Contents of X12_5010_HIPAA Examples project

This section describes the contents of the X12_5010_HIPAA Examples project, which shows EDI/XML transformations for each of the X12 5010 HIPAA specifications. For each transaction, a simple XML document demonstrates the commonly used portions of the EDI.

The examples provided here are intended to show various common mapping situations and also provide the best practices for naming and organizing maps associated with Health Care EDI. They are organized into transaction set pairs where the request transaction set is paired with its corresponding response, like the 270 Health Care Benefit Eligibility Inquiry and 271 Health Care Benefit Eligibility Response. For each transaction, there is a map with the EDI as input and output. In addition, map inheritance and reverse mapping are used to reuse the mapping instructions where possible.

The following table shows how the different HIPAA transactions correspond to the structures in the project.

Transaction	Specification Version	Structure	Description
270	5010X279A1	270-B1	Health Care Eligibility Benefit Inquiry
271	5010X279A1	271-B1	Health Care Eligibility Benefit Response
276	5010X212	276-A1	Health Care Claim Status Request
277	5010X212	277-B3	Health Care Claim Status Response
278	5010X217	278-A1	Health Care Services Review Information Request
278	5010X217	278-A3	Health Care Services Review Information Response
835	5010X221A1	835-W1	Health Care Claim: Payment/Advice
837	5010X222A1	837-Q1	Health Care Claim: Professional
837	5010X223A1	837-Q2	Health Care Claim: Institutional
837	5010X224A1	837-Q3	Health Care Claim: Dental

In addition, there are examples of the 997 and 999 acknowledgment transactions which are generated from the ExecutionStatus object that is returned from the execution of a map. The examples show how to translate the errors and descriptive information from the XML manifestation of the ExecutionStatus object into the 997 or 999. You can get the XML from the ExecutionStatus object by using the ExecutionStatus.exportToXml() method.

Here are the maps associated with each transaction pair:

EDI-XML-Base (e.g. 270-Eligibility-Base) - This is a base map at the transaction set level that provides the mapping that is common to both the request and response, since in the case of Health Care EDI the order and content of the transaction sets are very similar between the request (e.g. 270) and response (e.g. 271). This map is inherited by both the EDI to XML request and response transactions.
EDI-XMLRequest (e.g. 270-EligibilityRequest) - Contains the EDI to XML mapping of an inbound request. This inherits from the Base map (described above). All of the actual mapping instructions come from that map.
XMLRequest-EDI (e.g. EligibilityRequest-270) - This is done by creating a reverse map from the EDI to XML Request map, and then adding or fixing the necessary mappings to produce the correct EDI.
EDI-XMLResponse (e.g. 271-EligibilityResponse) - Contains the EDI to XML mapping of an inbound response. As with the corresponding request, this inherits from the Base map. Additional mapping is required to handle the elements provided in the response.
XMLResponse-EDI (e.g. EligibilityResponse-271) - This is done by creating a reverse map from the EDI to XML Response map, and then adding or fixing the necessary mappings to produce the correct EDI.

The following table shows the different mapping cases demonstrated.

#	Condition	Description	Example	Method
1	Simple	X12 to XML with one occurrence at one loop level	One HL loop for source	-
2	Looping	X12 to XML with multiple occurrences of looping	loop of one `Info Source Name` (`NM1` segment with `ABC Insurance`), one `Receiver` (`NM1` with `Marcus A Jones`), one `Subscriber` (`NMI` with `John L Smith`) and two `Dependents` (`NM1`'s with `Jim Smith` and `Kathy Smith`)	-
2	Looping	X12 to XML with multiple occurrences of looping	loop of multiple contact information (`PER`) in `Info Source`	-
3	Output Format	X12 to XML date format expressed as CCYYMMDDY	Transaction set creation date (`BHT04`)	structure's field data default
		X12 to XML date format expressed as YYMMDD	Subscriber date (DTP)	structure's field data format YYMMDD
		X12 to XML code mapping value from code to description	Info Source Name entity Id code (NM101) output changed from code PR to PayingPerson	loop using filter and constant
		X12 to XML code mapping value from code to description	`Info Source Communication Contact Telephone Number Qualifier TE` (`PER03`) mapped to `TelephoneNo`	loop using filter and constant
4	Code Value	X12 to XML with output field conditional on code value	`Subscriber Plan Begin Date` qualifier (`DTP01` with code `102`) selected from multiple dates and output to `PlanIssueDate`	-
5	Function	X12 to XML concatenate fields	`Name` (`NM1` in receiver loop) to concatenate `Subscriber`'s first name, middle initial and last name	map output field using concat function
5	Function	X12 to XML concatenate fields	`Address` (`N3` and `N4`) to concatenate `subscriber`'s address, city,state and zip	-

Contents of X12_5010_HIPAA Examples project - 7.3

Talend Data Mapper - X12 HIPAA Specifications