hipaa_x12 schema
The hipaa_x12 schema provides type 3 and 4 checking for 4050 and 5010 data, and also provides type 2 and type 1 checking. The top level group is HeaderInfo. This schema is used in x12t4precontentcheck.mmc for type 4 pass-through validation.
The hipaa_x12 schema describes the HIPAA X12 transaction sets and enveloping structures associated with the following finalized HIPAA X12 transaction sets:
| Transaction | Description | 4050 version | 5010 version | 6020 version |
|---|---|---|---|---|
| 270 | Health Plan Eligibility Inquiry | - | 005010X279A1 | - |
| 271 | Health Plan Eligibility Response | - | 005010X279A1 | - |
| 276 | Claim Status Request | - | 005010X212 | - |
| 277 | Claim Status Response | - | 005010X212 | - |
| 278(N/A) | Review Notification and Acknowledgment | - | 005010X216 | - |
| 278(Q/R) | Referral Request and Response | - | 005010X217 | - |
| 278(I/R) | Health Care Services Review - Inquiry and Response | - | 005010X215 | - |
| 820 | Health Plan Premium Payment | - | 005010X218 | - |
| 834 | Health Plan Enrollment | - | 005010X220A1 | - |
| 834 | Plan Member Reporting | - | 005010X318 | - |
| 835 | Health Care Claim Payment | - | 005010X221A1 | - |
| 837(I) | Health Care Claim and COB: Institutional | - | 005010X223A2 | - |
| 837(D) | Health Care Claim and COB: Dental | - | 005010X224A2 | - |
| 837(P) | Health Care Claim and COB: Professional | - | 005010X222A1 | - |
| 837(I) | Post Adjudicated Claims Data Reporting Institutional | - | V5010X299 | - |
| 837(D) | Post Adjudicated Claims Data Reporting Dental | - | V5010X300 | - |
| 837(P) | Post Adjudicated Claims Data Reporting Professional | - | V5010X298 | - |
| 275 | Additional Information to support a health care claim or Encounter | 004050X151 | 005010X210 | 006020X314 |
| 277 | Claim Request for Additional Information | 004050X150 | 005010X213 | - |
| 820 | Health Insurance Exchange Related | - | 005010X306 | - |
| 997 | Functional Acknowledgment for Health Care Insurance | - | 005010X230 | - |
| 999 | Implementation Acknowledgment | - | 005010X231A1 | - |
| 277CA | Health Care Claim Acknowledgment | - | 005010X214 | - |
| 277DRA | Data Reporting Acknowledgment | - | 005010X365 | - |
This schema enforces compliance of HIPAA X12 transmission data with the following WEDI/SNIP transaction compliance types:
- Type 1 - EDI Standard Integrity Testing
- Type 2 - HIPAA Implementation Guide Requirement Testing rules
- Type 3 - HIPAA balance testing
- Type 4 - HIPAA inter-segment situation testing
For a detailed description of Type 1, 2, 3 and 4 testing, see WEDI/SNIP HIPAA Transaction Compliance Types.
Partner X12 Inbound and Outbound Transmission EDI are the top-level definitions in this schema.
The hipaa_x12 schema is utilized in the following source maps:
- hipaa_x12_pass_through
- hipaa_276_5010_to_cms_flat
- cms_276_5010_flat_to_hipaa
- hipaa_277_5010_to_cms_flat
- cms_277_5010_flat_to_hipaa
- hipaa_835_5010_to_cms_flat
- cms_835_5010_flat_to_hipaa
- hipaa_837i_5010_to_cms_flat
- cms_837i_5010_flat_to_hipaa
- hipaa_837p_5010_to_cms_flat
- cms_837p_5010_flat_to_hipaa
- cms_277ca_5010_flat_to_hipaa
- hipaa_277ca_5010_to_cms_flat