Preview Draft 80X0

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The ASC X12 Insurance Subcommittee, called X12N, is currently managing a series of public review periods to define new implementation guides for the healthcare insurance industry. These implementation guides will eventually replace the HIPAA-adopted TR3s.

Because of the current status of the final versions of the implementation guides, the Pack for Healthcare includes examples that provide a preview based on the currently published but not adopted versions. The example includes a schema to allow for validation in accordance with the Type 2 HIPAA Implementation Guide Requirement Testing for the Published 8020 TR3 for these transactions:
  • HP – Health Care Claim Payment/Advice – 835, Version 008020X322
  • BE – Benefit Enrollment and Maintenance - 834, Version 008020X333
  • HS – Eligibility, Coverage, or Benefit Inquiry – 270, Version 008020X332
  • HB – Eligibility, Coverage, or Benefit Information - 271, Version 008020X332

For these transactions, step-up and step-down example maps are provided to demonstrate one way to transform data conforming to the HIPAA adopted version 5010 TR3’s to the draft TR3 requirements based on X12 8020.

The step-up maps also demonstrate one possible way to enrich the data with new information that is specified in the 8020 TR3’s through JSON input.

See the X12n example for X12 8020 and 8030-based schemas with transactions covered by currently published X12N implementation guides to allow for validation in accordance with WEDI/SNIP Type 1 EDI Standard Integrity Testing.

The example files install within the imported project.