HIPAA X12

www.altova.com Print this Topic Previous Page Up One Level Next page

Home >  Data Sources and Targets > EDI >

HIPAA X12

HIPAA X12 is the latest version of the standard for electronic health care records established by the US Department of Health and Human Services for electronic medical data transactions between insurers, providers, and employers, based on EDI X12 version 5010.

 

MapForce supports the latest release, A2, of the HIPAA implementation specs (TR3). Older releases are downloadable as separate ZIP file from Altova website.

 

HIPAA components are similar to ordinary ANSI X12 components, and MapForce supports the following transactions:

 

X12 name

Message name

X279A1

"Health Care Eligibility Benefit Inquiry (270)"

X279A1

"Health Care Eligibility Benefit Response (271)"

X212

"Health Care Claim Status Request (276)"

X212

"Health Care Information Status Notification (277)"

X214

"Health Care Claim Acknowledgment (277)"

X217

"Health Care Services Review - Request for Review (278)"

X217

"Health Care Services Review - Response (278)"

X218

"Payroll Deducted and Other Group Premium Payment for Insurance Products (820)"

X220A1

"Benefit Enrollment and Maintenance (834)"

X221A1

"Health Care Claim Payment/Advice (835)"

X222A1

"Health Care Claim: Professional (837)"

X224A2

"Health Care Claim: Dental (837)"

X223A2

"Health Care Claim: Institutional (837)"

X231A1

"Implementation Acknowledgment For Health Care Insurance (999)"

 

Differences to standard X12 message handling is that MapForce:

 

automatically maintains the hierarchy of HL segments
supports so called floating structures (in 837 messages)
auto-completes and validates more fields.

 

MapForce also supports the automatic generation of HIPAA X12 999 Implementation Acknowledgment, which is similar to 999 Implementation Acknowledgement of the X12 standard (see Generating an X12 999 Implementation Acknowledgment).

 

Multiple messages per interchange (i.e. EDI component) is also supported for HIPAA components.


© 2019 Altova GmbH