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How Do I Do X12 - HIPAA - EDI ?

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a1b2c3d4e5

I am seeking assistance in a method to produce an X12-type EDI file for HIPAA billing (and other transactions). The crux of the problem is that the flat ASCII file to be transmitted to our payor has records of different formats and loops of different number of records, e.g.:

 

Transmission Set Header Record

Submitter Information Record

Receiver Information Record

Provider Information Record

Subscriber Information Record

Claim Information Record

Service Provided Information Record

Service Provided Information Record

.....

Subscriber Information Record

Claim Information Record

Service Provided Information Record

Service Provided Information Record

.....

Subscriber Information Record

Claim Information Record

Service Provided Information Record

Service Provided Information Record

.....

Transaction Set Trailer Record

 

Since everyone in the country is having to change over to this type of electronic transaction, I'm hoping some one has determined how to build this type of file in FMP. Any help would be appreciated - and THANKS IN ADVANCE!

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CobaltSky

The mechanism for achieving this is threefold.

 

In the first instance, you will need to set up text calculations which convert groups of fields into fixed length text. So for example, where you have a field that has a variable number of characters in it, (eg a name field), you will need to ensure that the value in the field is topped up with spaces so that it fills the correct number of characters in the fixed length edi output.

 

This can be done with a formula along the lines of:

 

Left(FirstNameField & "....................", 20) &

Left(LastNameField & "....................", 20) &

Left(DateToText(DateOfBirth) & "............", 12)

 

where the row of dots I've used represents a string of spaces in your formula.

 

By this means, you will be able to assemble calculations which produce lines and blocks of text as required for the various component parts of the specified output file. What remains is then to string them all together in the sequence required.

 

This latter feat is most readily done by running a script which locates each of the required records, then writes (appends) the value of the relevant calc (ie the one of the fixed length text calcs as described above) to a global field.

 

The script will run along the lines of:

 

Set Field ["gHIPAA_txt", "cTransHeaderFixed_txt"]

Set Field ["gHIPAA_txt, "gHIPAA_txt & "¶" & cSubmitterInfoFixed_txt"]

Set Field ["gHIPAA_txt, "gHIPAA_txt & "¶" & cReceiverInfoFixed_txt"]

Set Field ["gHIPAA_txt, "gHIPAA_txt & "¶" & cProviderInfoFixed_txt"]

Go to Record/Request/Page [First]

Loop

Set Field ["gHIPAA_txt, "gHIPAA_txt & "¶" & cSubscriberInfoFixed_txt"]

Set Field ["gHIPAA_txt, "gHIPAA_txt & "¶" & cClaimInfoFixed_txt"]

Set Field ["gHIPAA_txt, "gHIPAA_txt & "¶" & cServiceProvided1Fixed_txt"]

Set Field ["gHIPAA_txt, "gHIPAA_txt & "¶" & cServiceProvided2Fixed_txt"]

Go to Record/Request/Page [Exit after last, Next]

End Loop

 

This will gather all the required components together into a single global text field, from which they can be exported.

 

You will then have to deal with the issue of formatting the field to take account of carriage return requirements, since most export options reserve carriage returns for delimiting records, and you will have them within a single field.

 

Although it is possible to resolve this problem using a text editor (and this procedure can be automated by macro - eg using VB or AppleScript), I recommend that you consider using one of the excellent plug-ins for text handling and export, which will allow you to script a solution for this from within FileMaker itself.

 

Leading examles of plug-ins which offer powerful and economical solutions for this and other related text handling and exporting issues are:

 

Troi File:

http://www.troi.com/software/fileplugin.html

 

Comm-Unity Networking Systems:

http://saveit.cnsplug-ins.com/

 

There are others, but the above are a good place to start.

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alainderzie

Where can I get the ASCII format for hipaa electronic claims transmission? I wrote a great medical billing db that I've been perfecting over the last few months and would love to add electronic trasnsactions. Unfortunately, I have no experience doing this and don't really know where to start. Can you point me in the right direction? Thanks

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CobaltSky

Different clearing houses have different format requirements, but there are a number of defacto standards that are common to most.

 

You'll find that a number of the online clearing houses have documentation about edi formats they accept, available for public download from their web sites. Others will generally send you details of their requirements if you contact them via email.

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a1b2c3d4e5

First, Thanks to CoboltSky for the most excellent assistance! I'll start this week on practice runs with the scripts you've presented. You have gone above and beyond in taking the time to help with this!!

 

Next, to the person who wants HIPPA/X12 implementation assistance, the X12 standards can be downloaded in PDF format FREE at www.wpc-edi.com. Be aware, however, that they are VERY DRY READING and, I think, extremely complicated. Also, note that each payor can have a local implementaion of the standard. I wish you happy billing!

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onthebass

A1, did you ever develop a solution for this? I'm trying to do the same thing. Hopefully ride on the coat tails of someone who solved this already ; )

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Maarten Witberg

This thread isn't old, it's antique!

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