834 example – raw data and human readable presentation
Guide to the ASC X12 Standards for Electronic Data Interchange Technical Report Type 3 (TR3 and Errata) adopted under HIPAA will clarify and specify Health Partners Plans, Inc. Communication protocols, business rules and information applicable to the 835 Electronic Remittance Advice Transaction. Jun 21, 2011 - Company on the Internet at Full Load Files – We will ignore a PCP that is being sent in the 834 if it differs from what.
834 example described in the post is a full file audit sent from a corporation to an insurance company. Although the TR3 Implementation Guides do not recommend sending the Full File Audit to perform changes, most insurance companies will accept them as changes if there is mismatch.
For example, an employee that is sent on the 834 example full file that is not currently active on the insurance side will generate an add transaction. See the 834 example below:
ST*834*0001*005010X220A1
BGN*00*1*20120106*010510****4
REF*38*170175
DTP*303*D8*20120107
QTY*TO*2
N1*P5*DISNEY INC*FI*953630868
N1*IN*BCBS DISNEY*FI*953761231
INS*Y*18*030*20*A
REF*0F*055090001
NM1*IL*1*MOUSE*MICKEY****34*055090001
PER*IP**HP*7146790999
N3*1565 DISNEYLAND DRIVE*SUITE 101
N4*ANAHEIM*CA*92802
DMG*D8*19281118*M
HD*030
DTP*348*D8*20120107
REF*1L*170805M001
INS*N*01*030*20*A
REF*0F*056090001
NM1*IL*1*MOUSE*MINNIE****34*056090001
PER*IP**HP*7146790999
N3*1565 DISNEYLAND DRIVE*SUITE 101
N4*ANAHEIM*CA*92802
![Edi Edi](/uploads/1/2/5/8/125857163/130350730.png)
DMG*D8*19301226*F
HD*030
DTP*348*D8*20120101
DTP*349*D8*20120813
REF*1L*170805M001
SE*29*0001
834 example in a human readable form
BGN*00*1*20120106*010510****4
Beginning Segment:
Transaction Set Purpose Code : Original
Reference Identification : 1
Date : 1/6/2012
Time : 1:05:10 AM
Action Code : Verify
Beginning Segment:
Transaction Set Purpose Code : Original
Reference Identification : 1
Date : 1/6/2012
Time : 1:05:10 AM
Action Code : Verify
Reference Identification: REF*38*170175
Master Policy Number : 170175
Master Policy Number : 170175
Date or Time or Period: DTP*303*D8*20120107
Date/Time Qualifier : Maintenance Effective
Date Time Period Format Qualifier : Date Expressed in Format CCYYMMDD
Date Time Period : 20120107
Date/Time Qualifier : Maintenance Effective
Date Time Period Format Qualifier : Date Expressed in Format CCYYMMDD
Date Time Period : 20120107
Quantity Information: QTY*TO*2
Quantity Qualifier : Total
Quantity : 2
Quantity Qualifier : Total
Quantity : 2
Plan Sponsor: N1*P5*DISNEY INC*FI*953630868
DISNEY INC (Federal Taxpayer’s Identification Number: 953630868)
DISNEY INC (Federal Taxpayer’s Identification Number: 953630868)
Insurer: N1*IN*BCBS DISNEY*FI*953761231
BCBS DISNEY (Federal Taxpayer’s Identification Number: 953761231)
BCBS DISNEY (Federal Taxpayer’s Identification Number: 953761231)
Insured Benefit: INS*N*01*030*20*A
Yes/No Condition or Response Code : N (N indicates the insured is a dependent.)
Individual Relationship Code :Spouse
Maintenance Type Code : Audit or Compare
Maintenance Reason Code : Active
Benefit Status Code : Active
Yes/No Condition or Response Code : N (N indicates the insured is a dependent.)
Individual Relationship Code :Spouse
Maintenance Type Code : Audit or Compare
Maintenance Reason Code : Active
Benefit Status Code : Active
Reference Identification: REF*0F*055090001
Subscriber Number : 055090001
Subscriber Number : 055090001
Individual or Organizational Name: NM1*IL*1*MOUSE*MICKEY****34*055090001
Entity Identifier Code : Insured or Subscriber
Entity Type Qualifier : Person
Name Last or Organization Name : MOUSE
Name First : MICKEY
Identification Code Qualifier : Social Security Number
Identification Code : 055090001
Entity Identifier Code : Insured or Subscriber
Entity Type Qualifier : Person
Name Last or Organization Name : MOUSE
Name First : MICKEY
Identification Code Qualifier : Social Security Number
Identification Code : 055090001
Contact Information: PER*IP**HP*7146790999
Insured Party :
Home Phone Number : 7146790999
Address Information: N3*1565 DISNEYLAND DRIVE*SUITE 101
Street : 1565 DISNEYLAND DRIVE – SUITE 101
Insured Party :
Home Phone Number : 7146790999
Address Information: N3*1565 DISNEYLAND DRIVE*SUITE 101
Street : 1565 DISNEYLAND DRIVE – SUITE 101
Address Information: N4*ANAHEIM*CA*92802
CITY: Anaheim, STATE: CA ZIP: 92802
CITY: Anaheim, STATE: CA ZIP: 92802
Demographic Information: DMG*D8*19281118*M
Date Time Period Format Qualifier : Date Expressed in Format CCYYMMDD
Date Time Period : 19281118
Gender Code : Male
Date Time Period Format Qualifier : Date Expressed in Format CCYYMMDD
Date Time Period : 19281118
Gender Code : Male
Health Coverage: HD*030
Maintenance Type Code : Audit or Compare
Maintenance Type Code : Audit or Compare
Date or Time or Period: DTP*348*D8*20120107
Date/Time Qualifier : Benefit Begin
Date Time Period Format Qualifier : Date Expressed in Format CCYYMMDD
Date Time Period : 20120107
Date/Time Qualifier : Benefit Begin
Date Time Period Format Qualifier : Date Expressed in Format CCYYMMDD
Date Time Period : 20120107
Reference Identification: REF*1L*170805M001
Group or Policy Number : 170805M001
Group or Policy Number : 170805M001
Insured Benefit: INS*Y*18*030*20*A
Yes/No Condition or Response Code : Yes (‘Y’ indicates the insured is a subscriber: an ‘NO’ value would indicate the insured is a dependent)
Individual Relationship Code : Self
Maintenance Type Code : Audit or Compare
Maintenance Reason Code : Active
Benefit Status Code : Active
Yes/No Condition or Response Code : Yes (‘Y’ indicates the insured is a subscriber: an ‘NO’ value would indicate the insured is a dependent)
Individual Relationship Code : Self
Maintenance Type Code : Audit or Compare
Maintenance Reason Code : Active
Benefit Status Code : Active
Reference Information:
Subscriber Number : 056090001 (Social Security #)
Subscriber Number : 056090001 (Social Security #)
Individual or Organizational Name: NM1*IL*1*MOUSE*MINNIE****34*056090001
Entity Identifier Code : Insured or Subscriber
Entity Type Qualifier : Person
Name Last or Organization Name : MOUSE
Name First : MINNIE
Identification Code Qualifier : Social Security Number
Identification Code : 056090001
Entity Identifier Code : Insured or Subscriber
Entity Type Qualifier : Person
Name Last or Organization Name : MOUSE
Name First : MINNIE
Identification Code Qualifier : Social Security Number
Identification Code : 056090001
Contact Information: PER*IP**HP*7146790999
Insured Party :
Home Phone Number : 7146790999
N3*1565 DISNEYLAND DRIVE*SUITE 101
N4*ANAHEIM*CA*92802
1565 DISNEYLAND DRIVE SUITE 101
ANAHEIM, CA 92802
Insured Party :
Home Phone Number : 7146790999
N3*1565 DISNEYLAND DRIVE*SUITE 101
N4*ANAHEIM*CA*92802
1565 DISNEYLAND DRIVE SUITE 101
ANAHEIM, CA 92802
Demographic Information: DMG*D8*19301226*F
Date Time Period Format Qualifier : Date Expressed in Format CCYYMMDD
Date Time Period : 19301226
Gender Code : Female
Health Coverage: HD*030
Maintenance Type Code : Audit or Compare
Date Time Period Format Qualifier : Date Expressed in Format CCYYMMDD
Date Time Period : 19301226
Gender Code : Female
Health Coverage: HD*030
Maintenance Type Code : Audit or Compare
Date or Time or Period: DTP*348*D8*20120101
Date/Time Qualifier : Benefit Begin
Date Time Period Format Qualifier : Date Expressed in Format CCYYMMDD
Date Time Period : 20120101
Date/Time Qualifier : Benefit Begin
Date Time Period Format Qualifier : Date Expressed in Format CCYYMMDD
Date Time Period : 20120101
Date or Time or Period: DTP*349*D8*20120813
Date/Time Qualifier : Benefit End
Date Time Period Format Qualifier : Date Expressed in Format CCYYMMDD
Date Time Period : 20120813
Date/Time Qualifier : Benefit End
Date Time Period Format Qualifier : Date Expressed in Format CCYYMMDD
Date Time Period : 20120813
Reference Information: REF*1L*170805M001
Group or Policy Number : 170805M001
Group or Policy Number : 170805M001
EDI Academy HIPAA EDI course is the ultimate source for all the details about EDI transactions including 834 Benefit Enrollment and Maintenance. The examples used at the seminars make it easier to understand the purpose of the HIPAA transactions.
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 don’t 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.
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 Excel’s 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.
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 translateview 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
- DelphiGen271X279 - Generate Transaction Set 271 5010 X279 HIPAA in Delphi
- DelphiTran271X279 - Translate Transaction Set 271 5010 X279 HIPAA in Delphi
- DelphiAck5010 - Functional Acknowledgment Transaction Set 997 5010 in 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 codeview 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.
Below are executable programs that will process HIPAA EDI files from/to a SQL database. Their source codes can be purchased from our eShop.
- Tran834X220A1_SqlClient - Translates HIPAA EDI 834 5010X220A1 files into a SQL database.
- Gen834X220A1_SqlClient - Generates an 834 5010X220A1 EDI file with data from a SQL database.
- Tran835X221A1_SqlClient - Translates HIPAA 835 5010X221A1 EDI files into a SQL database.
- Gen835X221A1_SqlClient - Generates an 835 5010X221A1 EDI file with data from a SQL database.
- Tran837X222A1_SqlClient - Translates 837 5010X222A1 HIPAA EDI files into a SQL database.
- Gen837X222A1_SqlClient - Generates a HIPAA 837 5010X222A1 EDI file with data from a SQL database.
- Tran837X223A2_SqlClient - Translates 837 5010X223A2 HIPAA EDI files into a SQL database.
- Gen837X223A2_SqlClient - Generates a HIPAA 837 5010X223A2 EDI file with data from a SQL database.
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.
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
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: