Schemas and JSON metadata

This topic describes the example 80x0 schemas and metadata files, as well as notes on how to use these schemas for validation.

The schema hipaa_x12_type_2_v80x0 provides type 2 validation of these transactions implemented in this example:

:
  • Health Care Claim Payment/Advice, or 835
  • Benefit Enrollment and Maintenance, or 834
  • Eligibility, Coverage, or Benefit inquiry/or information, or 270/271

Notes for using these schemas for validation:

  • Element values – for codes that have a limited set of allowed values that is different from the X12 code list, compliance is enforced through a limited restriction list on the element or with a component rule. The limited restriction list is used if all occurrences of the element in the transaction have the same set of allowed values.
  • Valid X12 elements that are not used in certain segments or composites are defined in the schema as components of the segment or composite but have the component rule of ABSENT($).
  • Segments or composites that are part of the base X12 transactions but are not used per the implementation guide are not included in the schema.
  • Where the implementation guides identify a limit for the maximum length of a text data element that is less than the X12 length, a component rule is used.
  • Where the implementation guides identify a limit for elements that represent monetary amounts, date, or time, the schema item properties for that element enforce the limitation.
  • If a situational rule within the implementation guide is based only on the data contained within a single segment, that rule is enforced with a component rule in the schema.
  • Component rules that enforce the relational conditions from the base X12 definition are included in the schema if they are not superseded by any of the Type 2 component rules.

For convenience, a 5010 Type 2 schema is included that contains only the 834 and 835 transactions, as well as the segments and elements required for those transactions. This schema is: hipaa_x12_type_2_step

The following JSON files are used as the input metadata for the step-up maps as one way to enrich the data with new information that is specified in the Preview Draft 8020 TR3s.
  • v80x0x322_template.json
  • v80x0x333_template.json
  • v80x0x332_template.json

These files do not contain objects to represent all the loops, segment, and elements in the 80x0 transactions, but only those that are changed or new for 8010 or higher version and are used in mapping rules in the step- up maps. The actual version to be used in mapping, 8020, is specified in the file.