On Healthcare Data Formats and More

December 5, 2023

EDI Parser for Java

Our EDI Parser for Java is now available. The parser is easy to use and requires no EDI knowledge. Here is a quick example: // parse all transactions in the file EdiParsingResults results = parser.parse(); // results contains claims, payments, etc. List<Claim> claims = results.claims(); Claim sampleClaim = claims.get(0); // get some key attributes of the claim BigDecimal billedAmount = sampleClaim.chargeAmount(); String patientControlNumber = sampleClaim.patientControlNumber(); // Providers OrgOrPerson billingProvider = sampleClaim.

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August 23, 2023

Running Claim Insight Locally

You can run our Claim Insight product locally on your laptop or server using docker and docker compose. Note that this version does not have any security enabled and is intended for evaluation purposes. Please follow the instructions below: Install docker Download this docker-compose file and save it locally, preferably to the folder named “clinsight”. Create a folder for the Mongo DB volume, it must be named “mongo_data”, e.g., mkdir mongo_data.

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August 13, 2023

Claim and Payment Lists in EDI Viewer

We’ve implemented claim and payment list views in our EDI Viewer. Claims and payments are now displayed in a table with sortable columns: The table contains all the key fields from a claim (837) or from a payment (835), such as billing provider, billed/paid amounts, and so on. Select an item by clicking on a row to see the rest of the fields. This will display the details view. The back button on the details view navigates back to the list:

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July 19, 2023

API for Parsing X12 EDI 835 as JSON Payment Objects

We now provide API to convert X12 EDI 835 transactions into “business-friendly” JSON objects. This API is similar to our 837 claim conversion API. X12 EDI text is “posted” in the request body; the service returns an array of payment objects. Another option is a file upload (this is part of our commercial offering). The schema of the JSON response is loosely based on the X12 EDI structure without any of the EDI’s complexity.

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June 20, 2023

Viewer for NCPDP Telecommunication Format (Pharmacy Claims)

We are pleased to announce the availability of the online viewer for NCPDP telecom format. The viewer is completely free; it supports all HIPAA transactions, such as B1, B2, N transactions, and so on. The viewer has many features to help you deal with the NCPDP format: Provides a human-readable description for all NCPDP segments and fields; Supports data conversion of NCPDP numeric fields; Decodes NDC numbers and other healthcare codes; Visualizes non-printable NCPDP separators, such as ␞ (RS-Record Start) and ␜ (FS-Field Start); Converts NCPDP to JSON; you can also use our API to do it automatically.

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June 7, 2023

Separators in NCPDP Telecom Format

NCPDP telecommunication format relies on non-printable ASCII characters to denote segments and fields. NCPDP batch standard adds several more non-printable separators to indicate the start/end of transactions and headers/trailers. This is needed to package multiple NCPDP telco transactions in the same file. Non-printable characters are shown as spaces in all browsers and in many text editors. This makes it difficult to work with text containing hidden characters. To solve this problem, more advanced editors and IDEs show small symbols representing non-printable characters, such as ␞ and ␜.

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June 1, 2023

Formatting of NDC Codes in Medical and Pharmacy Claims

NDC drug codes consist of three parts: [labeler]-[product code]-[package code] The number of digits for each part is not fixed: The 10-digit NDC will be in one of the following configurations: 4-4-2, 5-3-2, or 5-4-1, meaning that there are 4 or 5 digits for the labeler code, 4 or 3 digits for the product code and 2 or 1 digit(s) for the package code. Note that FDA proposed a new 12-digit, 6-4-2 format for NDC, but it is not yet in place.

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May 9, 2023

Support for HIPAA EDI Transactions

We now support all HIPAA EDI transactions in our X12 EDI parser and in our public EDI Viewer.

HIPAA transactions cover healthcare claim submissions, payments, eligibility checks, and enrollment. The master list of HIPAA transactions is published by CMS.

837 (claim submission) and 835 (claim payment/advice) transactions constitute the core of HIPAA/healthcare transactions. We’ve always had solid support for these two transaction types in our EDI Viewer and in our other products.

We’ve added support for the rest of the HIPAA transactions, namely:

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April 11, 2023

Healthcare Codeset Management as a Service

Healthcare industry relies on many medical code sets, such as CPT, ICD-10, NDC. There are multiple other code sets that are used for provider specialties, error codes and so on. A typical healthcare claim can use five or six different code sets defining diagnosis, services and supplemental information. Governance of medical code sets is de-centralized. ICD code sets are managed by CMS, but everything else is controlled by various government and non-government entities, such as FDA, X12, AMA, ADA, National Uniform Billing Committee (NUBC).

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