About Creating EDI Files
With the version 4.1, the creation of EDI files from database records was introduced. This is a powerful and important addition to the capabilities of the HIPAA Claim Master. Now you can create EDI files from your claim records whether they were imported into the database via EDI files or originated from your own claim system. This is an add-on component of the HIPAA Claim Master and needs to be licensed in order to use it.
The licensing of the database integration component is required to use this feature.
Note: HIPAA compliant EDI files are not easily created from records that don't originate from EDI. It might take a while to produce compliant records for several reasons:
| • | You might not have every field that is required by the implementation guides |
| • | The data that you have is not formatted according to the HIPAA guides |
| • | Data might have to be assembled from across your enterprise's applications |
We recommend that you also purchase and employ the EDI Exchange module. This way you can check each individual claim record before it is written to the EDI file and you can even suppress records that are not created without compliance warnings.
The menu item to create EDI files under the "Data Base" menu
No questions yet.
Setting up Company
Creating EDI files will include a lot of information on you and your trading partners. The company setup screen is designed to enter all the necessary information for the EDI creation.When you create EDI files there are a few elements needed to identify your company as the sender, the producer of this EDI file. For this matter, use the company setup screen. You can specify your company information and other setting related to your company there.
If you have the EDI Exchange component licensed then all this information is stored in the data file "COMPANY_SETUP". If you don't have this component then this information is stored in the Windows registry.
Note: You need to configure the database first. See Setting up Database Connection.
| 1. | To configure the company, select Setup  Company Setup in the main menu. The "Company Setup" menu |
| 2. | The following screen will appear. The "Company Setup" window |
| 3. | You can configure the following options: |
| • | Company Information |
| • | EDI Version |
| • | Contact Information |
| • | ISA 14 and 15 |
Read the detailed descriptions further.
| 4. | Once you have finished editing the options, click "Save." |
Company Information
| • | Name — Company name. Obligatory option. |
| • | Address 1 |
| • | Address 2 |
| • | City — Obligatory option. |
| • | State — Obligatory option. |
| • | ZIP |
| • | Plus 4 |
| • | ISA Segment Sender Identification — It is the most important option to choose. It identifies your organization for all EDI transactions. Most commonly the Qualifier "ZZ" and a free form ID up to 15 character in length is chosen. Other options include your tax ID and the Dun & Bradstreet ID. |
| • | Qualifier — The ISA Identifier and qualifier are the unique key to the trading partner database file. The ISA identifier can be up to 15 bytes long, the qualifier has to be 2 bytes. Approved qualifiers are: |
| • | 01 — Duns (Dun & Bradstreet) |
| • | 14 — Duns Plus Suffix |
| • | 20 — Health Industry Number (HIN) |
| • | 27 — Carrier ID Number (Identification Number as assigned by HCFA) |
| • | 28 — Fiscal Intermediary ID Number (Identification Number as assigned by HCFA) |
| • | 29 — Medicare Provider and Supplier ID Number (Identification Number as assigned by HCFA) |
| • | 30 — U.S. Federal Tax ID Number (Identification Number) |
| • | 33 — NAIC Company Code (National Association of Insurance Commissioners Company Code) |
| • | ZZ — Mutually Defined |
| • | Application Sender's Code GS_2 — The option represents the program or machine that created the file. Usually the same as the ISA Segment Sender Identification. You can select other ID if you need. Obligatory option. The GS_02 identifier is usually the same as the ISA identifier but you can also choose some other ID. It represents the program or machine that created the file, but the most common is a repetition of the ISA identifier. |
| • | Tax ID — Obligatory option. Also called an Employer Identification Number (EIN). |
| • | Plan ID / Payor ID — Fill in your Payer ID and Plan ID if you have one; this is only important for the 271 and 277 transactions. Optional setting. |
| • | Three letter identifier to prepend to all outgoing EDI files — Optional setting. Makes your files easily identifiable. |
EDI version
Specify EDI version:
| • | only 4010 |
| • | 4010 if in original otherwise 5010 |
| • | only 5010 |
Contact Information
The contact information goes into the PER segment of outgoing transactions:
| • | Contact Person |
| • | Telephone |
| • | Ext |
| • | Fax |
| • |
ISA 14 and 15
| • | EDI files will be — ISA element 14 determines if the resultant file contains test or production data: |
| • | Test |
| • | Production |
| • | Acknowledgement (TA1) req. — ISA element 15 indicates whether you want a TA1 acknowledgement for files that you send out. |
No questions yet.
Creating Company Setup Table
You can create the Company Setup Table by following the steps below in the HIPAA Claim Master.
| 1. | To configure the program options, select Setup Create Company Setup Table in the main menu. The "Create Company Setup Table" menu |
| 2. | The following screen will appear. "Create Table" window |
| 3. | This window allows you to edit, save and run the table scripts. |
| 4. | Define the following options: |
| • | Database |
| • | Microsoft SQL Server |
| • | MySQL/Genetic |
| • | Company Setup Table Script — SQL statements to create the Company table in your database. |
Tip: You can modify the scripts so that they run on your specific database.
| 5. | Once you have you modified the script, click "Save." The "Save" button |
| 6. | Click "Execute Script" to create the table in the database. The "Execute Script" button |
| 7. | Once the table has been created successfully, you will see the following notification: The success message |
Warning: Executing the script will wipe out any previous table you have created. Remove the script files once you are satisfied so nobody can occasionally destroy the database table.
Make sure there are no any error messages for successful table creation.
No questions yet.
Creating 834 EDI Files from the Attached Database
Once the EDI creation is enabled, you can create the EDI files. Follow the instructions below.
| 1. | To configure the company, select Data Base Create 837 EDI Files in the main menu. The menu item to create EDI files under the "Data Base" menu Alternatively, you can click the "Create 837 EDI File" button in the query builder ("Exported Claims" window). Refer to Exporting the Data.  The "Create 837 EDI File" button located on the "Exported Claims" screen |
| 2. | Clicking the button will bring up the "Create 837 Transaction Sets" window with the query that you designed. The fields are described in Understanding the "Create 837 Transaction Sets" Window. |
| 3. | After you have filled all necessary values, click "Go!" The "Create 837 Transaction Sets" window with the highlighted "Go!" button |
| 4. | You will see a confirmation dialog like this. Click "Yes." The verification message before the EDI records are created |
| 5. | After you click "Yes," the process of assembling the claims to the 837 files starts. You can see the progress bar on the bottom pane.  Progress bar at the bottom of the screen keeps you informed about the process |
| 6. | The bottom pane informs you about the number of transactions created. The bottom pane displaying the number of created EDI transactions |
| 7. | The EDI text is now displayed in the bottom part of the window. The EDI file content displayed |
| 8. | Now you can write down the EDI text that is still in memory and visible in the text box to a file. Click on the "Write to File" button and you will have the choice to write in the default location which is the trading partner's outbox, or specify any other location: |
| • | Use default path and names |
| • | Select path and names The "Write to File" button |
| 9. | After successful writing, you get a message where the file was written to. The confirmation message that the file was successfully written |
Viewing the Saved Files
The button "View EDI File" is now enabled and you can bring up the EDI Editor to view it.
The "View EDI File" button highlighted
The following preview window will open.
EDI preview window
No questions yet.
Understanding the "Create 837 Transaction Sets" Window
Here you can find the descriptions of the "Create 837 Transaction Sets" window fields.
| • | Query field — This field is located in the top left corner. It is used to narrow the records to be written to the EDI files. You can create your own query or you can use the query builder in the exported claims screen. |
| • | Live/Test Database radio buttons — They are located to the right of the query text box. They allow to choose between the Live database and the Test database as outlined in the data connection setup. |
| • | Effective date — It is the effective date of the file. By default, the current date is selected. |
| • | Version — Here you can select the version of the resulting EDI file. You have the choice of 4010 or 5010. It is generally possible to generate 4010 files from claims that came in 5010 files and vice versa, a third option is for claims that came from EDI files and that have been imported into the database. Here you have the option to preserve the original version so that a claim that came in an EDI file in 4010 format will also be output as 4010 files while a 5010 file will be output as 5010. |
EDI Envelopes
The next part of the screen contains the EDI envelopes:
| • | ISA Segment — The ISA segment contains the outermost envelope of the EDI file and it represents data that is required to read an EDI file. Listed here are the sender and receiver, the data and time, whether a response is expected and which characters to use as segment, element and sub-element separator. The picture above shows this screen and you can see the individual data elements. The data in black you can change, other elements are determined by the Company Setup screen. |
| • | GS Segment — The GS or Group Start segment contains transaction specific information, which transaction sets are in this file and also has information on the creation (Sender code) and consumption (Receiver Code) of the EDI files. Group control number and version will be filled in by the process since this is dependent on the claim type. |
| • | ST Segment — The ST or Start of Transaction Set segment again lists the transaction set code and a unique identifier for the transaction. |
| • | BHT Segment — The BHT segment further qualifies the claim in the 837 transaction set by specifying whether this is an original submission and whether the claims are chargeable or just encounter records. |
If you have the EDI Exchange component licensed, you can select the trading partner and fill the form with a specific trading partner's information.
| • | Select Trading Partner — Once this button has been clicked, a popup window appears where you can select your defined trading partner. |
No questions yet.