Notes on X12 Russell Bateman February 2023

Table of contents

Introduction

835 and 837

837

      Loops

      Segments

      Elements

Appendices

Yarsquidy parser

IMS X12 parser

Links

Getting back into X12...

• What are the differences between 835 and 837?
• How to Read an EDI (837) File
• Yarsquidy x12 Parser Documentation (on-line documentation)
• Yarsquidy x12 Parser Documentation (PDF of above; maybe it's just me, but the PDF appears more complete if less convenient)

837 is an electronic file containing patient-claim information and is submitted to an insurance company instead of paper.

In an 837, there are

1. loops,
2. segments and
3. elements.

(Note that Yarsquidy supports classes for each of these.)

Each loop contains multiple (different) segments. The following codes are commonly seen:

Within each segment appear many asterisks (*) which, like the pipe character (|) in HL7v2, separate elements of that segment. Also, the colon (:) is used to separate subelements.

Elements and subelements are introduced by a segment-identifier code, in this illustration, one of:

HI   segment-identifier code

02   element

1    subelement

An 837 contains patient claim information. This file is submitted to an insurance company or a clearinghouse.

• The data in an 837 file is called a Transaction Set.
• File must be sent to the payer or clearinghouse via a secure method due to patient health information within the file.

Formats are three:

1. 837D—for dental practices, crosses over to the CMS-1500 paper form
2. 837P—for professionals, crosses over to the UB-04 paper form
3. 837I—for institutions, over to the ADA-2012 paper form

837 files are broken down into loops, segments and elements. Each loop, segment and element contains specific information.

• Header (beginning of the file)
• Billing provider detail
• Subscriber detail
• Patient detail
• Claim detail
• Ending trailer, where the file ends.

Loops

Loops are difficult to distinguish. Normally, they begin with NM or HL segments. There are multiple types, but they are all broken down into 5 primary sections:

Segments

Here are common ones:

Elements

Generally separated by asterisks while subelements within are separated by colons. Common elements:

Appendices

There are a source- and javadoc JARs in the Huawei Cloud at https://mirrors.huaweicloud.com/repository/maven/com/yarsquidy/x12-parser/2.0.0/.

Maven expression

<dependency>
  <groupId>com.yarsquidy</groupId>
  <artifactId>x12-parser</artifactId>
  <version>2.0.0</version>
</dependency>

Yarsquidy Java classes

• Element as seen above, the data-building block of EDI. Also contains subelements if present (so, subelement doesn't have its own class nor is it separately parsed from elements).
• Segment as seen above, an aggregation of elements.
• Loop as seen above, the representation of a loop in an EDI transaction. Instances of Segment (above) are grouped as loops; a set of loops form an X12 transation.
• Cf represents a configuration element. Each configuration element instance offers items required to identify a Loop in EDI. Some loops can be identified by only the segment id while others require a segment id plus additional qualifiers to be able to identify the loop.

The Yarsquidy parser—classes

See page 3 of X12-Parser Documentation, release 1.0.1 by Prasad Balan and Ryan Colewell, 31 January 2016.

Some of what's below is robbed from the document, some is based on personal observation, some is pure speculation waiting to be verified by personal experience.

• imsweb/x12-parser, on Maven Central, com.imsweb.x12-parser (2012-present, latest version 1.15). This parser claims to be based on a Python project (pyx12).

  <dependency>
    <groupId>com.imsweb</groupId>
    <artifactId>x12-parser</artifactId>
    <version>1.15</version>
  </dependency>
  

We're going to peruse the documentation at imsweb / x12-parser.

This parser, requiring Java 8 or later, claims to support parsing of:

This is what I really care about:
• ANSI837 4010 X096 (institutional)
• ANSI837 4010 X097 (dental)
• ANSI837 4010 X098 (professional)
• ANSI837 5010 X222 (professional, since 2012-01-01)
• ANSI837 5010 X223 (institutional, since 2012-01-01)
 
I care a wee bit about 835, but not much:
• ANSI835 5010 X221
• ANSI835 4010 X091
 
Don't care whatsoever about these types.
• ANSI277 5010 X214 (since 2012-01-01)
• ANSI277 5010 X212 (since 2012-01-01)
• ANSI270 4010 X092
• ANSI271 4010 X092
• 999 5010

To process an X12 file:

X12Reader reader = new X12Reader( FileType.ANSI837_5010_X222, new File( "/path/file.txt" ) );

Accessing data... you can even access data arbitrarily deep down inside X12:

List< Loop > loops = reader.getLoops();

String data = loop.getLoop( "ISA_LOOP" )
             .getLoop( "GS_LOOP" )   // subloop of ISA_LOOP
             .getLoop( "ST_LOOP" )   // subloop of GS_LOOP
             .getLoop( "1000A" )
             .getSegment( "NM1" )    // segment of loop 1000A
             .getElement( "NM101" )  // first element of segment NM1
             .getSubElement( 1 );    // first subelement in NM101

Should loops or segments repeat (as they can), it's possible to access any particular one:

Loop    loop    = loop.getLoop( "1000A", 1 );
Segment segment = loop.getSegment( "NM1", 2 );

Search for all loops with an id of 1000B in the 1000A loop even if it occurs deep down in the loop:

Loop         loop  = loop.getLoop( "1000A" );
List< Loop > loops = loop.findLoop( "1000B" );

The same thing can be done for segments.

• X12: a consensus-based, interoperable, syntax-neutral data-exchange standard.
• X12 EDI Examples
• X12 Parsing with Loop detection
• Reading EDI Data in Java
• How to Read an EDI 837 File
• Therabill: How to Read an EDI (837) File - Overview
• Institution Health Care Claim: 837 Institutional Claim
• Indian Health Service: Understanding 837 5010