AnyToXML: HIPAA Example

This example demonstrates the conversion of an EDI 271 message, which is based on the HIPAA (Health Insurance Portability and Accountability Act of 1996) standard, to a well-formed XML message. Using the XML/EDI Wizard, an input file 271h3.edi is converted to a well-formed XML message. The conversion criteria used in the conversion is shown below:

• Input File: 271h3.edi

ST*271*1234
BHT*0022*11**19950101*1319
HL*1*0*20*1
NM1*PR*2*ABC COMPANY*****PI*842610001
HL*2*1*21*1
NM1*1P*2*BONE AND JOINT CLINIC*****SV*2000035
REF*N7*234899
N3*55 HIGH STREET
N4*SEATTLE*WA*98123
HL*3*2*22*0
TRN*2*93175-012547*14-1726485
NM1*IL*1*SMITH*ROBERT*B***MI*11122333301
REF*1L*599119
DMG*D8*19430519*M
INS*Y*18
EB*1*FAM*30*GP
DTP*307*RD8*19950501-19950515
SE*18*1234

<?xml version="1.0" encoding="utf-8" standalone="yes" ?>
<HIPAA271>
<Transaction-Set-Header>
<Transaction-Set-Identifier-Code Code= "271 X12.282 Health Care Eligibility/Benefit Information"/>
<Transaction-Set-Control-Number>1234</Transaction-Set-Control-Number>
</Transaction-Set-Header>
<Beginning-of-Hierarchical-Transaction>
<Hierarchical-Structure-Code Code= "0022 X12.282 Health Care Eligibility/Benefit Information"/>
<Transaction-Set-Purpose-Code Code= "11 Response"/>
<Date>19950101</Date>
<Time>1319</Time>
</Beginning-of-Hierarchical-Transaction>
<Hierarchical-Level>
<Hierarchical-ID-Number>1</Hierarchical-ID-Number>
<Hierarchical-Parent-ID-Number>0</Hierarchical-Parent-ID-Number>
<Hierarchical-Level-Code Code= "20 Eligibility or Benefit Information Source"/>
<Hierarchical-Child-Code Code= "1 Additional Subordinate HL Data Segment in This Hierarchical Structure."/>
</Hierarchical-Level>
<Individual-or-Organizational-Name>
<Entity-Identifier-Code Code= "PR Payer"/>
<Entity-Type-Qualifier Qual= "2 Non-Person Entity"/>
<Name-Last-or-Organization-Name>ABC COMPANY</Name-Last-or-Organization-Name>
<Identification-Code-Qualifier Qual= "PI Payor Identification"/>
<Identification-Code>842610001</Identification-Code>
</Individual-or-Organizational-Name>
<Hierarchical-Level>
<Hierarchical-ID-Number>2</Hierarchical-ID-Number>
<Hierarchical-Parent-ID-Number>1</Hierarchical-Parent-ID-Number>
<Hierarchical-Level-Code Code= "21 Eligibility or Benefit Information Receiver"/>
<Hierarchical-Child-Code Code= "1 Additional Subordinate HL Data Segment in This Hierarchical Structure."/>
</Hierarchical-Level>
<Individual-or-Organizational-Name>
<Entity-Identifier-Code Code= "1P Provider"/>
<Entity-Type-Qualifier Qual= "2 Non-Person Entity"/>
<Name-Last-or-Organization-Name>BONE AND JOINT CLINIC</Name-Last-or-Organization-Name>
<Identification-Code-Qualifier Qual= "SV Non-Person Entity"/>
<Identification-Code>2000035</Identification-Code>
</Individual-or-Organizational-Name>
<Reference-Numbers>
<Reference-Number-Qualifier Qual= "N7 Facility Network Identification Number"/>
<Reference-Number>234899</Reference-Number>
</Reference-Numbers>
<Address-Information>
<Address-Information>55 HIGH STREET</Address-Information>
</Address-Information>
<Geographic-Location>
<City-Name>SEATTLE</City-Name>
<State-or-Province-Code Code= "WA Facility Network Identification Number"/>
<Postal-Code Code= "98123 Facility Network Identification Number"/>
</Geographic-Location>
<Hierarchical-Level>
<Hierarchical-ID-Number>3</Hierarchical-ID-Number>
<Hierarchical-Parent-ID-Number>2</Hierarchical-Parent-ID-Number>
<Hierarchical-Level-Code Code= "22 Subscriber"/>
<Hierarchical-Child-Code Code= "0 No Subordinate HL Segment in This Hierarchical Structure."/>
</Hierarchical-Level>
<Trace>
<Trace-Type-Code Code= "2 Referenced Transaction Trace Numbers"/>
<Reference-Number>93175-012547</Reference-Number>
<Originating-Company-Identifier>14-1726485</Originating-Company-Identifier>
</Trace>
<Individual-or-Organizational-Name>
<Entity-Identifier-Code Code= "IL Insured or Subscriber"/>
<Entity-Type-Qualifier Qual= "1 Person"/>
<Name-Last-or-Organization-Name>SMITH</Name-Last-or-Organization-Name>
<Name-First>ROBERT</Name-First>
<Name-Middle>B</Name-Middle>
<Identification-Code-Qualifier Qual= "MI Member Identification Number"/>
<Identification-Code>11122333301</Identification-Code>
</Individual-or-Organizational-Name>
<Reference-Numbers>
<Reference-Number-Qualifier Qual= "1L Group or Policy Number"/>
<Reference-Number>599119</Reference-Number>
</Reference-Numbers>
<Demographic-Information>
<Date-Time-Period-Format-Qualifier Qual= "D8 Date Expressed in Format CCYYMMDD"/>
<Date-Time-Period>19430519</Date-Time-Period>
<Gender-Code Code= "M Male"/>
</Demographic-Information>
<Insured-Benefit>
<Yes-No-Condition-or-Response-Code Code= "Y Yes"/>
<Individual-Relationship-Code Code= "18 Self"/>
</Insured-Benefit>
<Eligibility-or-Benefit-Information>
<Eligibility-or-Benefit-Information Info= "1 Active Coverage"/>
<Coverage-Level-Code Code= "FAM Family"/>
<Service-Type-Code Code= "30 Health Benefit Plan Coverage"/>
<Insurance-Type-Code Code= "GP Group Policy"/>
</Eligibility-or-Benefit-Information>
<Date-or-Time-or-Period>
<Date-Time-Qualifier Qual= "307 Eligibility"/>
<Date-Time-Period-Format-Qualifier Qual= "RD8 Range of Dates Expressed in Format CCYYMMDD-CCYYMMDD"/>
<Date-Time-Period>19950501-19950515</Date-Time-Period>
</Date-or-Time-or-Period>
<Transaction-Set-Trailer>
<Number-of-Included-Segments>18</Number-of-Included-Segments>
<Transaction-Set-Control-Number>1234</Transaction-Set-Control-Number>
</Transaction-Set-Trailer>
</HIPAA271>