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HIPAA

The HIPAA data services implement the HIPAA messaging standard for administrative and financial health-care transactions. HIPAA is based on the X12 standard.

The data services repository includes HIPAA parser and serializer data services, as well as data services that validate input messages and generate acknowledgements. These data services implement the complete set of validation and acknowledgment types defined in the HIPAA standard up through version 5010A1.

HIPAA message structure

The following example shows a HIPAA message for a Benefit Enrollment and Maintenance transaction that an insurance sponsor uses to provide benefit enrollment information to payers:

ISA*00**00**ZZ*EDI0021*ZZ*54828*032403*1253*U*00405*000000905*1*T*:
GS*BE*EDI0021*54828*20030324*1253*5*X*004050X125~
ST*834*26608~
BGN*00*26608*20021226*1200*ES*2~
N1*P5*UES CORP*FI*111222333~
N1*IN*UNITED HEALTHCARE*FI*777888999~
INS*Y*18*021*28*A***FT~
REF*0F*851027461~
REF*1L*199301~
DTP*356*D8*20021219~
NM1*IL*1*CANOE*NANCY*A*MRS.*I*99*99999999~
PER*IP**HP*4104038790*WP*4104035500*EX*5684~
N3*9999 ROSE VILLAGE*FIRST FLOOR~
N4*FLOWERS*ND*999995*CY*WHEELING~
DMG*D8*19740801*F*M~
HD*021**PPO*PLAN COVERAGE DESCRIPTION*ESP~
DTP*348*D8*20021219~
SE*16*26608~
ST*834*26608~
BGN*00*26608*20021226*1200*ES*2~
N1*P5*UES CORP*FI*111222333~
N1*IN*UNITED HEALTHCARE*FI*777888999~
INS*N*01*021*28*A***FT~
REF*0F*948047150~
REF*1L*199301~

HIPAA message in XML format

The HIPAA parser data services can convert HIPAA messages into XML format. The following example shows a HIPAA message in XML format:

<interchange xmlns="http://www.informatica.com/B2B/HIPAA/4010" xmlns:H834="http://www.informatica.com/B2B/HIPAA/4010/834" >
  <delimiters>
    <field_separator>*</field_separator>
    <composite_separator>:</composite_separator>
    <segment_separator>!</segment_separator>
  </Delimiters>
  <ISA>
    <R01>00</R01>
    <R02 />
    <R03>00</R03>
    <R04 />
    <R05>ZZ</R05>
    <R06>101018</R06>
    <R07>ZZ</R07>
    <R08>107039</R08>
    <R09>04101</R09>
    <R10>1334</R10>

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Data Services Repository

Data Services Repository

HIPAA

HIPAA

HIPAA message structure

HIPAA message in XML format