X12 Interchange Model

The X12 Parser is designed around a set of objects that get loaded with the help of an X12Parser object. Once loaded, the Interchange object can operate without any further assistance from the X12Parser.

You can use these objects to:

• Read an existing X12 file without the use of the XML transformations.
• Load an existing X12 file and make modifications without disturbing any segments that you do not explicit change.
• Create a new X12 document using a built in or custom transaction specification.

An X12 envelop starts with an Interchange surrounding a set of Function Groups surrounding a set of Transactions. The transactions can hold individual segments, loops or hierarchical loops. The following domain model represents these objects with the least repetition of their common characteristics.

ParsingModel.png

Reading an existing X12 file

The following code sample shows loading an Interchange object from an existing X12 string.

It then demonstrates traversing the object model to test specific elements against the expected values.

private string inquiry = @"ISA*00*          *00*          *01*9012345720000  *01*9088877320000  *020816*1144*U*00401*000000031*0*T*:~
                                              GS*HS*901234572000*908887732000*20070816*1615*31*X*00501X092A1~
                                                ST*270*1234~
                                                  BHT*0022*13*10001234*20070816*1319*00~
                                                  HL*1**20*1~
                                                    NM1*PR*2*ABC BILLING SERVICE*****PI*842610001~
                                                    HL*2*1*21*1~
                                                      NM1*1P*2*BONE AND JOINT CLINIC*****SV*2000035~
                                                      HL*3*2*22*0~
                                                        TRN*1*93175-012547*9877281234~
                                                        NM1*IL*1*SMITH*ROBERT*MI****11122333301~
                                                          DMG*D8*19430519~
                                                          DTP*291*D8*20060501~
                                                          EQ*30~
                                                SE*13*1234~
                                              GE*1*31~
                                            IEA*1*000000031~
                                            ";

[TestMethod]
public void Read270Test()
{
    X12Parser parser = new X12Parser();
    Interchange interchange = parser.Parse(new MemoryStream(Encoding.ASCII.GetBytes(inquiry)));
    Assert.AreEqual("9088877320000  ", interchange.InterchangeReceiverId);

    Transaction transaction = interchange.FunctionGroups.First().Transactions.First();
    Segment bht = transaction.Segments.First();

    Assert.AreEqual("10001234", bht.GetElement(3));

    HierarchicalLoop subscriberLoop = transaction.FindHLoop("3");

    Loop subscriberNameLoop = subscriberLoop.Loops.First();

    Assert.AreEqual("SMITH", subscriberNameLoop.GetElement(3), "Subscriber last name not expected.");
    Assert.AreEqual("11122333301", subscriberNameLoop.GetElement(9), "Subscriber member id not expected.");

}

Modifying an existing X12 file

See the test ParseModifyAndTransformBackToX12 for an example of code to modify an existing file.

Creating a new X12 document

Some suggested reading for understanding the X12 format in general: http://docs.oracle.com/cd/E19398-01/820-1275/agdaw/index.html

Some suggested reading for understanding the 270 format: http://www.anthem.com/edi/noapplication/f3/s1/t0/pw_ad086850.pdf

Starting with an outlined version of a 270 file (This code will be included in the test Create270Test in the next release with the test code given above - Read270Test)

private string inquiryOutline = @"ISA*00*          *00*          *01*9012345720000  *01*9088877320000  *020816*1144*U*00401*000000031*0*T*:~
                                              GS*HS*901234572000*908887732000*20070816*1615*31*X*00501X092A1~
                                                ST*270*1234~
                                                  BHT*0022*13*10001234*20070816*1319*00~
                                                  HL*1**20*1~
                                                    NM1*PR*2*ABC BILLING SERVICE*****PI*842610001~
                                                    HL*2*1*21*1~
                                                      NM1*1P*2*BONE AND JOINT CLINIC*****SV*2000035~
                                                      HL*3*2*22*0~
                                                        TRN*1*93175-012547*9877281234~
                                                        NM1*IL*1*SMITH*ROBERT*MI****11122333301~
                                                          DMG*D8*19430519~
                                                          DTP*291*D8*20060501~
                                                          EQ*30~
                                                SE*13*1234~
                                              GE*1*31~
                                            IEA*1*000000031~
                                            ";

First you need to create the interchange (The ISA line above).

The following code creates this: ISA00 00 019012345720000 019088877320000 0208161144U004010000000310T:~ (Along with its ending code in IEA)

image

Once the interchange is created, you need to add the Function Group to it. (This is the second line in the above example 270 text starting with GS)

This section of code creates this: GSHS90123457200090888773200020070816161531X00501X092A1~(Along with its ending code in GE)

image

The next step is adding an actual transaction to the message. This is done by creating a transaction and a BHT – the header for the group of HL levels below.

This section of code creates this: ST2701234BHT0022131000123420070816131900(Along with its ending code in SE)

image

Now you will be adding the information for the HL levels to the BHT created above. There are 4 levels to a 270 request:

HL1 – The information source level

HL2 – The information receiver level

HL3 – The subscriber level

HL4 – The dependent level (Optional)

To create the HL1 level (Information Source):

image

To create the HL2 level (Information Receiver)

image

For the HL3 Level (Member/Subscriber):

image

And the same process would be used for creating an HL4 (Dependent) record addition to the 270.

Basically what you are doing is building up the document with each added hierarchal level or loop until the document is complete.