EDI 5010 Documentation 837 Professional - Loop 2430 Line Adjudication Information

EDI 270–5010 Documentation– Loop 2100C SUBSCRIBER Name

2100C Subscriber Name

EDI 5010 Documentation 837 Professional - Loop 2300 Date information

 

Payer Claim Number aka Internal Control Number (ICN) or Claim Control Number (CCN)

Parse EDI 835 Message into JSON

Claim Forward to Other Payer

Understanding X12 EDI Structure

Before Jumping to EDI Structure, let us understand what is a Page in a book or word document?

Structure of the Page

Word	A word is a single unit of language that can be represented in writing or speech and each word is separated by space.
Sentence	A combination of a group of words that gives a complete meaning and each sentence separated by a line
Paragraph	A combination of a group of sentences that gives a complete meaning

Let us see an example of two addresses using the above structure. Assume that we need a subscriber(insurer) address and Company address in the document.

Let us name the below paragraph as Paragraph 1 and contains Subscriber information.
Carrie J. Brown, DOB 01/13/1953, Male
3360 Lynn Street
Woburn, MA 01801
Let us name the above paragraph as Paragraph 2 and contains Company information with a tax id.
Healthservices LLC, Tax ID: xx1234512
2550 Adamsville Road
Harlingen, TX 78550
 Page Vs EDI

Page in a Book	Message in an EDI
Word	Elements
Sentence	Segments
Paragraph	Loop

Separators

Page in a Book	Message in an EDI
Words are separated by space	Elements as separated by a delimiter. Any Character can be a delimiter, but most used is Asterisk *
Sentence are separated by Line	Segments as separated by the terminator. Any character can be terminator, but most used is ~
Paragraph are separated by one or more lines	There are no separators for Loop

Let us rewrite our examples in EDI Structure.

Carrie*J*Brown*01/13/1953*Male~
3360*Lynn Street~
Woburn*MA*01801~

Healthservices LLC*xx1234512~
2550*Adamsville Road~
Harlingen*TX*78550~

Just for better understanding, the above information is separated with a newline character, but in real-time, it will look as follows

Carrie*J*Brown*01/13/1953*Male~3360*Lynn Street~Woburn*MA*01801~Healthservices LLC*xx1234512~2550*Adamsville Road~Harlingen*TX*78550~

Now let us get into more detail by looking at the above message. There are some issues for the computer to understand as follows.
1) Very first, the computer does not know what we are talking about, but we know that the above is two address representations where one is for the subscriber and one is for the company.
2) So, it is time to give information in a more structured way to the computer about this data.


X12 EDI expects before you start giving information, it needs a segment Name and segment type. Whenever we need to provide information about an entity or person, then the segment name is NM1. Second, we need to inform what is that entity or person, are its Patient details or is it Company Name, etc. That is called type qualifier, for example, for the subscriber, the type qualifier is IL and for Company, the type qualifier is 85, etc

Segments should start with Segment Name, optionally there should be segment type or type qualifier.

Let us rewrite our examples in EDI Structure

NM1*IL*Carrie*J*Brown*01/13/1953*Male~
N3*3360*Lynn Street~
N4*Woburn*MA*01801~

NM1*85*Healthservices LLC*xx1234512~
N3*2550*Adamsville Road~
N4*Harlingen*TX*78550~

As you can see, every segment starts with segment names such as NM1, N3, N4, etc and optionally it also contains type in the second position. An important point to note that is, for address segments, there is no need to provide type.
Other important notes on EDI Message
1) If you want to send any number such as NPI or tax ID or SSN, then before that number we need to tell what that number is. For example, the provider contains NPI number, so before we put the actual NPI number, it should be prefixed by XX as follows1) If you want to send any number such as NPI or tax ID or SSN, then before that number we need to tell what that number is. For example, provider contains NPI number, so before we put the actual NPI number, it should be prefixed by XX as followsNM1*85*2*Demo Clinic*XX*1215099528

JSON to EDI 270 Eligibility and Benefit Inquiry