X092Net - Generates and translates HIPAA EDI 270 X092 Health Care Eligibility, Coverage or Benefit
• Gen834X095NetDB - Generates a HIPAA EDI 834 X095 Benefit Enrollment and Maintenance from a database  view code
• Tran834X095NetDB - Translates a HIPAA EDI 834 X095 Benefit Enrollment and Maintenance into a database  view code
• X098NetDB - Generates and translates a HIPAA EDI 837 X098 Health Care Claim: Professional from/to a database
• 276_X093GenNet - Generates a HIPAA EDI 276X093 Health Care Claim: Status Request
• 276_X093TranNet - Translates a HIPAA EDI 276X093 Health Care Claim: Status Request

C# .NET sample programs using FREDI-NET Hybrid component to process outbound and inbound EDI files.

• CsharpGen270 - Generates HIPAA EDI 270 X092 Health Care Eligibility, Coverage or Benefit view code
• CsharpTranAck270 - Acknowledges and translates HIPAA EDI 270 X092 Health Care Eligibility, Coverage or Benefit view code
• CsharpGen837 - Generates a HIPAA EDI 837 X098 Health Care Claim: Professional view code
• CsharpTran837 - Translates a HIPAA EDI 837 X098 Health Care Claim: Professional view code
• CsharpAck - Creates a Functional Acknowledgment 997 and TA1 view code

Visual Basic 6 sample programs that generate and translate HIPAA EDI files using Framework EDI.

• X061- Transaction Set 820 X061. 
• X091- Transaction Set 835 X091. 
• 270X092 - Transaction Set 270 X092 view code
• 271X092 - Transaction Set 271 X092 view code
• 276X093 - Transaction Set 276 X093 view code
• 277X093 - Transaction Set 277 X093 view code
• X094- Transaction Set 278 X094
• X095- Transaction Set 834 X095
• X096- Transaction Set 837 X096 - Institutional.  
• X097- Transaction Set 837 X097 - Dental.  
• Gen837X098- Generates Transaction Set 837 X098 - Professional. view code
• Tran837X098- Translates Transaction Set 837 X098 - Professional. view code

Delphi 5 skeleton programs that uses Framework EDI

• DelphiX096Gen.zip - Generates an 837 X096 EDI file view code
• DelphiX096Tran.zip - Translates an 837 X096 EDI file view code
• DelphiAck.zip - Acknowledges EDI file with Functional Acknowledgment 997 and TA1 view code

FoxPro 6 skeleton programs that uses Framework EDI

• FoxX095GenDb.zip - Generates an 834 X095 EDI file with data from a FoxPro database view code
• FoxX095TranDb.zip - Translates an 834 X095 EDI file into a FoxPro database view code
• FoxX096Gen.zip - Generates an 837 X096 EDI file.
• FoxX096Tran.zip - Translates an 837 X096 EDI file.
• FoxX096Db.zip - Generates/Translates 837 X096 EDI file from/to a database.

Visual C++ skeleton programs that uses Framework EDI 

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

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

• AccessGenX096.zip - Generates an 837 X096 EDI file with multiple claims from a database view code
• AccessTranX096.zip - Translates an 837 X096 EDI file with multiple claims to a database view code
• AccessTranX091.zip - Translates an 835 X091 EDI file to a database.
• AccessGenX095.zip - Generates an 834 X095 EDI file from a database.
• AccessTranX095.zip - Translates an 834 X095 EDI file to a database.

Excel - demonstrates how to generate an EDI file from a spreadsheet

• ExcelGenTran834.zip - Generates and translates an 834X095 EDI file from an Excel spreadsheet.
• ExcelEdi835.zip - Generates and translates an 835X091 EDI file from and to an Excel spreadsheet.

Translating an EDI file into an Excel spreadsheet

Framework EDI HIPAA EDI validation

Framework EDI validates an 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/snip/ )

• 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 to demonstrate how one can easily use the Framework EDI component in a programming language to validate a HIPAA EDI file and automatically create a Functional Acknowledgment (997).

Visual Basic 6

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

ASP.NET 

• Click here for ASP .NET sample programs of the Ack and ValidateHipaa

C#

• CsharpAck - Creates a Functional Acknowledgment 997 EDI file in 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 in C++

Access

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

Note:  The correct version of SEF files must be used in both the "ValidateHipaa" and "Ack" sample program to generate a correct report and Functional Acknowledgment 997 file respectively.  Also, Framework EDI does not validate the calculations of an EDI file (e.g. total sum of ...).  To include this kind of test, you would have to do it programmatically.

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. 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_4010X098.SEF Health Care Claim: Professional
837_4010X097.SEF Health Care Claim: Dental
837_4010X096.SEF Health Care Claim: Institutional

Evaluation SEF files (encrypted and will only work with the evaluation copy of Framework EDI)

270_4010X092.SEF Eligibility, Coverage or Benefit Inquiry
271_4010X092.SEF Eligibility, Coverage or Benefit Information
276_4010X093.SEF Health Care Claim Status Request
277_4010X093.SEF Health Care Claim Status Notification
278_4010X094Request.SEF Health Care Service Review -  Request for Review
278_4010X094Response.SEF Health Care Service Review - Response to Request for Review
820_4010X061.SEF Payment Order/Remittance Advice
834_4010X095.SEF Benefit Enrollment and Maintenance
835_4010X091.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.  (Please note that the sample EDI files are structurally correct, but their data are nonsensical.)

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 EDI files with repeating elements using Framework EDI component.

C#

• CsharpGen271X279 - Generate Transaction Set 271 5010 X279
• CsharpTran271X279 - Translate Transaction Set 271 5010 X279
• CsharpAck5010 - Functional Acknowledgment Transaction Set 997 5010
• CsharpAck999 - Implementation Acknowledgment Transaction Set 999 5010 X231A1
• CsharpValidate - A simple C# validation program

Visual Basic 6

• Vb6Gen271X279 - Generate Transaction Set 271 5010 X279 in VB6
• Vb6Tran271X279 - Translate Transaction Set 271 5010 X279 in VB6
• Vb6Ack5010 - Functional Acknowledgment Transaction Set 997 5010 in VB6

Delphi

• DelphiGen271X279 - Generate Transaction Set 271 5010 X279 in Delphi
• DelphiTran271X279 - Translate Transaction Set 271 5010 X279 in Delphi
• DelphiAck5010 - Functional Acknowledgment Transaction Set 997 5010 in Delphi

Visual Basic .NET

• VbNetAck999 - Implementation Acknowledgment Transaction Set 999 5010 X231A1 in VB.NET
• VbNet_Validate - A simple VB.NET validation program

*** 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 the example programs have evaluation SEF files.

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

Other Topics

• Processing huge EDI files: Performance Test
• EDI to Database
• Overcoming EDI problems
• EDI Validation

If you have further questions or requests, please email support@edidev.com.

EDIdEv provides programming examples for illustration only, without warranty either expressed or implied, including, but not limited to, the implied warranties of merchantability and/or fitness for a particular purpose. This article assumes that you are familiar with the programming language being demonstrated and the tools used to create and debug procedures. EDIdEv  support engineers can help explain the functionality of a particular procedure, but they will not modify these examples to provide added functionality or construct procedures to meet your specific needs.

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