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CHIAPAS EDI ENTERPRISE USER MANUAL

1. OEISA 501 5 4 SEC NO SEC OEISA 501 15 06 SENDR ID OVL MUTLY DEFND ID OEISA 501 5 RECVR ID OVL MUTLY DEFND ID OEISA 501 5 09 DT OEISA SO1 ISA10 TM OEISA SO1 ISA11 REPTN SEPRTR OEISA SO1 ISA12 VERSN NR OEISA SO1 ISA13 ICN OEISA SO1 ISA14 ACK REQ OEISA SO1 ISA15 USG IND OEISA SO1 ISA16 SUBELE SEP OEISA 503 IEAO2 ICN GSHDR 501 4502 APP SENDR CD GSHDR 501 6503 APP RECVR CD GSHDR 501 GS04 DT GSHDR 501 6505 TM GSHDR 501 6506 GSHDR 501 6508 VERS ID CD GSHDR 503 GEO2 STHDR 501 STO2 CONTRL NR STHDR SO2 BHTO1 STRUCTR CD STHDR 502 BHTO2 TS PURPS CD STHDR 502 BHTO3 SUBMTR TRANSCTN 10 Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Purpose Primary Key Identity Foreign key to the BIN LOG table Page 64 STHDR 502 BHTO4 TS CREATN DT STHDR 502 BHTO5 TS CREATN TIM STHDR 504 SEO2 L2000A SO1 HLO1 HIERCHCL ID NR L2000A SO1 HLO4 HIERCHCL CHILD CD L2100A PR SO1 NM103 NFO SOURC LAST ORG NM OVL NONPRSN ENTY L2100A PR SO1 NM109 NFO SOURC PRIMRY ID OVL FED TAX ID NR L2000B SO1 HLO1 HIERCHCL ID NR L2000B SO1 HLO2 HIERCHCL PARNT ID NR L2000B 501 HLO4 HIERCHCL CHILD CD L2100B 1P 501 2 ENTY TYPE QUAL L2100B 1P 501 NM103 RECVR LAST ORG NM L2100B 1P 501 NM109 RECVR ID NR OVL FED TAX ID NR L2000C 501 HLO1 HIERCHCL ID NR
2. CGateArg A To CGateState 01 To CGateState Arg02 To CGateState Arg03 To CGateState Arg04 Error Messages Purpose This activity enables an easy way to transfer information from the automation system to a running workflow When a new event is created there are four columns available to hold argument data EVENT_DATAO1 EVENT DATAO2 EVENT_DATAO3 and EVENT_DATA04 varchar 200 data type When a user places a string variable within these fields whatever value was present within the column will be propagated to the string variable See the EVENTS table schema for more information about the values generated by the automation system when it generates new events Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 130 CGateMerge Parameters DestCnn string DestTable string Error Messages CGateMerge Exception The Merge command is only functional for SQLite and SQL Server connections Unmerged Mapping Purpose This activity is a more advanced method for storing a Flat register to a database table Unlike the CGateFlatToTable activity or the CGateTransfer activity this will do a schema analysis on the destination and insert only those fields that both the Flat register and the destination table have in common Fields that are present within the Flat Register but not in the destination table will result in Unmerged Mapping errors ad
3. 4010 277 A1 BIN Addenda 1 4010 278 REQ BIN Health Care Services Review Request for Review 278 4010 278 REQ A1 BIN Addenda 1 4010 278 RESP BIN Health Care Services Review Response 278 4010 278 RESP A1 BIN Addenda 1 4010 820 BIN Payroll Deducted and Other Group Premium Payment for Insurance Product 820 4010 820 A1 BIN Addenda 1 4010 834 BIN Benefit Enrollment and Maintenance 834 4010 834 A1 BIN Addenda 1 4010 835 BIN Health Care Claim Payment Advice 835 4010 835 A1 BIN Addenda 1 4010 837D BIN Health Care Claim Dental 837 4010 837D A1 BIN Addenda 1 4010 8371 BIN Health Care Claim Institutional 837 4010 837I A1 BIN Addenda 1 4010 837P BIN Health Care Claim Professional 837 4010 837P A1 BIN Addenda 1 5010 270 BIN Health Care Eligibility Benefit Inquiry 270 5010 270 A1 BIN Addenda 1 5010 271 BIN Health Care Eligibility Benefit Inquiry Response 271 5010 271 A1 BIN Addenda 1 5010 276 BIN Health Care Claim Status Request 276 5010 277 BIN Health Care Claim Status Response 277 5010 277CA BIN Health Care Claim Acknowledgment 277CA 5010 278 REQ BIN Health Care Services Review Request for Review 278 5010 278 RESP BIN Health Care Services Review Response 278 5010 820 BIN Payroll Deducted and Other Group Premium Payment for Insurance Products 8
4. RIGHT CONVERT VARCHAR RAND DATEPART mm GETDATE 100000 DATEPART ss GETDATE 1000 DATEPART ms GETDATE 6 STHDR S02 3 ORGNTR APLCTN TRANSCTN ID CH STHDR S02 CLM ENCNTR ID SENDR PV COMPANY NM L1000A 501 NM103 SUBMTR LAST ORG NM OVL NONPRSN ENTY SENDR PV TAX ID L1000A 501 NM109 SUBMTR ID OVL ETN NR SENDR PV CONTACT NM L1000A S02 PERO2 CONTCT NM SENDR PV WORK PH L1000A 502 PERO4 COMM NR OVL TELPHN RECVR PV COMPANY NM L1000B 5 1 NM103 RECVR NM OVL NONPRSN ENTY RECVR PV TAX ID L1000B 501 NM109 PRIMRY ID OVL ETN NR Pu L2000A 501 HLO4 HIERCHCL CHILD CD SENDR PV COMPANY NM L2010AA 501 NM103 BILNG PROV ORGL NM OVL NONPRSN ENTY SENDR PV NPI ID L2010AA 5 1 NM109 PROV ID OVL CENTRS MEDCR MEDCD SVCS SENDR_PV ADD1 L2010AA 502 3 1 BILNG PROV ADRS LIN SENDR PV ADD2 L2010AA S02 N302 BILNG PROV ADRS LIN SENDR PV CITY L2010AA 503 01 BILNG PROV CITY NM SENDR PV STATE L2010AA 503 N402 STAT PROVNC CD CONVERT VARCHAR SENDR PV ZIP CD 0000 L2010AA 503 4 3 POSTL ZON ZIP CD SENDR PV TAX ID L2010AA 504 2 ID NR OVL EMPLYR ID NR 120008 501 HLO4 HIERCHCL CHILD CD ps L2000B 502 SBRO1 PAYR RESP SEQNC NR CD fg L2000B 502 SBRO2 INDVDL REL CD ep L2000B 502 SBRO9 FILNG IND CD SUB LAST NAME L2010BA 5 1 NM103 SUB LNAME OVL PERSN SUB FIRST NAME L2010BA 501 NM104 SUB FNAME SUB SSN L2010BA 501 NM109 PRIMRY ID OVL MEM ID
5. 401 CITY NM L2010BA 503 N402 STAT CD L2010BA 503 403 SUB POSTL ZON ZIP CD L2010BA S04 DMGO2 BIRTH DT OVL DT CCYYMMDD L2010BA 504 DMGO03 GENDR CD L2010BB 501 NM103 PAYR NM OVL NONPRSN ENTY L2010BB 501 NM109 PAYR ID OVL PAYR ID L2300 SO1 CLMO1 PATNT CONTRL NR L2300 501 CLMO2 TOTL CLM AMT 12300 501 CLMO5 01 PLAC SVC CD L2300 SO1 CLMO5 03 CLM FREQNCY CD OVL PLAC SVC CODS PROF DENTL L2300 501 CLMO6 PROV SUPLR SIGNTR IND Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 86 L2300 501 CLMO7 ASGNMNT PLAN PARTCPTN CD L2300 501 CLMO8 BENFTS ASGNMNT CERT IND 12300 501 CLMO9 RELS CD L2300 504 DTPO3 SVC DT OVL SVC RD8 L2400 501 LXO1 ASGND NR L2400 502 SV301 02 PROC CD OVL AMRCN DENTL ASCTN CD L2400 502 SV302 LIN CHG AMT Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 87 BIN 8371 Table This BIN table holds mappings matching that of a minimal 5010 837 Institutional A2 EDI file For additional possible mappings see the CGIF reference HTML file in the C chiapas docs CGIF folder Column Name Data Type Purpose BIN PK INT PK Primary Key Identity BIN ID INT Foreign key to the BIN LOG table 2 OEISA 501 ISA02 OVL NO AUTH OEISA 501 ISAO4 SEC NO SEC OEISA 501 15 06 SENDR ID OVL MUTLY DEFND ID OEISA 501 5
6. 3 1 BILNG PROV ADRS LIN L2010AA 502 N302 BILNG PROV ADRS LIN L2010AA 503 01 BILNG PROV CITY NM L2010AA 503 N402 STAT PROVNC CD Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 158 CONVERT VARCHAR SENDR PV ZIP CD 0000 L2010AA 503 03 POSTL ZON ZIP CD SENDR PV TAX ID L2010AA 504 2 ID NR OVL EMPLYR ID NR 120008 501 HLO4 HIERCHCL CHILD CD pt 120008 502 SBRO1 PAYR RESP SEQNC NR CD 18 120008 502 SBRO2 INDVDL REL CD or 120008 502 SBRO9 CLM FILNG IND CD SUB LAST_NAME L2010BA 501 NM103 SUB LNAME OVL PERSN SUB FIRST NAME L2010BA 501 NM104 SUB FNAME SUB SSN L2010BA 501 NM109 PRIMRY ID OVL MEM ID NR SUB ADDRESS L2010BA 502 3 1 ADRS LIN SUB CITY L2010BA 503 N401 CITY NM SUB STATE L2010BA 503 402 STAT CD SUB ZIP CODE L2010BA 503 03 SUB POSTL ZON ZIP CD SUB BIRTH DATE L2010BA 504 DMGO2 BIRTH DT OVL DT CCYYMMDD SUB SEX L2010BA 504 DMGO3 GENDR CD RECVR PV COMPANY NM L2010BB SO1 NM103 PAYR NM OVL NONPRSN ENTY RECVR PV TAX ID L2010BB 501 NM109 PAYR ID OVL PAYR ID RECVR_PV ADD1 L2 1 BB_S 2_N301_ADRS_LIN RECVR_PV CITY 1201088 503 01 CITY NM RECVR PV STATE L2010BB 503 N402 PAYR STAT PROVNC CD CONVERT VARCHAR RECVR PV ZIP CD 0000 L2010BB 503 03 PAYR POSTL ZON ZIP CD CLM CLAIM ID 12300 501 CLMO1 PATNT CONTRL NR SELECT dbo fx HIPAA NUMBER SUM CONVERT MONEY SERVICE CHARGE 1 COAL
7. 3 1 BILNG PROV ADRS LIN SENDR PV ADD2 L2010AA 502 N302 BILNG PROV ADRS LIN SENDR PV CITY L2010AA 503 01 BILNG PROV CITY NM SENDR PV STATE L2010AA 503 N402 STAT PROVNC CD CONVERT VARCHAR SENDR PV ZIP CD 0000 L2010AA 503 4 3 POSTL ZON ZIP CD SENDR PV TAX ID L2010AA 504 2 ID NR OVL EMPLYR ID NR L2000B 501 HLO4 HIERCHCL CHILD CD spe L2000B 502 SBRO1 PAYR RESP SEQNC NR CD 187 L2000B 502 SBRO2 INDVDL REL CD er L2000B 502 SBRO9 FILNG IND CD Once the view is updated we refresh the Chiapas Studio information to ensure that the information is being propagated 000001 ISA 00 00 ZZ GP CLINIC ID ZZ FBN HMO ID 140708 0121 00501 100000000 1 P 000002 GS HC GP CLINIC ID FBN HMO ID 20140708 0121 1 X 005010X222A1 000003 ST 837 100000000 005010X222A1 000004 BHT 0019 00 996305 20140708 0121 CH 000005 NM1 41 2 GEORGE PICKLE CLINIC 46 999488801 000006 PER IC GEORGE PICKLE JR TE 4155551212 000007 NM1 40 2 FLY BY NIGHT HMO 46 999488802 000008 HL 1 20 1 000009 NM1 85 2 GEORGE PICKLE CLINIC XX 123400001 000010 N3 4000 MAIN ST SUITE 201 000011 N4 ANYTOWN CA 000010000 000012 REF EI 999488801 000013 HL 2 1 22 0 000014 SBR P 18 CT 000015 SE 13 100000000 000016 GE 1 1 000017 IEA 1 100000000 Note that we can observe the HL values being automatically generated the SE segment count values automatically generated
8. AND SUB FIRST NAME CLM FIRST NAME AND SUB SSN CLM SSN INNER JOIN SELECT CLAIM ID SERVICE CODE 1 CD SERVICE DATE 1 DT SERVICE CHARGE 1 CH FROM BIN FBN WHERE BIN ID TMP_ID UNION SELECT CLAIM ID SERVICE CODE 2 CD SERVICE DATE 2 DT SERVICE CHARGE 2 CH Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 159 FROM BIN FBN WHERE BIN ID ID UNION SELECT CLAIM ID SERVICE CODE 3 CD SERVICE DATE 3 DT SERVICE CHARGE 3 CH FROM BIN FBN WHERE BIN ID TMP_ID UNION SELECT CLAIM ID SERVICE CODE 4 CD SERVICE DATE 4 DT SERVICE CHARGE 4 CH FROM BIN FBN WHERE BIN ID TMP_ID SVC ON SVC CLAIM ID CLM CLAIM ID AND SVC CD lt gt SELECT ID2 The final statement selects the value of the new BIN ID in this way the stored procedure can supply a value back to the automation for the next step in the process Returning to our workflow CSVLegacy xaml we need to add a new variable to the CGateContext object called strBinID that will accept the new output from the stored procedure Instead of declaring it as string we ll just set it as object so that it can be used with the CGateCNNSQLGetScalar activity Next we add the CGateCNNSQLGetScalar activity and copy all values from the CGateCNNSQLExec activity put in the strBinID reference to the Result field and then delete the CGateCNNSQLExec activity CNNName TriggerDB EZ CNNSQL EXEC USP PROCESS CSV strEventI
9. Finally it is critical to have access to properly licensed HIPAA Implementation Guides as published by the Washington Publishing Company wpc edi com They are the sole publishers on behalf of the national standards body ASC X12 Even though an enterprise may receive a companion guide from a trading partner it should be explicitly understood that all such companion guides are supplements to the core HIPAA Implementation Guides and will not contain the information necessary to properly handle HIPAA EDI transactions Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 2 INSTALLING CHIAPAS EDI ENTERPRISE REQUIREMENTS Chiapas EDI Enterprise requires the following minimum hardware requirements 64 Bit Windows Operating System Windows 7 Windows Server 2008 R2 Windows 8 or Windows Server 2012 NET 4 0 Although installed by default on Windows 7 and 8 it is normally an optional Feature on Server operating systems SQL Server 2012 R2 or Above Express or Standard versions 8 GB of RAM 5GB Free disk space Local Administrator rights when installing By default Chiapas EDI installs to a fixed directory on the C drive C chiapas This cannot be reconfigured so itis important at least 5 GB is free on the C drive Although the default workflows are also tied to the C drive this is completely reconfigurable INSTALLATION 1 2 Chiapas EDI Enterprise is distributed as a single MSI file To run it dou
10. This activity handles 1 0 for the SegPoolAck register which is an internal representation of a 999 file See the CGateAckParse and CGateAckGenerate activities for more information CGateMsg CGateMsg Action Add Full Error v string bata Enter a VB expression Parameters ActionType string See Entera VE eee IntData01 int IntData02 int Mesg string MesgData string ErrorMessages None Purpose This activity controls the ErrLog register It can be used to clear the message log or create custom user messages When a workflow completes all messages in the ErrLog register are automatically recorded to the chiapasData MSGLOG table Actions Add Simple Message This adds a message to the message log Add Full Message This action adds a complex message to the log including string data and numeric data values Add Simple Error Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 110 Adds a single message to the log and flags as an error Add Full Error Adds a complex error and flags it as an error Clear Clears the message log Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 111 CGateAckParse Parameters None Error Messages SegPoolAck Register is not loaded Unrecognized Segment ID Unexpected Segment Required Segment Missing Loop Occurs Over Maximum Times Segment Exceeds Maximum Use Segment not
11. 5 09 DT OEISA 501 ISA10 TM OEISA 501 ISA11 REPTN SEPRTR OEISA SO1 ISA12 VERSN NR OEISA SO1 ISA13 ICN OEISA SO1 ISA14 ACK REQ OEISA SO1 ISA15 USG IND OEISA SO1 ISA16 SUBELE SEP OEISA 503 IEAO2 ICN GSHDR 501 GSO2 APP SENDR CD GSHDR 501 6503 APP RECVR CD GSHDR 501 6504 DT GSHDR 501 6505 TM GSHDR 501 6506 GCN GSHDR 503 GEO2 GCN STHDR 501 STO2 CONTRL NR STHDR 501 STO3 GUID VERSN NM STHDR SO2 BHTO1 STRUCTR CD STHDR 502 BHTO3 SUBMTR TRANSCTN 10 STHDR 502 BHTO4 TS CREATN DT STHDR 502 BHTO5 TS CREATN TIM Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Purpose Primary Key Identity Foreign key to the BIN LOG table Page 74 STHDR 502 BHTO6 TRANSCTN TYPE CD STHDR 504 SEO2 L2000A 501 HLO1 HIERCHCL ID NR L2000A 501 HLO4 HIERCHCL CHILD CD L2010A X3 501 NM102 ENTY TYPE QUAL L2010A X3 501 NM103 UMO NM LAST ORG NM L2010A X3 501 NM109 ID CD OVL EMPLYR ID NR L2000B SO1 HLO1 HIERCHCL ID NR L2000B SO1 HLO2 HIERCHCL PARNT ID NR L2000B 501 HLO4 HIERCHCL CHILD CD L2010B 1P 501 2 ENTY TYPE QUAL L2010B 1P 501 NM103 REQSTR LAST ORG NM L2010B 1P 501 NM104 REQSTR FNAME L2010B 1P 501 NM109 REQSTR ID OVL EMPLYR ID NR L2000C 501 HLO1 HIERCHCL ID NR L2000C SO1 HLO2 HIERCHCL PARNT ID NR L2000C 501 HLO4 HIERCHCL CHILD CD L2010C 501 NM103 SUB LNAME L2010C 501 NM104 SUB FNAME L2010C 501
12. DTMO2 02 CLM DT OVL CLM STATMNT PERD END L2100 518 2 6 SUPP AMT OVL COVG AMT L2110 501 SVCO1 02 ADJDCTD PROC CD OVL HCPCS CD L2110 SO1 SVCO2 LIN ITM CHG AMT L2110 501 SVCO3 LIN ITM PROV AMT L2110 SO1 SVCO5 UNTS SVC PD CT L2110 S02 DTMO2 SVC DT OVL SVC L2110 S03 CASO1 CLM CD L2110 S03 CASO2 ADJ RSN CD L2110 S03 CASO3 ADJ AMT Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 83 BIN 837D Table This BIN table holds mappings matching that of a minimal 5010 837 Dental A2 EDI file For additional possible mappings see the CGIF reference HTML file in the C chiapas docs CGIF folder Column Name Data Purpose Type BIN PK INT PK Primary Key Identity BIN ID INT Foreign key to the BIN LOG table V2 OEISA 501 5 2 AUTH OVL NO AUTH OEISA 501 ISAO4 SEC NO SEC OEISA 501 15 06 SENDR ID OVL MUTLY DEFND ID OEISA 501 5 RECVR ID OVL MUTLY DEFND ID OEISA 501 5 09 DT OEISA SO1 ISA10 TM OEISA SO1 ISA11 REPTN SEPRTR OEISA SO1 ISA12 VERSN NR OEISA SO1 ISA13 ICN OEISA SO1 ISA14 ACK REQ OEISA SO1 ISA15 USG IND OEISA SO1 ISA16 SUBELE SEP OEISA 503 IEAO2 ICN GSHDR 501 GSO2 APP SENDR CD GSHDR 501 6503 APP RECVR CD GSHDR 501 6504 DT GSHDR 501 6505 TM Copyright 2015 Chi
13. Element Repeat Counter The new 5010 Implementation Guide allows a select few elements to have a new feature element repeats In this situation a single element or group of composite elements can iterate a number of times with the separate iterations delineated by the Element Repeat character described within character 83 of the ISA segment When an element repeats the second repetition has an X02 identifier inserted after the Segment Code amp Element Identifier section of the field name Composite Element Identifier If the element being referenced is a composite element a second zero prefixed number along with a separation underscore follows the Element Identifier above to identify the composite element Segment Repeat Counter If the segment iterates two or more times then this component relays the iteration of that segment Just as a loop iteration this value is prefixed with an I followed by a zero prefixed two digit number Element Abbreviation This is an abbreviated name of the element Qualified Overload Abbreviation If this mapped element is qualified by a value in another element generally the previous element acts as the qualifier to indicate what kind of identifier is present then the mapped element will always be accompanied by a suffix that indicates the value in the qualifier element Examples Scenario 1 Claim Note Segment Iterations The twenty fourth segment in the 5010 837 I 2300 loop is the Claim Note
14. Examining the vw Export 837P view it appears to draw many defaulted values from the SAMPL TRAD PARTNER and SAMPL PROVIDER tables Our first step would then be to replicate these tables to production tables and insert the new defaults according to the business requirements In order to satisfy the deliverables we will need to create entries for the following Table PROD TRAD PARTNER FBN HMO UPLOAD 1 2 SPACE 10 SPACE 10 GP CLINIC ID SPACE 3 FBN HMO ID SPACE 5 A 1 row describing the elements for a transaction from PB Clinic to FBN HMO INSERT INTO PROD TRAD PARTNER SELECT TP NAME SENDR PROV ID RECVR PROV ID ISA02 ISA04 ISA06 SENDR ID ISA08 RECVR ID ISA11 REPTN SEP PROD PROVIDER 1 ISA14 ACK REQ tpt ISA15_USG_IND s ISA16 SUBELE SEP 100000000 ICN 1 GCN 100000000 TCN GP CLINIC ID 6502 APP SENDR CD FBN HMO ID 4503 APP RECVR CD Table INSERT INTO PROD PROVIDER SELECT 999488801 TAX ID 123400001 NPI ID GEORGE PICKLE CLINIC COMPANY NM NULL FIRST_NM 5 rows describing the rows for all of the entities involved One each for the sender and receiver GP Clinic and FBN HMO and three additional providers to represent the three sites that are generating claims The autonumber will automatically assign a PROV_ID to each of the rows Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 142 NULL LAST NM 4000
15. HI BK V7283 000021 LX 1 000022 When we research Loop 2010BB in the HIPAA Implementation Guide we see that the Payer loop is required In this case the Payer Provider is the same as the Receiving Provider so we merely have to repeat some mappings for the 2010BB loop and we fulfill the requirement Here is the vw Extract FBN in its entirety SV1 HC 99213 42 UN 1 ALTER VIEW dbo vw Export FBN AS SELECT ISA02 ISA04 ISA06 SENDR ID ISA08 RECVR ID ISA11 REPTN SEP 501 ICN ISA14 ACK REQ ISA15 USG IND ISA16 SUBELE SEP ICN GS02 APP SENDR CD GS03 APP RECVR CD GCN 005010X222A1 GCN TCN 005010X222A1 TCN 0019 apt X1_OEISA_S 1_ISA 2_AUTH_NFO_OVL_NO_AUTH_NFO OEISA 501 ISAO4 SEC OVL NO SEC OEISA 501 ISA06 SENDR ID OVL MUTLY DEFND ID OEISA 501 ISAO8 RECVR ID OVL MUTLY DEFND ID OEISA 501 ISA11 REPTN SEPRTR OEISA 501 ISA12 VERSN NR OEISA 501 ISA13 ICN OEISA 501 ISA14 REQ OEISA 501 ISA15 USG IND OEISA 501 ISA16 SUBELE SEP OEISA 503 IEAO2 GSHDR 501 GS02 APP SENDR CD GSHDR 501 0503 APP RECVR CD GSHDR 501 0506 GCN GSHDR 501 0508 VERS ID CD GSHDR S03 2 GCN STHDR 501 STO2 CONTRL NR STHDR 501 STO3 IMPLMNTN GUID VERSN NM STHDR 506 5 2 STHDR S02 BHTO1 STRUCTR CD STHDR S02 2 TS PURPS CD Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 151
16. Separator Composite Element Separator and whether it has Carriage Return Line Feed formatting at the end of each segment Also it gives an option to scrub Protected Health Information from the file prior to saving SegPool to File Exports the loaded SegPool register File to SegPool Imports an EDI file to the SegPool register CR Setting CR will append a Carriage Return ASCII 13 character to each segment LF Setting LF will append a LineFeed ASCII 10 character to each segment Scrub PHI Setting this option before exporting will scrub it of Protected Healthcare Information Dates Names and Identifiers will be altered from the originals Note that this is merely a best guess to filter out the most common pieces of publically identifiable information the only way to guarantee a file contains no PHI is to manually review and alter the file SegPool File File name of the file to be loaded or saved Double clicking on the textbox will bring up an Open File or Save File dialog SegSeg Segment Separator EleSep Element Separator Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 33 SubEleSep Sub Element Separator 999 Ack File 999 Ack 999 ACK to File Execute O File to 999 ACK Parse 999 Generate 999 ACK 999 File Chiapas EDI 2012 has limited built in support for 999 transactions A 999 transaction is generally a tool clearinghouses and trading par
17. Since we are not supplying these necessary values to the encoder it generates these values on its own View vw Export FBN Deliverable 1 E The HIPAA Implementation Guide describes Hierarchical Level structures where information is aggregated by increasing specificity one level is Subscriber the next level is Claim then Service Line Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 147 Therefore we need to rearrange the information within the CSV data source so that it fits in this hierarchical system For Deliverable 1 E we need to fulfill the requirements for the 2000B Hierarchical Level which means supplying correct information for the 2010BA Subscriber Loop We ll start with a simple aggregation SELECT statement SELECT LAST NAME FIRST NAME REPLACE SSN SSN ADDRESS CITY STATE ZIP CODE REPLACE BIRTH DATE BIRTH DATE SEX FROM BIN FBN GROUP BY LAST NAME FIRST NAME REPLACE SSN ADDRESS CETY STATE ZIP CODE REPLACE BIRTH DATE SEX Notice that by scrubbing out the dashes in the output the fields now follow HIPAA compliant syntax Next we map the results of this query into the View SUB LAST_NAME L2010BA 501 NM103 SUB LNAME OVL PERSN SUB FIRST NAME L2010BA 501 NM104 SUB FNAME SUB SSN L2010BA 501 NM109 PRIMRY ID OVL MEM ID NR SUB ADDRESS L2010BA 502 N301 ADRS LIN SUB CITY L2010BA 503 01 CITY NM SUB STATE L2
18. the best way to validate the data operation is fully complete is to check the FSTOR PENDS table to ensure the data is successfully written Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 14 009 EncodeFromCSV Directories 01 in csv 02 out edi 03 done csv 04 err csv Any CGIF Flat formatted CSV file exactly the same as produced from the output of Pipeline 004 dropped into the input directory will be translated to an EDI file and placed in the output directory If there is an error processing the CSV file it will be moved to the Err directory 010 EncodeFromXML Directories 01 in xml 02 out edi 03 done xml 04 err xml Any CGIFXML2 Formatted XML file the same as produced from the output of Pipeline 005 dropped into the input directory will be translated to an EDI file and placed in the output directory If there is an error processing the XML file it will be moved to the Err directory 011 EncodeFromXMLDB Directories 01 out edi EVENT Parameters EVENT XML ID reference to a row within the XML STOR table EVENT 2 Filename of the file to create within the output directory This is a passive pipeline in that it is not triggered via the normal background automation system but rather a direct insert into the EVENTS table This pipeline works similarly to Pipeline 010 in that it encodes an EDI file from XML data but instead of sourcing it from a data file placed in a directory
19. true D Data Source TUTORIAL_834 Table Next ensure the connection string in Data Source is correct For this demo the default connection string points to the chiapasData database that is set up as part of the installation instructions Select the Flat to Table radio button and then press EXECUTE Next open up SQL Server Management Studio open a new query on the chiapasData database and run the following query EXEC SP COLUMNS TUTORIAL 834 The results show the columns that have been created in the new table which should contain 23 rows of data Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 7 COLUMN NAME OEISA 501 ISA02 OVL NO OEISA 501 5 04 SEC PASSWD OEISA 501 5 06 SENDR ID OVL DEFND ID OEISA 501 5 08 RECVR ID OVL MUTLY DEFND ID OEISA 501 5 09 DT OEISA 501 ISA10 TM OEISA 501 ISA11 REPTN SEPRTR OEISA 501 ISA12 VERSN NR OEISA 501 ISA13 ICN OEISA 501 ISA14 ACK REQ OEISA 501 ISA15 USG IND OEISA 501 ISA16 SUBELE SEP OEISA 503 GS CT OEISA 503 2 ICN GSHDR S01 GS02 APP SENDR CD GSHDR 501 GS03 APP RECVR CD GSHDR 501 GS04 DT GSHDR 501 GS05 GSHDR 501 GS06 GSHDR 501 GSOS8 VERS ID CD 65 503 GEO1 TS CT GSHDR S03 6 02 GCN STHDR 501 STO2 CONTRL NR STHDR 501 STO3 REFNC STHDR S02 BGNO1 TS PURPS CD STHDR S02 BG
20. BHTO1 STRUCTR CD STHDR 502 BHTO2 TS PURPS CD STHDR 502 BHTO3 SUBMTR TRANSCTN 10 Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Purpose Primary Key Identity Foreign key to the BIN LOG table Page 62 STHDR 502 BHTO4 TS CREATN DT STHDR 502 BHTO5 TS CREATN TIM STHDR 504 SEO2 L2000A SO1 HLO1 HIERCHCL ID NR L2100A PR SO1 NM103 NFO SOURC LAST ORG NM OVL NONPRSN ENTY L2100A PR 501 NM109 SOURC PRIMRY ID OVL FED TAX NR L2000B SO1 HLO1 HIERCHCL ID NR L2000B SO1 HLO2 HIERCHCL PARNT ID NR L2100B 1P 501 3 RECVR LAST ORG NM NONPRSN L2100B 1P 501 NM109 RECVR ID NR OVL FED TAX ID NR L2000C 501 HLO1 HIERCHCL ID NR L2000C SO1 HLO2 HIERCHCL PARNT ID NR L2000C 501 HLO4 HIERCHCL CHILD CD L2100C 501 NM102 ENTY TYPE QUAL L2100C 501 NM103 SUB LNAME L2100C 501 NM104 SUB FNAME L2100C 501 NM109 PRIMRY ID OVL MEM ID NR L2100C S06 DMGO2 BIRTH DT OVL DT CCYYMMDD L2100C S06 DMG03 GENDR CD L2110C SO1 EQO1 SVC TYPE CD Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 63 BIN 271 Table This BIN table holds mappings matching that of a minimal 5010 271 A1 EDI file For additional possible mappings see the CGIF reference HTML file in the C chiapas docs CGIF folder Column Name Data Type BIN PK INT PK BIN ID INT N1 OEISA 501 5 2 AUTH OVL NO AUTH
21. CAchiapas hig x217 pdf CAchiapas hig x217 pdf 5010_820 CAchiapas hig x218 pdf 5010_834 CAchiapas hig x220 pdf 5010_835 CAchiapas hig x221 pdf 5010 837D CAchiapas hig x224 pdf 5010 8371 CAchiapas hig x223 pdf 5010 837P CAchiapas hig x222 pdf GUI Options 1 Refresh Segment Pane on Encode This checkbox controls whether the Segment Pane is displayed after an Encode operation If you are working with extremely large files this can prevent long freezes within the user interface 2 Refresh HKey Pane on Decode Whenever a HIPAA file is decoded the XML within the HKey pane is automatically refreshed If you are working with HIPAA files more than 5 MB in size this can lead to user interface freezes Deactivating the interface has no bearing on the underlying registers working properly 3 Enable Flat Data Pane Again when working with large data sets disabling the display refresh can increase user interface performance Clear Notification Area This will reset the notification window in the upper right hand corner Clear Messages Clear the message log register Reset All This will completely reset the internal state object When handling different files it is normal to select this option to make sure no error messages or registers are left over from a previous operation Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 40 WORKFLOW INTERFACE Chiapas Studio is
22. EDI Technologies Inc All Rights Reserved Page 45 The main interface is divided into three areas The main interface elements are in the bottom left quadrant of the screen At the top left is a list showing Active Triggers All Triggers and Pending Events On the right is an area reserved for showing message logs from selected events Trigger Info Tab Name This is the name and or description of the Trigger Enabled This determines if a trigger is actively polled or not Poll Interval This is the time in seconds to wait between polls to this trigger Setting this value very low 5 or 15 will mean that this poll will be checked very often The user should balance between responsiveness from the automation system and excessive resource usage by the background service generally values of 15 to 30 are best Workflow File This is the XAML workflow file to run when the trigger is fired Double clicking into the window will bring up an Open File dialog New Pressing this will create a new inactive trigger with a default name In order to change the information from the defaults click on it in the All Triggers tab at top enter in the correct information and then press SAVE Delete This allows you to delete an existing trigger from the automation system The XAML workflow file will not be affected Save This button commits any changes made to the trigger information to the backend database Any changes made to the trig
23. Error with SMTP Activity Subject Error with SMTP Activity Message Body Error with SMTP Activity Sender Error with SMTP Activity Receiver Error with SMTP Activity creating network credentials Error with SMTP Activity getting server Error with SMTP Activity SSL argument must be set to true or false Error with SMTP Activity error on sending message Purpose This activity will open a connection to an SMTP SendMail server and send out an Email with the specified login credentials EMailBody The main text of the Email A string variable or expression can x EMailBody String be supplied or a tagged XML expression such as the following eon can be used to easily embed variables Critical error processing received file lt strFileName gt Please contact customer support at 888 555 1212 lt string gt Value If the expression resolves to HTML an HTML formatted Email will be transmitted OK Cancel EmailReceiver This string should contain at least one valid Email address Multiple Email addresses can be specified by separating them with a semicolon EMailSender The Email address of the sending party Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 134 EMailSubject Subject of the Email SMTP Host Server name or IP address of the SendMail server Example smtp gmail com SMTP Password Password used for the SendMail logi
24. GSHDR 501 6505 TM GSHDR 501 6506 GCN GSHDR 501 6508 VERS ID CD GSHDR 503 GEO1 TS CT GSHDR S03 2 GCN STHDR 501 STO2 CONTRL NR STHDR 502 BHTO1 STRUCTR CD STHDR 502 BHTO2 TS PURPS CD STHDR 502 BHTO3 ORGNTR APLCTN TRANSCTN ID STHDR 502 BHTO4 TS CREATN DT STHDR 502 BHTO5 TS CREATN STHDR 502 BHTO6 CLM ENCNTR ID STHDR SO6 SEO1 SEG CT STHDR 506 SEO2 L1000A 501 NM103 SUBMTR LAST ORG NM OVL NONPRSN ENTY L1000A 501 NM109 SUBMTR ID OVL ETN NR L1000A 502 PERO2 CONTCT NM L1000A 502 PERO4 COMM NR OVL TELPHN L1000B 501 NM103 RECVR NM OVL NONPRSN ENTY L1000B 501 NM109 PRIMRY ID OVL ETN NR L2000A SO1 HLO1 HIERCHCL ID NR L2010AA SO1 NM103 LAST ORGL NM OVL NONPRSN ENTY Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 93 L2010AA 502 N301 BILNG PROV ADRS LIN L2010AA 503 01 BILNG PROV CITY L2010AA 503 N402 STAT PROVNC CD L2010AA 503 N403 POSTL ZON ZIP CD L2010AA 504 REFO2 ID NR OVL EMPLYR ID NR L2000B SO1 HLO1 HIERCHCL ID NR L2000B SO1 HLO2 HIERCHCL PARNT ID NR L2000B SO1 HLO4 HIERCHCL CHILD CD L2000B SO2 SBRO1 PAYR RESP SEQNC NR CD L2000B 502 SBRO2 INDVDL REL CD L2000B 502 SBRO9 CLM FILNG IND CD L2010BA 501 NM103 SUB LNAME OVL PERSN L2010BA 501 NM104 SUB L2010BA 501 NM109 ID OVL MEM ID NR L2010BA SO2 N301 ADRS LIN L2010BA 503 CITY NM L2010BA 503 02 STAT CD L2010BA 503 N403 SUB POSTL ZON ZIP CD L2010BA 504 DMGO2 BIRTH DT OVL DT CCY
25. ID ISA08 RECVR ID ISA11 REPTN SEP 501 ICN ISA14 ACK REQ ISA15 USG IND ISA16 SUBELE SEP ICN GS02 APP SENDR CD GS03 APP RECVR CD GCN X1 OEISA 501 ISA02 AUTH OVL NO OEISA 501 ISAO4 SEC OVL NO SEC OEISA 501 ISA06 SENDR ID OVL MUTLY DEFND ID OEISA 501 ISAO8 RECVR ID OVL MUTLY DEFND ID OEISA 501 ISA11 REPTN SEPRTR OEISA 501 ISA12 VERSN OEISA 501 ISA13 ICN OEISA 501 ISA14 REQ OEISA 501 ISA15 USG IND OEISA 501 ISA16 SUBELE SEP OEISA S03 IEAO2 GSHDR 501 0502 APP SENDR CD GSHDR 501 GS03 APP RECVR CD GSHDR 501 6506 GCN it to these new Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 145 005010X222A1 GSHDR 501 0508 VERS ID CD GCN GSHDR S03 2 GCN TCN STHDR 501 STO2 CONTRL NR 005010X222A1 STHDR 501 STO3 IMPLMNTN GUID VERSN NM TCN STHDR 506 5 2 0019 STHDR 502 BHTO1 STRUCTR CD STHDR S02 2 TS PURPS CD RIGHT CONVERT VARCHAR RAND DATEPART mm GETDATE 100000 DATEPART ss GETDATE 1000 DATEPART ms GETDATE 6 STHDR 502 3 ORGNTR APLCTN TRANSCTN ID CH STHDR S02 6 CLM ENCNTR ID SENDR PV COMPANY NM L1000A SO1 NM103 SUBMTR LAST ORG NM OVL NONPRSN ENTY SENDR PV TAX ID L1000A 501 NM109 SUBMTR ID OVL NR SENDR PV CONTACT NM L1000A S02 PERO2 CONTCT NM SENDR PV WORK PH 11000 5
26. L2000C SO1 HLO2 HIERCHCL PARNT ID NR L2000C 501 HLO4 HIERCHCL CHILD CD L2100C 501 NM103 SUB LNAME L2100C 501 NM104 SUB FNAME L2100C 501 NM109 PRIMRY ID OVL MEM ID NR L2100C SO3 N301 ADRS LIN L2100C 504 401 CITY NM L2100C 504 N402 STAT CD L2100C 504 403 SUB POSTL ZON ZIP CD L2100C S10 DTPO3 DT TM PERD OVL PLAN D8 L2100C S10 DTPO3 02 DT TM PERD OVL ELIG BEGN D8 L2110C SO1 EBO1 BENFT NFO L2110C SO1 EBO3 SVC TYPE CD Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 65 BIN 276 Table This BIN table holds mappings matching that of a minimal 5010 276 EDI file For additional possible mappings see the CGIF reference HTML file in the C chiapas docs CGIF folder Column Name Data Type BIN PK INT PK BIN ID INT OO OEISA 501 ISA02 OVL AUTH OEISA 501 ISAO4 SEC NO SEC OEISA 501 15 06 SENDR ID OVL MUTLY DEFND ID OEISA 501 5 RECVR ID OVL MUTLY DEFND ID OEISA 501 5 09 DT OEISA 501 ISA10 TM OEISA 501 ISA11 REPTN SEPRTR OEISA SO1 ISA12 VERSN NR OEISA SO1 ISA13 ICN OEISA SO1 ISA14 ACK REQ OEISA SO1 ISA15 USG IND OEISA SO1 ISA16 SUBELE SEP OEISA 503 IEAO2 ICN GSHDR 501 GSO2 APP SENDR CD GSHDR 501 4503 APP RECVR CD GSHDR 501 6504 DT GSHDR 501 6505 TM GSHDR 501 6506 GCN 65 S03 GEO2 GCN STHDR SO1 STO2 CONTRL NR ST
27. MAIN ST ADD1 SUITE 201 ADD2 ANYTOWN CITY CA STATE 00001 ZIP_CD GEORGE PICKLE JR CONTACT_NM 4155551212 WORK PH NULL EMAIL UNION SELECT 999488802 TAX ID 123400002 NPI ID FLY BY NIGHT HMO COMPANY NM NULL FIRST NM NULL LAST NM 100 MAIN ST ADD1 NULL ADD2 ANYTOWN CITY CA STATE 00001 ZIP CD MICHAEL NIGHT CONTACT NM 4155551213 WORK PH NULL EMAIL UNION SELECT 999488801 TAX ID 123400001 NPI ID GP FELIX LOCATION COMPANY NM NULL FIRST NM NULL LAST NM 101 CAT ST ADD1 NULL ADD2 ANYTOWN CITY 09001 ZIP CD NULL CONTACT NM NULL WORK PH NULL EMAIL UNION SELECT 999488801 TAX ID 123400001 NPI ID GP JELLY LOCATION COMPANY NM NULL FIRST NM NULL LAST NM 303 PEANUT BUTTER AVE ADD1 NULL ADD2 ANYTOWN CITY CA STATE 09001 ZIP CD NULL CONTACT NM NULL WORK PH NULL EMAIL UNION SELECT 999488801 TAX ID 123400001 NPI ID GP UNLIT LAB COMPANY NM NULL FIRST NM NULL LAST NM 1000 MAD SCIENTIST WY ADD1 NULL ADD2 ANYTOWN CITY CA STATE 00001 ZIP_CD Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 143 NULL CONTACT NM NULL WORK NULL EMAIL Table BIN FBN Before we can get further we ll need to get the storage area for the legacy CSV file set up Using that as a data source we will have the data available to feed into
28. NM102 ENTY TYPE QUAL L2100B 501 NM103 RECVR LAST ORG NM L2100B 501 NM109 RECVR ID NR OVL ETN NR L2000C SO1 HLO1 HIERCHCL ID NR L2000C SO1 HLO2 HIERCHCL PARNT ID NR L2000C 501 HLO4 HIERCHCL CHILD CD L2100C 501 NM102 ENTY TYPE QUAL L2100C 501 NM103 PROV LAST ORG NM L2100C 501 NM109 PROV ID OVL FED TAX ID NR L2000D SO1 HLO1 HIERCHCL ID NR L2000D 501 HLO2 PARNT ID NR L2000D 501 HLO4 HIERCHCL CHILD CD L2100D 501 NM103 SUB LNAME OVL PERSN L2100D 501 NM104 SUB FNAME L2100D 501 NM109 SUB ID OVL MEM ID NR L2200D 501 TRNO2 REFNCD TRANSCTN TRAC NR L2200D 502 STCO1 01 HLTHCR CLM STATS CATGRY CD L2200D 502 STCO1 02 STATS CD L2200D 502 STCO2 STATS EFF DT L2200D 503 REFO2 PAYR CONTRL NR OVL PAYR CLM NR L2200D 509 DTPO3 SVC PERD SVC RD8 Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 69 BIN 277CA Table This BIN table holds mappings matching that of a minimal 5010 277CA EDI file For additional possible mappings see the CGIF reference HTML file in the C chiapas docs CGIF folder Column Name BIN PK BIN ID P5 OEISA 501 ISA02 AUTH OVL NO AUTH OEISA 501 ISAO4 SEC NO SEC OEISA 501 5 0 6 SENDR ID OVL MUTLY DEFND ID OEISA 501 5 RECVR ID OVL MUTLY DEFND ID OEISA 501 5 09 DT OEISA SO1 ISA10 TM OEISA SO1 ISA11 REPTN SEP
29. RECVR ID OVL MUTLY DEFND ID OEISA 501 5 09 DT OEISA SO1 ISA10 TM OEISA SO1 ISA11 REPTN SEPRTR OEISA SO1 ISA12 VERSN NR OEISA SO1 ISA13 ICN OEISA SO1 ISA14 ACK REQ OEISA SO1 ISA15 USG IND OEISA SO1 ISA16 SUBELE SEP OEISA 503 IEAO2 ICN GSHDR 501 4502 APP SENDR CD GSHDR 501 6503 APP RECVR CD GSHDR 501 6504 DT GSHDR 501 6505 TM GSHDR 501 6506 Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 88 GSHDR 501 GSO8 VERS ID CD GSHDR 503 GEO2 STHDR SO1 STO2 CONTRL NR STHDR SO2 BHTO1 STRUCTR CD STHDR 502 BHTO2 TS PURPS CD STHDR 502 BHTO3 ORGNTR TRANSCTN ID STHDR 502 BHTO4 TS CREATN DT STHDR 502 BHTO5 TS CREATN TIM STHDR 502 BHTO6 CLM ID STHDR 506 5 02 L1000A 501 NM103 SUBMTR LAST ORG NM NONPRSN 1000 501 NM109 SUBMTR ID OVL NR L1000A SO2 PERO2 CONTCT NM L1000A 502 PERO4 COMM NR OVL TELPHN L1000B 501 NM103 RECVR NM OVL NONPRSN ENTY L1000B SO1 NM109 PRIMRY ID OVL ETN NR L2000A SO1 HLO1 HIERCHCL ID NR L2010AA SO1 NM103 BILNG PROV ORGL NM OVL NONPRSN ENTY L2010AA SO2 N301 BILNG PROV ADRS LIN L2010AA 503 N401 BILNG PROV CITY NM L2010AA 503 N402 STAT PROVNC CD L2010AA 503 403 POSTL ZON ZIP CD 2010 504 REFO2 ID NR OVL EMPLYR ID NR Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Pa
30. SegPool register will be set to a new set of segments and elements The specific rules for creating valid EDI files are covered in the HIPAA Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 118 Implementation Guides and are beyond the scope of this manual the thirteen vw Export views bundled with the distribution database can be used as a starting point of the minimal data elements needed to create a compliant transaction CGatex ltDecode Parameters None Error Messages Data present on an element marked as Unused Element x data Mismatch with Data Type AN 1 80 Missing qualifier for an identifier This element is not a valid value for this element This element is not a valid value for this element Data not present on an element marked as Required Data not present on an element marked as Required Premature End of File Detected Mandatory Segment Loop Name 501 SegName Not Found Mandatory Loop Loop Name Not Found Segment LoopName SegmentName Exceeded Maximum Iterations max Loop LoopName Exceeded Maximum Iterations iterations Insufficient segments found within source X12 file Insufficient elements in the Group Envelope GS segment This is not a HIPAA 4010 5010 file The Element Separator Segment Separator and Composite Element Separator characters defined in the ISA segment must all be different ChiapasGate could not determine the specification from
31. TSRC 10 lt f EVENT ID t MSGLOG ID TSRC ID EVENT ID FILES t FILE ID TSRC_ID Note In the relationship diagram above the underlined column name is the primary key while the other fields represent foreign keys Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 51 TSRC Table This table is responsible for storing active and inactive triggers The different types of triggers are covered in the chapter on the Scheduling System Column Name TSRC ID TSRC ENABLED TSRC TYPE WF FILENAME TSRC POLL INTERVAL NAME TSRC DATAO1 TSRC_DATAO2 TSRC_DATAO3 TSRC_DATA04 TSRC_DATAO5 TSRC_CREATEDAT Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Data Type INT PK INT VARCHAR 50 VARCHAR 250 INT VARCHAR 50 VARCHAR 4000 VARCHAR 4000 VARCHAR 4000 VARCHAR 4000 VARCHAR 4000 DATETIME Purpose Primary Key Identity 0 Trigger Disabled 1 Trigger Enabled Indicates the type of trigger Valid values SCHEDULED EVENT SQL TRIGGERED EVENT LOCAL UPLOAD DIRECTORY EVENT LOCAL ARCHIVE DIRECTORY EVENT Full path to the Workflow XAML file that is executed as part of the event spawned by this trigger This is the number of seconds the background ChiapasService will wait between checks for this trigger Caution should be exercised when setting this to a value less than 60 This number of seconds should always b
32. They are created by the activities within a Chiapas EDI Enterprise workflow and the possible error messages are documented within each activity Column Name MSGLOG ID Origin Message MsgData Str MsgData Num1 MsgData Num2 IsError TimeStamp EVENT ID MSGLOG NR Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Data Type INT PK VARCHAR 200 VARCHAR 200 VARCHAR 200 VARCHAR 200 VARCHAR 200 VARCHAR 200 VARCHAR 200 INT VARCHAR 200 Purpose Primary Key Identity Chiapas EDI Module that created the message Error Message Message Data String Message Data Num 1 Message Data Num 2 Flags whether this message is an error Timestamp of when the error was generated ID of the triggering Event Number indicating the sequence of the message within the event Page 55 FSTOR FILES Table This table stores filenames associated with an archive directory An archive directory is defined as a holding area that holds a number of uniquely named files As new files appear in that directory the automation system will trigger a workflow to act upon that file This table assists the automation system in deciding when a new file arrives At specific interval all of the files in a directory are compared with entries in this directory Note that this gets increasingly inefficient the more files accumulate in a directory it is recommended that files should be archived so that the total number of files in a d
33. WorkerProcess crash or hang the ChiapasService will restart it Stopping ChiapasService will also stop all WorkerProcesses If the ChiapasService process is killed the running WorkerProcesses will automatically exit The pipelines included with the distribution are located in C chiapas pipeline as follows All of these are active once the installation is complete and the ChiapasService is started Active Triggers All Triggers Pending Events TSRC ID TSRC TYPE TSRC NAME TSRC WF FILENAME SCHEDULED EVENT Pipeline 012 EncodeFromBINDB C chiapas xaml Pipeline 012 EncodeFromBINDB xaml SCHEDULED EVENT Pipeline 011 EncodeFromXMLDB chiapas xaml Pipeline 011 EncodeFromXMLDB xaml LOCAL UPLOAD DIRECTORY EVENT Pipeline 1 EncoderromxML chiapas xaml Pipeline 010 EncodeFromXML xaml LOCAL UPLOAD DIRECTORY EVENT Pipeline ee9 Encoderromcsv chiapas xaml Pipeline 009 EncodeFromCSV xaml LOCAL UPLOAD DIRECTORY EVENT Pipeline 8_DecodeToBINDB_ForceMerge C chiapas xaml Pipeline_ 8_DecodeToBINDB_ForceMerge xam E LOCAL UPLOAD DIRECTORY EVENT Pipeline 067 DecodeToBINDB Merge chiapas xaml Pipeline 007 DecodeToBINDB Merge xaml LOCAL UPLOAD DIRECTORY EVENT Pipeline eee DecodeToxMLDE chiapas xaml Pipeline_8 6_DecodeToXMLDB xaml LOCAL UPLOAD DIRECTORY EVENT Pipeline ees DecoderoxML chiapas xaml Pipeline 0605 DecodeToXML xaml LOCAL UPLOAD DIRECTORY EVENT Pipeline 4_DecodeToCSV chiapas xaml Pipeline 004 DecodeT
34. a modified vw Export 837P view Reviewing the existing BIN repositories we observe they each have a BIN ID foreign key to the BIN LOG table We will replicate that system for this data source by creating the BIN FBN table with these fields as well as the fields indicated in the CSV specification CREATE TABLE BIN FBN BIN ID INT FILE DATE VARCHAR 200 LAST NAME VARCHAR 200 FIRST NAME VARCHAR 200 SSN VARCHAR 200 ADDRESS VARCHAR 200 CITY VARCHAR 200 STATE VARCHAR 200 ZIP CODE VARCHAR 200 BIRTH DATE VARCHAR 200 SEX VARCHAR 200 CLAIM ID VARCHAR 200 CLINIC ID VARCHAR 200 DX VARCHAR 200 SERVICE CODE 1 VARCHAR 200 SERVICE DATE 1 VARCHAR 200 SERVICE CHARGE 1 VARCHAR 200 SERVICE CODE 2 VARCHAR 200 SERVICE DATE 2 VARCHAR 200 SERVICE CHARGE 2 VARCHAR 200 SERVICE CODE 3 VARCHAR 200 SERVICE DATE 3 VARCHAR 200 SERVICE CHARGE 3 VARCHAR 200 SERVICE CODE 4 VARCHAR 200 SERVICE DATE 4 VARCHAR 200 SERVICE CHARGE 4 VARCHAR 200 Next we need to populate the table to aid us in making the transformations necessary to create the EDI view Taking the CSV Sample text save it as a text file called DATA CSV then use SQL Server Import to pull the sample data into the BIN FBN table Also ensure all columns are mapped Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 144 SQL Server Import and Export Wizard Choose a D
35. an Open File or Save File dialog Execute This will carry out the specific operation For save operations the extension of the filename will help the engine to determine the file type XLS files will be saved as the old Excel 97 format whereas XLSX files will be saved with the newer Excel 2003 format The Excel 97 format has hard limitations on the number of rows and columns that can be stored and is not recommended HKey Register Interfaces The HKey Data 1 0 tab enables easy loading and saving of the HKey register It supports saving to DB Tables and XML the XML DB interface is supported only within Automation DB Tables DB Tables XML DB Tables To HKey Execute 2 HKey to DB Tables Export View DB Type z Data Source Prefix This tab represents a transport mechanism between SQL database tables and the HKey register When exporting a loaded HKey the engine will create a number of database tables with the indicated prefix and then populate them with data The data will be formatted in a way very similar to CGIF Flat except that all loops are isolated from one another and furthermore each table will have a primary key called KEY ID type of INT and a foreign key called PAR KEY ID type of INT All other fields are typed VARCHAR 200 DB Tables to HKey Radio button to select loading the HKey from DB tables HKey to DB Tables Radio button to select saving the HKey to DB tables DB Type Database type D
36. an EDI file CGateHKeyToFlat Parameters None Error Messages Exception while transferring HKey to Flat Purpose Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 114 The counterpart to the CGateHKeyFromFlat activity this will transform the HKey to the two dimensional Flat register CGateHKeyFromXMLDB Parameters SrcCnn string SrcTable string SrcXMLID string Error Messages CGateHKeyFromXMLDB Exception There was a problem loading the HKey from the XML DB table Purpose This activity enables loading the HKey register directly from a table that follows the BIN XML schema The CGIFXML2 XML data is taken from the XML STOR column from the row that matches the XML ID given in the SrcXMLID argument Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 115 CGateHKeyToXMLDB Parameters DestCnn string DestTable string Error Messages CGateHKeyToXMLDB Exception There was a problem loading the HKey from the XML DB table Purpose This activity enables loading the HKey register directly from a table that follows the BIN XML schema The CGIFXML2 XML data is taken from the XML STOR column from the row that matches the XML ID given in the SrcXMLID argument Both the EVENT ID and the XML ID will be populated automatically CGateHKeyToXElement Parameters HKeyXML XE
37. and loops that can iterate many times and these iterations need to be represented in a two dimensional format XML being naturally hierarchical does not need any specific syntax to handle iterations X vs Y Axis To understand how these iterations impact the CGIF Flat format we need to understand what triggers a new row New rows are triggered by the deepest loop used within the EDI file that can repeat 24 or more times Thus even though the 2300 Claim Information loop present within an 837 transaction can repeat many times it is not the deepest loop used in the transaction that would generally be the 2400 Service Line loop Thus occurrences of this loop will trigger new data rows and thus represent the Y axis of a two dimensional grid Now that we have the Y what about the X axis As we observed in an example in the previous section L2900 S02 REF02 SHOE ID OVL SHOE SIZ and L2900 S02 REF02 SHOE ID OVL SHOE WGT are column names that would be used to encode data for two fictional segments If these segments were not transmitted for that particular data row the columns would be set to blank strings or NULL in a SQL table When decoding an EDI file every qualifier identifier pair encountered is bundled into a single column in this fashion with an OVL embedded in the column name itself to show a short abbreviation of the qualifier General Structure of CGIF Flat Fields Here is the specific struct
38. both Upload and Archive file trigger mechanisms 2 Schedule a SQL Server Job to insert a new row to the EVENTS table 3 Manually insert a new row to the EVENTS table In every three of the above methods new rows are created with the EVENT OWNER column set to 1 This is the signal to Worker Processes polling the chiapasData database in the background that this is event has yet to be processed When a Worker Process is idling it will look for these events and attempt to take ownership if this succeeds the process will load the XAML Workflow file and process it with the arguments provided within the EVENTS entry During Workflow execution the CGateArgs command acts to assign the four VARCHAR EVENT DATA columns to string variables Also the workflow can also obtain the EVENT ID by calling on CGateParse with the EVENT string so that it can obtain information about the activating trigger Once the workflow is complete any messages residing in the state object are sent to the MSGLOG table If an unhandled exception occurs then the state object will be unavailable the EVENT RESULT column is setto THREAD ABORT ERROR SEE C CHIAPAS ERRLOG FILE and the user must research the file created within the C chiapas directory that contains more information about the exception Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 53 Column Name EVENT ID EVENT OWNER TSRC ID EVE
39. data to the SELECT statement will be more difficult Examining the existing vw Export 837P loop we see that there is a header level summation of all claim charges We will inherit the default values for the Claim Header that exist in the sample view but we will match the four possible Service Line Charge fields to the CLAIM ID and sum them up We insert these additional lines to the VIEW statement prior to the FROM clause CLM CLAIM ID 12300 501 CLMO1 CONTRL NR SELECT SUM CONVERT MONEY SERVICE CHARGE 1 CONVERT MONEY SERVICE CHARGE 2 CONVERT MONEY SERVICE CHARGE 3 CONVERT MONEY SERVICE CHARGE 4 FROM BIN_FBN WHERE CLAIM ID CLM CLAIM ID 12300 501 CLMO2 TOTL CLM CHG AMT qu 12300 501 CLMe5 01 PLAC SVC CD 1 L2300 501 CLMO5 03 FREQNCY CD OVL PLAC SVC CODS PROF DENTL aye L23 _S 1_CLM 6_PROV_SUPLR_SIGNTR_IND A L2300_S01_CLM07_ASGNMNT_PLAN_PARTCPTN_CD sy 12300 501 CLMO8 BENFTS ASGNMNT CERT IND 12300 501 CLMO9 RELS CD CLM DX 12300 S43 HIO1 02 DIAG CD ICD9CM PRINCPL DIAG Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 149 When we refresh the Chiapas Studio output we immediately see a problem with the output 000035 CLM 8980153156 69 0000 11 B 1 Y A Y Y 000036 HI BK 27900 The extended zeroes here at the end of the SUM statement are not HIPAA compliant therefore we can use the fx HIPAA NUMBER function
40. directly to a supplied DataTable variable CGateHKeyToXML Parameters HKeyXML string Error Messages CGateHKeyToXML Exception Exception while transferring XmlDocument to HKey Purpose This activity copies the HKey register to a supplied string variable using the CGIFXML2 format CGateHKeyFromXML Parameters HKeyXML string Error Messages CGateHKeyFromXML Exception Exception while transferring XmlDocument to HKey Purpose This activity loads the HKey register from a supplied string variable using the CGIFXML2 format Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 125 CGateQueryState Parameters Query string Result string Error Messages CGateQueryState Exception Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 126 Purpose This activity allows you to directly poll various internal registers and variables belonging to the Chiapas EDI state object that is associated with the containing CGateContext activity The following table describes the query string to be set on the Query field and the expected return value that will be stored in the variable supplied in the Result field Query String EVENT ID SEGTERM ELETERM SUBELETERM SPEC SHRT NM Return Value Automation EVENT ID that spawned this workflow execution Segment Terminator character of the current SegPool objec
41. file is available A successful implementation would meet the following criteria 1 The Legacy CSV process is the sole data source and should be mapped in such a way as to create a compliant 837P file 2 Once the Legacy CSV file is dropped into the input directory it should automatically push the converted EDI file to the outbound directory ready to be uploaded to FBN HMO Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 138 CSV Specifications The Legacy CSV Process consists of a CSV file containing the following mappings Each row represents one claim with up to four service lines If a claim contains more than four service lines the claim header information is repeated All patients are considered subscribers in FBN HMO so there is no need for transmitting patient data separately from subscriber data No header row is transmitted in this format so the column names are for reference only All fields are quote delimited Column Name Description and Possible Values FILE_DATE Timestamp the file was generated in the format YYYY MM DD Example 2014 07 04 LAST NAME Patient Last Name FIRST NAME Patient First Name SSN Patient Social Security Number in the format NNN NN NNNNN Example 555 55 5555 ADDRESS Patient Home Address CITY Patient City STATE Patient State ZIP_CODE Patient ZIP Code BIRTH_DATE Patient Date of Birth in the format YYYY MM DD Example 1939 04 05 SE
42. loads the SegPoolAck register depending on the outcome of the Decode operation 8 CGateTransfer sends the SegPoolAck register to an EDI file Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 113 CGateSeg Parameters bol80Col true false bolCR true false bolDelPHI true false bolLF true false EleSep string SegSep string SubEleSep string Error Messages None Purpose This activity will set a number of options on the SegPool register that will affect any new SegPool registers created by the CGateXltEncode activity These options will set the Segment Separator Element Separator Sub Element Separator and on the right Carriage Return at the end of a segment Line Feed at the end of a segment 80 columns split and whether to scrub Protected Healthcare Information This activity needs to be present prior to encoding of the file for these formatting options to be applied on the final outgoing file CGateHKeyFromFlat Parameters None Error Messages Exception while transferring Flat to HKey Error Invalid Mapping Purpose This activity will translate the Flat register to the HKey register transforming the two dimensional column row layout of the Flat register into the hierarchical format of the HKey register This activity is necessary any time the Flat register is loaded so that it can be transformed into an HKey and finally into
43. other systems EDI stands for Electronic Data Interchange which is refers to the process of exchanging business information between trading partners Platform means that this program allows you to create other programs giving you all the resources necessary to develop and test solutions and then roll them into production Within an enterprise EDI is rarely necessary because usually the different parts of the business have access to a centralized database if all of the information is in one spot there is no need to transform it to a different format In the healthcare sphere however a business could in fact be a complex partnership integrating dozens of different corporations In order to fulfill the legal and contractual obligations for this partnership it may be necessary to transmit and receive a variety of encounter data enrollment information healthcare claims and remittances from a variety of sources For these specific sets of healthcare information Federal law mandates that the information be exchanged via the 5010 transaction sets maintained by the ASC X12 standards body and published as the HIPAA Implementation Guides The 5010 transactions define a dozen different types of business information exchanges containing thousands of individual data elements Chiapas EDI Enterprise contains sufficient information about these standards to parse them into XML and SQL table formats The resulting formats are called CGIF or Chiapas Gate In
44. sample seed_ these variables to do some processing There are twelve workflows included with the distribution see the Quick Start guide for more information that can be used as examples for how to process a variety of situations Furthermore there are a number of additional CGateXitDecode activities to handle tasks such as Email notifications and SecureFTP transfers CGateHKeyToFlat Variables 1 CGateTransfer gt To create a new variable first click on the CGateContext activity and ion Flat CSV Fil v AR zs then click on the blue Variables label at the bottom area of the screen this will extend an area showing all the currently defined FilePath CAchiapasN834_out csv variables for this scope Click on the Create Variable label and set the name and type This variable can then be used in your workflows Arguments are not currently used in this implementation Imports Like any NET language you will need to add a reference to a NET class assembly to use certain functions This is accessible via the Imports tab next to the Variables tab and then either typing in the assembly name or selecting it in the pane The System IO assembly needs special attention as it adds a lot of functionality to a workflow It is beyond the scope of this manual to detail exactly how NET assemblies work but here are a few example System IO functions that are useful in workflows Path GetFileName variable Removes the path inform
45. session Copy CGIF to Clipboard Copies the currently selected CGIF mapping to the clipboard Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 38 Open HIG If there is a currently selected mapping and the options have been set properly to link to a set of HIPAA Implementation Guide PDFs available from Washington Publishing Company http wpc edi com this will open the PDF to the page number describing the mapped element Quit This quits out of the application Data 1 0 Flat HKey These menu options provide an alternate path to access commonly used Data I O functions In addition it adds one new function Flat Maps Clipboard If there is a loaded Flat register this will create a four column description of the mappings contained within that register and paste it to the clipboard The Seed specifications at the end of this manual were created with the help of this function Window Studio Interface Workflow Interface Scheduler Interface These menu options are available throughout the Chiapas EDI Enterprise and allows you to freely switch between these interfaces Note that files and work is not saved when you leave an interface WinSCP Sessions This launches the WinSCP client that comes bundled with Chiapas EDI Enterprise The ChiapasGate Workflow activities as well as the Scheduler system use this bundled client for remote SecureFTP operations Note that when configuring WinSCP sessio
46. starts with detailed business requirements This is followed up with step by step instructions following the path of discovery to fulfill these business requirements including testing and correcting problems that occur along the way The example solution relies heavily on SQL Server and therefore you should have SQL Server Management Studio available SOLUTION Legacy Data to 837P Claim EDI Files Business Requirements The George Pickle Clinic is a medium sized healthcare services provider in Anytown USA founded in the 1970 s GP Clinic submits professional claims to the Fly by Night HMO for all its product lines However FBN HMO has mandated that legacy text files will not be accepted after an internal deadline in order to become HIPAA compliant Furthermore FBN HMO charges a 5 surcharge for processing all paper claims which is not a financially viable option with the normally lower cost services GP Clinic provides GP Clinic runs off a UNIX based mainframe and contains all of GP Clinics patient and billing information The closed proprietary architecture is not especially amenable to connecting to a database but the legacy process of creating Comma Separated Values files containing necessary billing information is well established and has been the cornerstone of billing to FBN HMO GP Clinic needs to create 837P compliant EDI files according using the legacy CSV files it has been generating and then Email the EDI coordinator when the
47. table storage and XML Here is a comparison of both Flat o Easiestto use usable for a majority of business situations o Not space efficient results in large duplication of information within the SQL tables o Most difficult to use provides the most flexibility o Space efficient file size is usually only 2 3 times the original EDI file Flat BIN Storage In the previous diagram the upper part is dedicated to the Input Storage Output flow of the Flat BIN storage objects Data is inserted via the USP BULK TEMP TABLE and USP PROCESS PENDS stored procedures as called by the following workflows Pipeline 007 DecodeToBINDB Merge Pipeline 008 DecodeToBINDB ForceMerge Pipeline ProcessPends For every file stored a new BIN LOG row is created that gives that particular file a primary key BIN ID and associates a filename specification type and the EVENT ID that spawned this entry The BIN ID is then stored as a foreign key in each of the BIN x tables Data is imported by two stored procedures working in tandem USP BULK TEMP TABLE followed by USP PROCESS PENDS USP BULK TEMP TABLE creates a temporary table that is populated by the workflow It will also create new entry the FSTOR PENDS table where a separate SQL driven event will later transfer the temp table to the destination table via the USP PROCESS PENDS stored procedure The reason why the workflows do not directly insert the data into the destination tables is one of resource c
48. the CNNTable parameter and set it to the System Data DataTable variable supplied in the Result field CGateCNNPutDT Parameters CNNName string DT System Data DataTable CNNTable string Replace string Error Messages CGateCNNPutDT Exception This does not contain the specified named connection There was an exception raised while storing the datatable to the specified named connection Limiting SQL table to first 1024 columns Purpose This activity will translate a supplied DataTable into a series of INSERT statements If the supplied table does not exist it will be created If the Replace parameter is set to true lowercase the table will first be dropped and recreated If the supplied DataTable contains more than 1024 columns the output will be limited to only the first 1024 columns Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 124 CGateDTToFlat Parameters DT System Data DataTable Error Messages CGateDTToFlat Exception Purpose This activity provides a way to programmatically setting the Flat register directly from a DataTable variable The DataTable must contain string fields named according to the conventions of the CGIF Flat format CGateDTFromFlat Parameters DT System Data DataTable Error Messages CGateDTFromFlat Exception Purpose This activity copies the Flat register
49. the error The CSV Legacy automation system is now complete Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 160
50. to fire Minute Interval Hourly Interval End Time 11 48 00 AM Run Always Run every time the trigger is polled Date Span From Date To Date Months Second Interval Run after the number of Wakaq seconds specified in Interval has elapsed Minute Interval Run after the number of minutes specified in Interval has elapsed Hourly Interval Run after the number of hours specified in Interval has elapsed Start Time End Time Specify a window in a 24 hour clock when the event can fire Date Span From Date To Date The Calendar dialogs will specify a date span window during which the event can fire Day Of Week Fire the event only on specified days of the week Months Fire the event only on specified months Example To set an event to happen once a day at 8 AM set the Trigger Type to Hourly Interval set an Interval to 1 and set the Start Time to 8 00 AM and the End Time to 8 55 AM Even if the ChiapasService was suspended for a half an hour from 8 to 8 30 AM the event would still fire at 8 31 AM and then again at 8 AM the following day Note The Automation system does not use the current timestamp when updating the Last Execution on the TSRC table as that would introduce increasing inaccuracies Instead it applies the Interval in seconds minutes or hours to the last execution time and then generates a new event If you set an Interval of 1 second and the Trigger Poll at 30 seconds then
51. 010BA 503 N402 STAT CD SUB ZIP CODE L2010BA 503 N403 SUB POSTL ZON ZIP CD SUB BIRTH DATE L2010BA 504 DMGO2 BIRTH DT OVL DT CCYYMMDD SUB SEX L2010BA 504 DMGO3 GENDR CD FROM PROD TRAD PARTNER TP INNER JOIN PROD PROVIDER SENDR PV ON TP SENDR PROV ID SENDR PV PROV ID INNER JOIN PROD PROVIDER RECVR PV ON TP RECVR PROV ID RECVR PV PROV ID INNER JOIN SELECT DISTINCT LAST NAME FIRST NAME REPLACE SSN SSN ADDRESS CITY STATE ZIP CODE REPLACE BIRTH DATE BIRTH DATE SEX FROM BIN FBN SUB ON 1 1 Again we alter the View and run the results through Chiapas Studio 000001 ISA 00 00 ZZ GP CLINIC ID ZZ FBN HMO ID 140708 0936 00501 100000000 1 P 000002 GS HC GP CLINIC ID FBN HMO ID 20140708 0936 1 X 005010X222A1 000003 ST 837 100000000 005010X222A1 000004 BHT 0019 00 657746 20140708 0936 CH 000005 NM1 41 2 GEORGE PICKLE CLINIC 46 999488801 000006 PER IC GEORGE PICKLE JR TE 4155551212 000007 NM1 40 2 FLY BY NIGHT HMO 46 999488802 000008 HL 1 20 1 000009 NM1 85 2 GEORGE PICKLE CLINIC XX 123400001 000010 N3 4000 MAIN ST SUITE 201 000011 N4 ANYTOWN CA 000010000 000012 REF EI 999488801 000013 HL 2 1 22 0 000014 SBR P 18 CT 000015 NMl IL 1 KNIFE MACK MI 111229000 000016 N3 123 WHITTLEBIRD ST 000017 N4 ANYTOWN CA 00001 000018 DMG D8 19730716 M 000019 HL 3 1 22 0 000020 SBR P 18 Cr 000021 NMl IL 1 STEW MARNE
52. 02 PERO4 COMM NR OVL TELPHN RECVR PV COMPANY NM L1000B 5 1 NM103 RECVR NM OVL NONPRSN ENTY RECVR PV TAX ID L1000B 501 NM109 PRIMRY ID NR FROM PROD TRAD PARTNER TP INNER JOIN PROD PROVIDER SENDR PV ON TP SENDR PROV ID INNER JOIN PROD PROVIDER RECVR PV ON TP RECVR PROV ID SENDR PV PROV ID RECVR PV PROV ID At this point we need to stop and validate our work so far With the Chiapas Studio interface this is very straightforward and can be done in seconds We simply open up the Studio put vw Export FBN into the table text box under Flat gt DB Table press Execute then press the Flat gt HKey button under the middle HKey Tab then press Encode and we see this result 000001 ISA 90 0 ZZ GP CLINIC ID 77 140708 0053 00501 100000000 1 P 000002 GS HC GP CLINIC ID FBN HMO ID 20140708 0053 1 X 005010X222A1 000003 ST 837 100000000 005010X222A1 000004 BHT 0019 00 150927 20140708 0053 CH 000005 NM1 41 2 GEORGE PICKLE CLINIC 46 999488801 000006 PER IC GEORGE PICKLE JR TE 4155551212 000007 NM1 40 2 GP FELIX LOCATION 46 999488801 000008 sE 6 100000000 000009 GE 1 1 000010 IEA 1 100000000 The most important part of quickly developing EDI mappings is the ability to quickly iterate In this case we observe that the 1000B is not correct instead of listing FBN HMO it is listing information related to another clinical location This is simply corrected by updating
53. 20 5010 820X BIN Health Insurance Exchange Related Payments 5010 820 A1 BIN Addenda 1 5010 824 BIN Application Reporting for Insurance 824 5010 834 BIN Benefit Enrollment and Maintenance 834 5010 834 A1 BIN Addenda 1 5010 835 BIN Health Care Claim Payment Advice 835 5010 835 A1 BIN Health Care Claim Payment Advice 835 A1 5010 837D BIN Health Care Claim Dental 837 5010 837D A1 BIN Addenda 1 5010 837D A2 BIN Addenda 2 5010 837I BIN Health Care Claim Institutional 837 5010 8371 A1 BIN Addenda 1 5010 8371 A2 BIN Addenda 2 5010 837P BIN Health Care Claim Professional 837 5010 837P A1 BIN Addenda 1 Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 129 CGateClearRegister Parameters Register string Error Messages CGateClearRegister Exception Purpose This activity enables you to clear loaded registers The Register argument must contain one of the following values SEGPOOL Clears the SegPool register HKEY Clears the HKey register FLAT Clears the Flat register ALL Clears all three registers This is helpful when you need an added degree of memory management control and have no need of certain registers after a certain point in your workflow CGateArg Parameters Tol string To2 string To3 string To4 string
54. 200B 502 STCO3 ACTN CD L2200B 502 5 4 TOTL SUBMTD CHGS WORK L2200B S03 QTYO2 TOTL ACCPTD QTY L2200B 504 QTYO2 TOTL REJECTD QTY Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 71 BIN 278 REQ Table This BIN table holds mappings matching that of a minimal 5010 278 Request EDI file For additional possible mappings see the CGIF reference HTML file in the C chiapas docs CGIF folder Column Name Data Type BIN PK INT PK BIN ID INT 00 501 5 02 OVL 501 5 04 SEC OVL NO SEC OEISA 501 5 06 SENDR ID OVL DEFND ID OEISA 501 5 08 RECVR ID OVL MUTLY DEFND ID OEISA 501 ISAO9 DT OEISA 501 ISA10 TM OEISA SO1 ISA11 REPTN SEPRTR OEISA SO1 ISA12 VERSN NR OEISA 501 ISA13 ICN OEISA 501 ISA14 REQ OEISA 501 ISA15 USG IND OEISA SO1 ISA16 SUBELE SEP OEISA 503 2 ICN GSHDR 501 6502 APP SENDR CD GSHDR 501 6503 APP RECVR CD GSHDR 501 6504 DT GSHDR 501 6505 TM GSHDR 501 6506 GCN GSHDR S03 GE02 STHDR 501 STO2 CONTRL NR STHDR SO1 STO3 IMPLMNTN GUID VERSN NM STHDR 502 BHTO1 STRUCTR CD Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Purpose Primary Key Identity Foreign key to the BIN LOG table Page 72 STHDR SO2 BHTO2 TS PURPS CD STHDR 502 BHTO3 SUBMTR TRANSCTN 10 STHDR 502 BHTO4 TS CREATN DT STHDR 502 BHTO5 TS CRE
55. 250 2014 07 01 205 007 mu ww wu wn Mor na 2014 07 06 SUNDAE DEVIN 111 22 8000 842 TURBAN DR ANYTOWN CA 00001 1970 01 14 8980153156 3 279 00 80048 2014 07 02 15 00 80076 2014 07 02 15 00 80202 2014 07 02 17 00 85025 2014 07 02 10 00 2014 07 06 SUNDAE DEVIN 111 22 8000 842 TURBAN DR ANYTOWN CA 00001 1970 01 14 8980153156 3 279 00 85652 2014 07 027 712 00 ase nw Technical Analysis Requirement 1 The Legacy CSV process is the sole data source and should be mapped in such a way as to create a compliant 837P file Assessment This requirement is basically stating that the CSV file is the sole input data source from the legacy environment since this has been used successfully as the production billing data feed in the past it should therefore have all the data necessary for a valid EDI file A close look at the 837P EDI requirements shows the following steps will be needed to fulfill the requirement Deliverable 1 A Outer Loops ICN The ISA GS and ST envelope loops will all need to be given default values There needs to be a mechanism implemented to generate a new incrementing ISA13 Interchange Control Number for each transaction Deliverable 1 B Fixed values for the 1000A Submitter Loop and 1000B Receiver Loop need to 1000A be establishe
56. 28 Data 1 0 Pane This area focuses on providing import and export capabilities to registers within the Chiapas Studio state The top row of tabs identify the register whereas the sub tabs identify individual 1 0 interfaces relating to that register Flat Register Interfaces DB Table Interface DB Table CSV Excel 2 Flat To Table EH m r 1 Table to Flat ForceMerge Merge DB Type SQL Server Data S Data UU CSENIECE Source Database chiapasData Trusted Connection true Table vw Export 834 This pane enables the user to import data from or export data to a database Interfaces for ODBC Ole SQL Server and SQLite are presented All data pulled externally is expected to be in CGIF Flat format similarly all data exported will be the same Flat to Table Radio button option for exporting Flat register to database Table to Flat Radio button option for importing the Flat register from a database DB Type Sets the database type Data Source The Data Source field must be populated with a valid connection string as it is known in the NET development space An excellent resource on this topic is the website at http connectionstrings com The default Data Source string assumes that there is a local server with a default name containing the distribution chiapasData database Table For operations storing data to Table this must be a table name For operations loading data from a table then the T
57. 400 S02 SV104 SVC UNT CT OVL UNT ae 12400 502 SV107 01 DIAG CD POINTR REPLACE SVC DT 12400 S11 DTPO3 SVC DT OVL SVC D8 FROM PROD TRAD PARTNER TP INNER JOIN PROD PROVIDER SENDR PV ON TP SENDR PROV ID SENDR PV PROV ID INNER JOIN PROD PROVIDER RECVR PV ON TP RECVR PROV ID RECVR PV PROV ID Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 152 INNER JOIN SELECT FROM SUB ON 1 INNER JOIN SELECT FROM CLM ON AND AND INNER JOIN DISTINCT LAST NAME FIRST NAME REPLACE SSN SSN ADDRESS CITY STATE ZIP CODE REPLACE BIRTH DATE BIRTH DATE SEX BIN FBN 1 DISTINCT CLAIM ID REPLACE DX DX LAST NAME FIRST NAME REPLACE SSN SSN BIN_FBN SUB LAST_NAME CLM LAST_NAME SUB FIRST_NAME CLM FIRST_NAME SUB SSN CLM SSN SELECT CLAIM_ID SERVICE_CODE_1 CD SERVICE_DATE_1 DT SERVICE_CHARGE_1 CH FROM BIN_FBN UNION SELECT CLAIM ID SERVICE CODE 2 CD SERVICE DATE 2 DT SERVICE CHARGE 2 CH FROM BIN FBN UNION SELECT CLAIM ID SERVICE CODE 3 CD SERVICE DATE 3 DT SERVICE CHARGE 3 CH FROM BIN FBN UNION SELECT CLAIM ID SERVICE CODE 4 CD SERVICE DATE 4 DT SERVICE CHARGE 4 CH FROM BIN FBN SVC ON SVC CLAIM ID CLM CLAIM ID AND SVC CD lt gt Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 153 Deliverable 2 As described in the assessment this is where we tie in the ETL
58. 402 STAT CD L2010BA 503 03 SUB POSTL ZON ZIP CD L2010BA 504 DMGO2 BIRTH DT OVL DT CCYYMMDD L2010BA 504 DMGO3 GENDR CD L2010BB 501 NM103 PAYR NM OVL NONPRSN ENTY L2010BB 501 NM109 PAYR ID OVL PAYR ID L2010BB 502 N301 ADRS LIN L2010BB 503 01 CITY NM L2010BB 503 02 PAYR STAT PROVNC CD L2010BB 503 4 3 PAYR POSTL ZON ZIP CD L2300 5 1 CLMO1 CONTRL NR 12300 501 2 TOTL CLM CHG AMT L2300 501 CLMO5 01 PLAC SVC CD 12300 501 CLMO5 03 FREQNCY CD OVL PLAC SVC CODS PROF DENTL 12300 501 CLMO6 PROV SUPLR SIGNTR IND L2300 501 CLMO7 ASGNMNT PLAN PARTCPTN CD 12300 501 CLMOS BENFTS ASGNMNT CERT IND 12300 501 CLMO9 RELS CD L2300 S43 HIO1 02 DIAG CD OVL ICD9CM PRINCPL DIAG L2400 502 SV101 02 PROC CD OVL HCPCS CD L2400 S02 SV102 LIN ITM CHG AMT L2400 S02 SV104 SVC UNT CT OVL UNT 12400 502 SV107 01 DIAG CD POINTR L2400 S11 3 SVC DT OVL SVC D8 SELECT QTMP ID2 15 02 1 OEISA 501 ISA02 OVL ISA04 OEISA 501 ISA04 SEC NO SEC ISA06 SENDR ID OEISA 501 15 06 SENDR ID OVL MUTLY DEFND ID ISA08 RECVR ID OEISA 501 15 68 RECVR ID OVL MUTLY DEFND ID 11 REPTN SEP OEISA 501 ISA11 REPTN SEPRTR 00501 OEISA 5 1 ISA12 VERSN NR ICN OEISA 501 ISA13 ICN v w w 9 w w v lt w w lt x lt Xx ISA14_ACK_REQ ISA15_US
59. AIM HDR table Column Name Data Type CLAIM DTL ID INT PK CLAIM ID INT AMT MONEY COPAY AMT MONEY PAID AMT MONEY FROM DT DATE TO DT DATE SVC CD VARCHAR 10 UNIT CT INT Purpose Unique Claim Detail Line Identifier Foreign Key reference to the Claim Header table Claim Line Charge Amount Claim Line Patient Copay Amount Claim Line Paid Amount Claim Line Service From Date Claim Line Service To Date Claim Line Procedure Code Claim Line Unit Count Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 98 SAMPL CLAIM AD Table This table stores sample claim service line adjustment information with a foreign key link to the Claim Detail table Column Name Data Type Purpose CLAIM ADJ ID PK Unique Claim Detail Adjustment Identifier CLAIM DTL ID INT Foreign Key reference to the Claim Detail table ADJ REASN VARCHAR 2 Adjustment Reason Code ADJ AMT MONEY Adjustment Amount ADJ SEQ INT Adjustment Sequence Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 99 SAMPL MEMBER Table This table stores mock members The last names are all set to food names so that files generated with this data will not be mistaken for real Protected Healthcare Information Column Name Data Type Purpose MEM ID INT PK Unique Member Adjustment Identifier FIRST NM VARCHAR 50 First Name LAST NM VARCHAR 50 Last Name SSN ID VARCHAR 20 Social Security Number BIR
60. APP SENDR CD lt S01 gt lt STHDR gt 5015 STO2 CONTRL NR 100000000 STO2 CONTRL NR lt ST03_IMPLMNTN_CONVNTN_REFNC gt 005010X220A1 lt ST03_IMPLMNTN_CONVNTN_REFNC gt lt S01 gt lt S02 gt lt BGN01_TS_PURPS_CD gt 00 lt BGNO1_TS_PURPS_CD gt lt S02 gt L1000A S01 N102 PLAN SPONSR NM CHIAPAS EDI TECH N102 PLAN SPONSR lt S01 gt lt L1000A gt lt L1000B gt S01 N102 INSR NM DOOLITTLE HOSPITAL N102 INSR NM lt S01 gt lt L1000B gt lt L2000 gt lt S01 gt INSO1 MEM IND Y INSO1 MEM IND lt S01 gt S02 REF02 SUB ID OVL SUB NR 987654320 REF02 SUB ID OVL SUB NR lt S02 gt lt S03 gt REF02 MEM GRP POLCY NR OVL GRP POLCY NR BASICHEALTHCAREPLAN REF02 MEM GRP POLCY NR OVL POLCY NR lt S03 gt lt S04 gt REF02 SUPP ID OVL CLIENT REPRTNG CATGRY 100001 2 SUPP ID OVL CLIENT REPRTNG CATGRY S04 S05 3 STATS EFF DT OVL ELIG BEGN 8 gt 20120101 3 STATS EFF DT OVL ELIG BEGN D8 S05 L2100A IL S01 NM103 MEM LNAME OVL PERSN BURGER NM103 MEM LNAME OVL PERSN lt S01 gt lt S02 gt PERO4 COMM NR OVL HOM PHON NR 4155551200 PERO4 COMM NR OVL HOM NR lt S02 gt lt S03 gt lt N301_ADRS_LIN gt 123 A ST lt N301_ADRS_LIN gt lt S03 gt lt S04 gt lt N401_CITY_NM gt SAN FRANCISCO lt N401_CITY_NM gt lt S04 gt lt S05 gt lt DMG02_BIRTH_DT_OVL_DT_
61. ATN STHDR 504 SEO2 L2000A SO1 HLO1 HIERCHCL ID NR L2010A X3 501 NM102 ENTY TYPE QUAL L2010A X3 501 NM103 UMO NM LAST ORG L2010A X3 501 109 ID CD OVL EMPLYR ID NR L2000B SO1 HLO1 HIERCHCL ID NR L2000B SO1 HLO2 HIERCHCL PARNT ID NR L2010B 1 501 NM102 ENTY TYPE QUAL L2010B 1P 501 NM103 REOSTR LAST ORG NM L2010B 1P 501 NM104 REQSTR FNAME L2010B 1P 501 NM109 ID OVL ETN NR L2000C SO1 HLO1 HIERCHCL ID NR L2000C 501 HLO2 HIERCHCL PARNT ID NR L2010C 501 NM103 SUB LNAME L2010C 501 NM104 SUB FNAME L2010C 501 NM109 PRIMRY ID OVL MEM ID NR L2000E SO1 HLO1 HIERCHCL ID NR L2000E SO1 HLO2 HIERCHCL PARNT ID NR L2000E 501 HLO4 HIERCHCL CHILD CD L2000E 503 UMO1 REOST CATGRY CD L2000E S03 UMO2 CERT TYPE CD L2000E 503 UMO4 01 FACLTY TYPE CD L2000E S03 02 FACLTY CD QUAL L2000E S03 UMOO9 RELS CD L2000E S11 DTPO3 PROPSD ACTL ADMSN DT OVL ADMSN D8 Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 73 BIN 278 RESP Table This BIN table holds mappings matching that of a minimal 5010 278 Response EDI file For additional possible mappings see the CGIF reference HTML file in the C chiapas docs CGIF folder Column Name BIN PK BIN ID OEISA SO1 5 2 AUTH OVL NO AUTH OEISA 501 ISAO4 SEC NO SEC OEISA 501 15 06 SENDR ID OVL MUTLY DEFND ID OEISA 501 5 RECVR ID OVL MUTLY DEFND ID OEISA 501
62. CCYYMMDD gt 19800707 DMG02 BIRTH DT OVL DT CCYYMMDD lt S05 gt L2100A IL lt L2000 gt lt S10 gt lt SE02_TCN gt 100000000 lt SE02_TCN gt lt S10 gt lt STHDR gt lt S03 gt lt GE02_GCN gt 1 lt GE02_GCN gt lt S03 gt lt GSHDR gt lt S03 gt lt IEA02_ICN gt 100000000 lt IEA02_ICN gt S03 OEISA CGIFXML2Root Ti From this example we can observe how the data is arranged Note that L2100A being a qualified loop possesses the IL qualifier suffix in this example Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 25 CHIAPAS EDI ENTERPRISE Registers and Runtime Environment Both the Chiapas Studio and the Worker Processes that make up the automation environment share something in common a runtime state object The state is a collection of various registers variables and database connections that make up the Chiapas EDI runtime environment The state is transparent to the end user it can only be accessed indirectly by changing the registers opening and closing connections and so on Here are the registers as well as the primary interfaces they connect to Chiapas EDI Enterprise State Register SegPoolAck SegPool Name E g Purpose Storage Hierarchical EDI Projection Tabular Projection of EDI Message and Error Storage UT Pi B 5 ui Emphasis is added to the SegPool HKey and Flat registers to highlight the conversion path between the
63. CHIAPAS EDI ENTERPRISE USER MANUAL Copyright 2015 Chiapas EDI Technologies Inc All rights reserved This work may not be copied or distributed without written prior authorization This company and product have no affiliation with Mexico or the Mexican State of Chiapas CHIAPAS EDI TECHNOLOGIES INC Healthcare Integration Solutions Contents INTRODUCTION 1 WHO IS THIS PRODUCT FOR etr ssi ee aa ve sau 2 INSTALLING CHIAPAS EDI 3 REQUIREMENTS aise ua EM 3 INSTALLATION e 3 Ul E M 4 QUICK START GUIDE uu a 5 DECODING m 5 ENCODING a kum a Ei 9 AUTOMATION inete paha 12 USER REFERENCE uuu u aa 17 Whatis Chiapas EDI Enterprise s iiie e cate re ie pete serena he eue euge 17 CHIAPAS GATE INTERMEDIATE FORMAT n 18 GENERAL CONCEPTS ERE 18 scr 20 CGIFXNIL2 Format 24 CHIAPAS EDI ENTERPRI
64. CVRID 128810 2914 P SAMPL SENDRID SAMPL RECVRID 120818 9914 g P SAMPL SENDRID SAMPL RECVRID 120818 9914 SaL SEMORID SAMPL RECVRID 120818 esa 5 SAMPL SENDRID SAMPL RECVRID 120818 914 P SAMPL SEMDRID SANPL_RECVRID _ 120610 esa g SAMPLSENDRID SANPL_RECVATD 120810 esa 5 SAMPL SENDRID SAMPL RECVRID 120818 9914 g P sue ser SANPL_RECVAID _ 20810 esa P SAPL_SENORID _ SANPL_RECVRID _ 120810 esa e SANPL SENDRID SAMPL RECVRID 120810 e914 SAMPL SENDRID SAMPL RECVRID 128518 914 9 P SAMPL SENDRID SAMPL RECVRID 120818 2914 g P SAMPL SENDRID SAMPL RECVRID 120810 914 e P SamPL StNORID samel nECuRID 120810 esa 5 SAMPL SENDRID SAMPL RECVRID 120819 e914 9 P SAMPL SENDRID SANPL_RECVRID 120810 esa g P SAMPL SENDRID SaMeL RECWRID 120810 esa 5 SAMPL SENDRID SAMPL RECVRID 120818 9914 180000000 g P Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 36 This interface enables the user to view the Flat register interactively as well as modify both the mappings and the information contained within This capability allows the user to test different situations with data and mappings without refreshing from a data source Note that generally the Flat is loaded either from the Data 1 0 interface or from the HKey pane and then this interface is updated wit
65. D strFileName DisplayName CGateCNNSQLGetScalar Result strBinID 5 At this stage we now have all of the necessary components needed to create a new EDI file The next few activities will utilize the built in automation stored procedure for extracting an EDI file from the BIN and then writing it out to the outbound directory ees Drag the CGateTransfer activity to the bottom of the workflow stack and sen Flat DP Table x select Flat DB Table as Action SQL Server as DB Type TriggerDB as pempe Server Data Source and the following for the Data Table Data Source TriggerDB Data Table EXEC USP FETCH CULLEI EXEC USP FETCH CULLED BIN strBinID ToString CGateHKeyFromFlat Then simply drag and drop CGateHKeyFromFlat and CGateXItEncode to the bottom of the stack 1 CGateXitEncode 51 CGateTransfer Action SegPool File ue DI The next activity is another CGateTransfer this time with the SegPool File action and a File Path set to this C chiapas pipeline e13_CSVLegacy 3_out_edi Path GetFileNameWithoutExtension strFileName edi The activity immediately grows a red dot to flag an error In this case the NET function Path GetFileNameWithoutExtension is part of the System IO library which is not included by default Clicking the Imports tab at the bottom typing in System IO in the Enter or Select Namespace window and hitting Enter will resolve
66. D SAMPL RECVRID __ SAMPL_SENDRID SAMPL RECVRID 777777 TSAMPL SENDRID SAMPL RECVRID 0 0 0 SAPU necvaro 1 sawtsewRr 0 0 SAMPL_RECVRID SAMPL RECVRID 1 saMPL SENDRID SAMPL RECVRID SENPRID SAMPL RECVRID sawetsewRr 0 0 0 0 samet necvaro SAMPL SENDRID SAMPL RECVRID SAMPL SENDRID SAMPL RECVRID SAMPL SENDRID SAMPL RECVRID SAMPL_SENDRID SAMPL_RECVRID SAMPL SENDRID SAMPL RECVRID SAMPL SENDRID SAMPL_RECVRID SAMPL_SENDRID SAMPL_RECVRID samet SENDRID SAMPL RECVRID The business information present within the original EDI file has now been transformed into both CGIFXML2 format via the HKey Register and the CGIF Flat format within the Flat Register These two formats represent interfaces by which enterprises can parse the business information within the original EDI files and are further defined later in this manual The CGIF Flat format is generally the most accessible First we ll need to press the Flat tab of the Data I O pane and then type TUTORIAL 834 in the Table text box Flat HKey SegPool Log DB Table CSV Excel Flat To Table Execute O Table to Flat ForceMerge Merge DB Type SQL Server ata ource Database chiapasData Trusted Connection
67. D L2000A 501 HLO4 HIERCHCL CHILD CD VARCHAR 200 ALTER TABLE BIN 837P ADD L2010AA 5 1 NM103 BILNG PROV ORGL NM OVL NONPRSN ENTY VARCHAR 200 ALTER TABLE BIN 837P ADD L2010AA 5 1 NM109 PROV ID OVL CENTRS MEDCR MEDCD SVCS VARCHAR 200 Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 156 ALTER TABLE BIN 837P ADD L2010AA 502 N302 BILNG PROV ADRS LIN VARCHAR 200 Go ahead and ALTER the USP PROCESS CSV stored procedure and add these lines to the end Create a new BIN LOG entry for the 837P data we re about to create Set the filename to be a current datestamp DECLARE TMP_ID2 INT BEGIN TRAN INSERT INTO BIN_LOG BIN FILENAME BIN RECV DATE BIN TYPE EVENT ID SELECT QFN GETDATE 5010 837P A1 EVENT ID SET TMP_ID2 SCOPE IDENTITY COMMIT TRAN INSERT INTO BIN 837P BIN ID X1 OEISA 501 5 2 OVL NO OEISA 501 ISA04 SEC NO SEC OEISA 501 ISA06 SENDR ID OVL MUTLY DEFND ID OEISA 501 ISA08 RECVR ID OVL MUTLY DEFND ID OEISA 501 ISA11 REPTN SEPRTR OEISA 501 ISA12 VERSN NR OEISA 501 ISA13 ICN OEISA 501 ISA14 REQ OEISA 501 ISA15 056 IND OEISA 501 ISA16 SUBELE SEP OEISA 503 IEAO2 GSHDR 501 GS02 APP SENDR CD GSHDR 501 GS03 APP RECVR CD GSHDR 501 GS06 GCN GSHDR 501 0508 VERS ID CD GSHDR 503 2 GCN STHDR 501 5 2 CONTRL STHDR 501 STO3 IMPLMNTN GUID VERSN NM STH
68. DR 506 5 2 STHDR S02 STRUCTR CD STHDR 502 2 TS PURPS CD STHDR 502 3 ORGNTR APLCTN TRANSCTN ID STHDR 502 CLM ENCNTR ID L1000A 501 NM103 SUBMTR LAST ORG NM OVL NONPRSN ENTY L1000A 501 NM109 SUBMTR ID OVL NR L1000A 502 PERO2 CONTCT NM L1000A 502 PERO4 COMM NR OVL TELPHN L1000B 501 NM103 RECVR NM OVL NONPRSN ENTY L1000B 501 NM109 PRIMRY ID OVL NR L2000A 501 HLO4 HIERCHCL CHILD CD L2010AA SO1 NM103 BILNG PROV ORGL NM OVL NONPRSN ENTY L2010AA 501 NM109 PROV ID OVL CENTRS MEDCR MEDCD SVCS L2010AA 502 361 BILNG PROV ADRS LIN L2010AA 502 N302 BILNG PROV ADRS LIN L2010AA 503 01 BILNG PROV CITY NM L2010AA 503 4 2 STAT PROVNC CD L2010AA 503 03 POSTL ZON ZIP CD L2010AA 504 2 ID NR OVL EMPLYR ID NR L2000B 501 HLO4 HIERCHCL CHILD CD L2000B 502 SBRO1 PAYR RESP SEQNC NR CD L2000B S02 SBRO2 INDVDL REL CD L2000B 502 SBRO9 CLM FILNG IND CD L2010BA 501 NM103 SUB LNAME OVL PERSN L2010BA 501 NM104 SUB FNAME Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 157 L2010BA 501 NM109 PRIMRY ID OVL MEM ID NR L2010BA 502 3 1 ADRS LIN L2010BA 503 01 CITY NM L2010BA 503 N
69. E 110 s a a teda e er Een 112 CGateAckGen ertate 5 u de 113 CGate ACkTATGenertat e n etre tee rt testi 113 GI GE TE ETES P 114 CGateHkKeyEromblatu ERR HR ERE RERO ere 114 CGateH Key TOR lat i e ttti ted den e Besten 114 nennen 115 CGateHKeyTOXMEDB iecore nere t a de aqa a ide ted edel 116 GGateHKeyToXElemient 5 5 t e ER rex M 116 acri 117 CGateXItDecode onere e ee e ee 119 CGateCNNAdd iei aa nd DO u Au AMP dose 120 EE 120 CGateCNNC o6s a 121 CGate CNNSQLEX6C u ras RII RENE S E EIS 121 CGateCNNSQLEXecScripDt a ede entere petes etit nine ER states 122 CGateCNNSQLGetScalat Li een eee xt eh dant uu pa dae 122 GGateCNNEISETOTable si eret ed cae ette det eiie ette dede e 123 CGateCNNFlatFromTable 5 er ete APRES YE RAE 123 CGateCNNFetchDT EEUU 124 CGateCNNPutDT EE 124 CGate DIT OF at ide ut pee eet rein th dieit 125 CGateDTEtrormiF lat acd pdt a D a a e aere RS A RES 125 CGateHKeyTOXML e tee cater ertet eve au a a cafe e vb eve eve gae 125 cru udeniijme a Et 125
70. ECT clause after the CLM DX SVC CD L2400 502 SV101 02 PROC CD OVL HCPCS CD dbo fx HIPAA NUMBER SVC CH L2400 502 SV102 LIN ITM AMT ud L2400 502 SV104 SVC UNT CT OVL UNT EM L2400 502 SV107 01 DIAG CD POINTR REPLACE SVC DT L2400 511 DTPO3 SVC DT OVL SVC D8 Next we alter the View and refresh the segment output in Chiapas Studio Everything looks good Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 150 000035 000036 000037 000038 000039 000040 000041 000042 000043 000044 000045 000046 000047 000048 000049 000050 000051 000052 000053 000054 000055 000056 HL 4 1 22 0 SBR P 18 CTI NM1 IL 1 SUNDAE DEVIN MI 111228000 N3 842 TURBAN DR NA4 ANYTOWN CA 00001 DMG D8 19700114 M CLM 8980153156 69 11 B 1 Y A Y Y HI BK 27900 LX 1 SV1 HC 80048 15 UN 1 DTP 472 D8 20140702 LA 2 SV1 HC 80076 15 UN 1 DTP 472 D8 20140702 LX 3 SV1 HC 80202 17 UN 1 DTP 472 D8 20140702 LX 4 SVI HC 85025 10 UN 1 DTP 472 D8 20140702 LX 5 SV1 HC 85652 12 UN 1 At this point we have what appears to be a HIPAA compliant file Because Chiapas EDI Enterprise provides SNIP Level 1 and 2 compliance checking however we do not need to take this on faith we just press the DECODE button and see the results 000017 N4 ANYTOWN CA 00001 000018 DMG D8 19620301 F 000019 CLM 8980153154 42 11 B 1 Y A Y Y 000020
71. EM FNAME L2100A S02 PERO4 COMM NR OVL HOM NR L2100A S03 N301 ADRS LIN L2100A S04 N401 CITY NM L2100A S04 N402 STAT CD L2100A S04 N403 MEM POSTL ZON ZIP CD L2100A S05 DMGO02 BIRTH DT OVL DT CCYYMMDD L2100A S05 DMG03 GENDR CD Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 80 BIN 835 Table This BIN table holds mappings matching that of a minimal 5010 835 A1 EDI file For additional possible mappings see the CGIF reference HTML file in the C chiapas docs CGIF folder Column Name Data Type Purpose BIN_PK INT PK Primary Key Identity BIN ID INT Foreign key to BIN LOG U1 OEISA 501 5 2 AUTH OVL NO AUTH OEISA 501 ISAO4 SEC NO SEC OEISA 501 15 06 SENDR ID OVL MUTLY DEFND ID OEISA 501 ISAO8 RECVR ID OVL MUTLY DEFND ID OEISA 501 5 09 DT OEISA 501 ISA10 TM OEISA SO1 ISA11 REPTN SEPRTR OEISA SO1 ISA12 VERSN NR OEISA SO1 ISA13 ICN OEISA SO1 ISA14 ACK REQ OEISA SO1 ISA15 USG IND OEISA SO1 ISA16 SUBELE SEP OEISA 503 IEAO2 ICN GSHDR 501 GSO2 APP SENDR CD GSHDR 501 6503 APP RECVR CD GSHDR 501 6504 DT GSHDR 501 6505 TM GSHDR 501 6506 Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 81 GSHDR 501 6508 VERS ID CD GSHDR 503 GEO2 STHDR 501 STO2 CONTRL NR ST
72. ESCE SERVICE CHARGE 2 CONVERT MONEY 0 00 COALESCE SERVICE CHARGE 3 CONVERT MONEY 0 00 COALESCE SERVICE CHARGE 4 CONVERT MONEY 0 00 FROM BIN FBN WHERE CLAIM ID CLM CLAIM ID AND BIN ID QTMP ID 12300 501 CLMO2 TOTL CLM AMT ha L2300 501 CLMO5 01 PLAC SVC CD 12300 501 CLMO5 03 FREQNCY CD OVL PLAC SVC CODS PROF DENTL iya L2300_S01_CLM 6 PROV SUPLR SIGNTR IND ins 12300 501 CLMO7 ASGNMNT PLAN PARTCPTN CD y 12300 501 CLMOS BENFTS ASGNMNT CERT IND 12300 501 CLMO9 RELS CD CLM DX 12300 S43 HIO1 02 DIAG CD OVL ICD9CM PRINCPL DIAG SVC CD L2400 S02 SV101 02 PROC CD OVL HCPCS CD dbo fx HIPAA NUMBER SVC CH L2400 S02 SV102 LIN ITM CHG AMT ga L2400 S02 SV104 SVC UNT CT OVL UNT ER 12400 502 SV107 01 DIAG CD POINTR REPLACE SVC DT 12400 511 3 SVC DT OVL SVC D8 FROM TRAD PARTNER TP INNER JOIN PROD PROVIDER SENDR PV ON TP SENDR PROV ID SENDR PV PROV ID INNER JOIN PROD PROVIDER RECVR PV ON TP RECVR PROV ID RECVR PV PROV ID INNER JOIN SELECT DISTINCT LAST NAME FIRST NAME REPLACE SSN SSN ADDRESS CITY STATE ZIP CODE REPLACE BIRTH DATE BIRTH DATE SEX FROM BIN FBN WHERE BIN ID QTMP ID SUB ON 1 1 INNER JOIN SELECT DISTINCT CLAIM ID REPLACE DX DX LAST_NAME FIRST_NAME REPLACE SSN SSN FROM BIN FBN WHERE BIN ID QTMP ID CLM ON SUB LAST NAME CLM LAST NAME
73. Each of these categories defines a specific revision of a set of healthcare communication specifications such as claims authorizations enrollments and remittance advice The 4010 set of specifications were finalized in 2002 whereas the 5010 specifications were finalized in 2008 Although 5010 deprecated the 4010 set some trading partners have not yet converted to the new revision Many of the transactions have one or two formally published Addenda that materially impact the specification Within each specification information is grouped into hierarchical structures called loops Loops are composed of segments which are themselves made of elements In certain cases elements are further divided into composite elements At every level numeric and alphabetical text qualifiers are used to identify the information being described within the loops and segments The specifications define every element possible with a given transaction but trading partners generally need to exchange only a small fraction of these elements to meet their business requirements Larger trading partners will often formalize the required mappings into a Companion Guide which serves as an easy point of reference about what information is being exchanged Hierarchical protocols like XML and HIPAA are generally used to transmit groups of information in batches However within healthcare enterprise systems healthcare data is almost never stored this way often it lays embedde
74. G_IND ISA16_SUBELE_SEP ICN GS02_APP_SENDR_CD GS03_APP_RECVR_CD GCN 005010X222A1 GCN TCN 005010X222A1 TCN 0019 RIGHT CONVERT VARCHAR RAND GETDATE 100000 DATEPART ss GETDATE 1000 DATEPART ms GETDATE 6 CH SENDR_PV COMPANY_NM L1 A_S 1_NM103_SUBMTR_LAST_ORG_NM_OVL_NONPRSN_ENTY SENDR PV TAX ID SENDR PV CONTACT NM SENDR PV WORK PH RECVR PV COMPANY NM RECVR PV TAX ID SENDR PV COMPANY NM L2010AA 5 1 NM103 BILNG PROV ORGL NM OVL NONPRSN ENTY SENDR PV NPI ID L2010AA 5 1 NM109 PROV ID OVL CENTRS MEDCR MEDCD SVCS SENDR PV ADD1 SENDR PV ADD2 SENDR PV CITY SENDR PV STATE OEISA 501 ISA14 ACK REQ OEISA 501 ISA15 USG IND OEISA 5 1 ISA16 SUBELE SEP OEISA 503 IEAO2 ICN GSHDR 501 GS02 APP SENDR CD GSHDR 501 GS03 APP RECVR CD GSHDR 501 0506 GCN GSHDR 501 0508 VERS ID CD GSHDR 503 2 GCN STHDR 501 STO2 CONTRL NR STHDR 501 STO3 IMPLMNTN GUID VERSN NM STHDR 506 5 2 STHDR S02 STRUCTR CD STHDR 502 2 TS PURPS CD STHDR S02 3 ORGNTR APLCTN TRANSCTN ID STHDR 502 CLM ENCNTR ID L1000A 501 NM109 SUBMTR ID NR L1000A S02 PERO2 CONTCT NM L1000A 502 4 COMM NR OVL TELPHN L10008 501 NM103 RECVR NM OVL NONPRSN ENTY L1000B 501 NM109 PRIMRY ID NR L2000A 501 HLO4 HIERCHCL CHILD CD L2010AA 502
75. HDR 501 STO3 VERS RELS INDSTRY ID STHDR SO2 BHTO1 STRUCTR CD STHDR 502 BHTOS3 REF ID STHDR 502 BHTO4 TS CREATN DT Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Purpose Primary Key Identity Foreign key to the BIN LOG table Page 66 STHDR 502 BHTO5 TS CREATN TIM STHDR 504 SEO2 L2000A SO1 HLO1 HIERCHCL ID NR L2100A 501 NM103 PAYR NM OVL NONPRSN L2100A 501 NM109 PAYR ID OVL PAYR ID L2000B SO1 HLO1 HIERCHCL ID NR L2000B SO1 HLO2 HIERCHCL PARNT ID NR L2100B 501 NM102 ENTY TYPE QUAL L2100B 501 NM103 RECVR LAST ORG NM L2100B 501 NM109 RECVR ID NR OVL ETN NR L2000C 501 HLO1 HIERCHCL ID NR L2000C SO1 HLO2 HIERCHCL PARNT ID NR L2100C 501 NM102 ENTY TYPE QUAL L2100C 501 NM103 PROV LAST ORG NM L2100C 501 NM109 PROV ID OVL FED TAX ID NR L2000D SO1 HLO1 HIERCHCL ID NR L2000D 501 HLO2 HIERCHCL PARNT ID NR L2000D 501 HLO4 HIERCHCL CHILD CD L2000D 502 DMGO02 BIRTH OVL DT CCYYMMDD L2000D S02 DMG03 GENDR CD L2100D 501 NM103 SUB LNAME OVL PERSN L2100D 501 NM104 SUB FNAME L2100D 501 NM109 SUB ID OVL MEM ID NR L2200D 501 TRNO2 CURNT TRANSCTN TRAC NR L2200D 502 REFO2 PAYR CLM CONTRL NR OVL PAYR CLM NR L2200D S10 DTPO3 SVC PERD SVC RD8 Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 67 BIN 277 Table This BIN table holds mappings matching that o
76. HDR 502 BPRO2 TOTL ACTL PROV PMT AMT OVL REMTNC ONLY STHDR SO2 BPRO3 CREDT DEBT FLAG CD 5 502 BPRO4 PMT METHD CD STHDR SO2 BPR16 CHK IS EFT EFF DT STHDR 503 TRNO2 CHK EFT TRAC NR STHDR 503 TRNO3 PAYR ID STHDR 505 REFO2 RECVR ID OVL RECVR ID NR STHDR 507 DTMO2 PRODCTN DT OVL PRODCTN STHDR S12 SEO2 TCN L1000A SO1 N102 PAYR NM L1000A SO1 N104 PAYR ID OVL MDCR MDCD SVCS PLAND L1000A 502 N301 ADRS LIN L1000A 503 N401 CITY NM L1000A 503 NA402 STAT CD L1000A 503 403 PAYR POSTL ZON ZIP CD L1000A 506 PERO2 PAYR TECHNCL CONTCT NM L1000A 506 PERO4 PAYR CONTCT COMNCTN NR OVL TELPHN L1000B SO1 N102 PAY NM L1000B SO1 N104 ID CD OVL FED TAX ID NR L1000B SO2 N301 ADRS LIN Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 82 L1000B 503 401 CITY NM L1000B 503 402 STAT CD L1000B 503 N403 PAY POSTL ZON ZIP CD L2000 501 LXO1 ASGND NR L2100 SO1 CLPO1 PATNT CONTRL NR L2100 501 CLPO2 STATS CD L2100 501 CLPO3 TOTL 6 AMT L2100 SO1 CLPO4 PMT AMT L2100 SO1 CLPO6 CLM FILNG IND CD L2100 501 CLPO7 PAYR CLM CONTRL NR L2100 S03 NM103 PATNT LNAME L2100 S03 NM104 FNAME L2100 S03 NM109 PATNT ID OVL MEM ID NR L2100 S14 DTMO2 CLM DT OVL STATMNT PERD START L2100 S14
77. I Enterprise supports thirteen different transaction types and provides a number of different resources developers can use for development purposes SEED FILES Located in the C chiapas samples directory these files represent fully tested HIPAA compliant transactions as generated from the distribution environment For developers needing to generate outbound transactions these can be used as a starting point that can be tailored to specific business purposes ETL Export Views The seed files are generated by the vw Export views present within the distribution database They generate CGIF Flat recordsets To see the files being generated open up Chiapas Studio and follow these steps 1 Make sure the Flat DB Table tab is opened selected and the Table to Flat radio button is selected 2 Ensure the Data Source is correct to the chiapasData database 3 Inthe Table window enter EXEC USP ORDEREDI vw Export 834 4 Press Execute in the DB Table sub tab Under the HKey pulldown menu select Flat to HKey Press the Encode button Select the SegPool Data 1 0 tab select the SegPool to File radio button Enter in a new filename in the SegPool File box Press Execute D 00 These are the steps necessary to regenerate any of the seed files from the sample data The views themselves are standard T SQL code written to create the standard EDI transactions from the SAMPL mock healthcare data tables They can be considered the mi
78. ICD9CM DIAG L2310A 501 NM103 PROV LNAME OVL PERSN L2310A 501 NM104 PROV FNAME L2310A 503 REFO2 ATNDNG PROV 2ND ID OVL PROV COMRCL NR L2400 501 LXO1 ASGND NR 12400 502 SV201 SVC LIN CD L2400 SO2 SV202 02 PROC CD OVL HCPCS CD L2400 SO2 SV203 LIN CHG AMT L2400 SO2 SV205 UNT CT OVL UNT L2400 SO4 DTPO3 SVC DT OVL SVC D8 Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 91 BIN 837P Table This BIN table holds mappings matching that of a minimal 5010 837 Professional A2 EDI file For additional possible mappings see the CGIF reference HTML file in the C chiapas docs CGIF folder Column Name BIN PK BIN ID X1 OEISA 501 ISAO02 OVL OEISA 501 ISAO4 SEC NO SEC OEISA 501 5 06 SENDR ID OVL MUTLY DEFND ID OEISA 501 5 08 RECVR ID OVL DEFND ID OEISA SO1 ISAO9 DT OEISA SO1 ISA10 TM OEISA 501 ISA11 SEPRTR OEISA 501 ISA12 VERSN NR OEISA 501 ISA13 ICN OEISA SO1 ISA14 ACK REQ OEISA SO1 ISA15 USG IND OEISA SO1 ISA16 SUBELE SEP OEISA SO3 IEAO1 GS CT OEISA 503 2 ICN GSHDR 501 6502 APP SENDR CD GSHDR 501 6503 APP RECVR CD Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Data Type INT PK INT Purpose Primary Key Identity Foreign key to the BIN LOG table Page 92 GSHDR 501 6504 DT
79. NM109 PRIMRY ID OVL MEM ID NR L2010C S06 DMGO2 BIRTH DT OVL DT CCYYMMDD L2010C S06 DMG03 GENDR CD L2000E SO1 HLO1 HIERCHCL ID NR L2000E 501 HLO2 HIERCHCL PARNT ID NR L2000E 501 HLO4 HIERCHCL CHILD CD L2000E 504 UMO1 5 CATGRY CD L2000E S04 UMO2 CERT TYPE CD L2000E S04 UMO3 TYPE CD L2000E 504 UMO4A 01 FACLTY TYPE CD L2000E S04 UMO4 02 FACLTY CD QUAL L2000E 505 HCRO1 ACTN CD L2000E 505 HCRO2 REVW ID NR Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 75 BIN 820 Table This BIN table holds mappings matching that of a minimal 5010 820 EDI file For additional possible mappings see the CGIF reference HTML file in the C chiapas docs CGIF folder Column Name Data Purpose Type BIN PK INT PK Primary Key Identity BIN ID INT Foreign key to the LOG table SO OEISA 501 ISA02 OVL NO OEISA 501 5 04 SEC OVL NO SEC OEISA 501 5 06 SENDR ID OVL DEFND ID OEISA 501 5 08 RECVR ID OVL MUTLY DEFND ID OEISA SO1 5 09 DT OEISA 501 ISA10 TM OEISA SO1 ISA11 REPTN SEPRTR OEISA SO1 ISA12 VERSN NR OEISA 501 ISA13 ICN OEISA 501 ISA14 REQ OEISA SO1 ISA15 USG IND OEISA SO1 ISA16 SUBELE SEP OEISA 503 2 ICN GSHDR 501 6502 APP SENDR CD GSHDR 501 6503 APP RECVR CD GSHDR 501 6504 DT GSHDR 501 6505 TM GSHDR 501 6506 GCN GSHDR S03 6 2 GCN STHDR 501 STO2 TS CONTRL N
80. NO2 TS REF NR STHDR S02 BGNO3 TS CREATN DT STHDR 502 BGNO4 TS CREATN STHDR S02 BGNOS ACTN CD STHDR S10 SEO1 SEG CT STHDR S10 SEO2 TCN L1000A 501 N102 PLAN SPONSR NM L1000A 501 N104 SPONSR ID OVL FED TAX ID NR L1000B 501 N102 INSR NM L1000B 501 N104 INSR ID CD OVL FED TAX ID NR L2000 501 INSO1 MEM IND L2000 501 INSO2 INDVDL REL CD L2000 501 503 MAINTNC TYPE CD L2000 501 505 STATS CD L2000 501 INSO8 EMPLYMNT STATS CD L2000 502 REFO2 SUB ID OVL SUB NR L2000 S03 REF02 MEM GRP POLCY NR OVL POLCY NR L2000 504 REFO2 SUPP ID OVL CLIENT REPRTNG CATGRY L2000 505 DTPO3 STATS EFF DT OVL ELIG BEGN D8 L2100A IL 501 NM103 MEM OVL PERSN L2100A IL 501 NM104 MEM FNAME L2100A IL S02 PERO4 COMM NR OVL HOM PHON NR L2100A IL 503 3 1 ADRS LIN L2100A IL 504 401 CITY L2100A IL S04 N402 STAT CD L2100A IL 504 N403 POSTL ZON ZIP CD L2100A IL 505 2 BIRTH DT OVL DT CCYYMMDD L2100A IL 505 DMGO03 GENDR CD This table represents all of the information necessary to re create the original EDI file Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 8 ENCODING This example will demonstrate how to use Chiapas EDI to progress from some simple mock healthcare information and transform it into a fully compliant EDI file Let s start with examining some of the mock healthcare information First let s investigate the Member table Using SQL Server Manageme
81. NR SUB ADDRESS L2010BA 502 361 ADRS LIN SUB CITY L2010BA 503 01 CITY NM SUB STATE L2010BA 503 N402 STAT CD SUB ZIP CODE L2010BA 503 4 3 SUB POSTL ZON ZIP CD SUB BIRTH DATE L2010BA S04 DMGO2 BIRTH DT OVL DT CCYYMMDD SUB SEX L2010BA 504 DMGO3 GENDR CD RECVR PV COMPANY NM L2010BB SO1 NM103 PAYR NM OVL NONPRSN ENTY RECVR PV TAX ID L2010BB 501 NM109 PAYR ID OVL PAYR ID RECVR_PV ADD1 L2 1 BB_S 2_N3 1_ADRS LIN RECVR_PV CITY L2010BB 503 01 CITY NM RECVR PV STATE L2010BB 503 NA02 PAYR STAT PROWNC CD CONVERT VARCHAR RECVR PV ZIP CD 0000 L2010BB 503 N403 PAYR POSTL ZON ZIP CD CLM CLAIM ID 12300 501 CLMO1 PATNT CONTRL NR SELECT dbo fx HIPAA NUMBER SUM CONVERT MONEY SERVICE CHARGE 1 COALESCE SERVICE CHARGE 2 CONVERT MONEY 0 00 COALESCE SERVICE CHARGE 3 CONVERT MONEY 0 00 COALESCE SERVICE CHARGE 4 CONVERT MONEY 0 00 FROM BIN FBN WHERE CLAIM ID CLM CLAIM ID 12300 501 CLMe2 TOTL CLM CHG AMT ig 12300 501 CLMe5 01 PLAC SVC CD P 12300 501 CLMO5 03 CLM FREQNCY CD OVL PLAC SVC CODS PROF DENTL id 12300 501 CLMe6 PROV SUPLR SIGNTR IND E 12300 501 CLMO7 ASGNMNT PLAN PARTCPTN CD uy 12300 501 CLMO8 BENFTS ASGNMNT CERT IND sie 12300 501 CLMO9 RELS CD CLM DX 12300 S43 1 02 DIAG CD ICD9CM PRINCPL DIAG SVC CD L2400 S02 SV101 02 PROC CD OVL HCPCS CD dbo fx HIPAA NUMBER SVC CH 12400 502 SV102 LIN ITM AMT ps L2
82. NT DATAO1 EVENT DATAO2 EVENT DATA03 EVENT 4 EVENT CREATED EVENT PROCESS BEGIN EVENT PROCESS COMPLETE EVENT RESULT Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Data Type INT PK INT INT VARCHAR 200 VARCHAR 200 VARCHAR 200 VARCHAR 200 DATETIME DATETIME DATETIME VARCHAR 200 Purpose Primary Key Identity This is refers to the numeric ID of the background worker process that took ownership and processed the event For the lowest licensing tier which supports two Worker Processes this number will be either 1 or 2 Events that are not assigned to an owner will start with 1 All events inserted into this table should have a 1 in the column or else it will not be processed Foreign key to the Trigger table of the trigger that spawned this event Event Data 01 For Scheduled and SQL Triggered events that do not carry data this value is blank For Archive events this value is the filename without path For Upload events this value is the filename with path Event Data 02 Event Data 03 Event Data 04 Timestamp of when the event was created Timestamp of when the event began processing Timestamp of the completion of processing Values CRITICAL ERROR SEE MESSAGE LOGS CRITICAL ERROR NO LOGS COMPLETE WITH MESSAGE LOGS COMPLETE NO LOGS Page 54 MSGLOG Table This table stores the Message Logs that are associated with a specific event
83. PROD TRAD PARTNER to the correct ID of 5 UPDATE PROD TRAD PARTNER SET RECVR PROV ID 5 WHERE ID 1 Then we select the Reset All to clear the state of the Chiapas Studio and re run the above steps and we observe that the Receiving Provider is now set correctly to FBN HMO View vw Export FBN Deliverable 1 C 1 D Next we must extend the view to encode proper values for the 2010 AA Billing Provider and SBR segment We alter the view and insert the following lines prior to the FROM clause The L2000A HL04 mapping allows the encoder to encode the 2000A loop by the rules of the logic engine every loop Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 146 must have at least one mapped element Following this is the Billing Provider information which is the same as the Submitting Provider Note that the ZIP Code is padded with four O s For the SBR susbscriber segment this describes the type of insurance for the subscriber Since all patients in this file are subscribers in Fly By Night HMO s commercial product then P Primary Subscriber 18 Relationship Self and Cl Commercial Insurance are the correct values to populate in this transaction ps L2000A 501 HLO4 HIERCHCL CHILD CD SENDR PV COMPANY NM L2010AA 501 NM103 BILNG PROV ORGL NM OVL NONPRSN ENTY SENDR PV NPI ID L2010AA 501 NM109 PROV ID OVL CENTRS MEDCR MEDCD SVCS SENDR_PV ADD1 L2010AA 502
84. R STHDR SO1 STO3 IMPLMNTN CONVNTN REFNC STHDR 502 BPRO2 TOTL PREM PMT AMT OVL REMTNC ONLY Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 76 STHDR 502 BPRO4 PMT METHD CD STHDR 502 BPR10 PAYR ID STHDR SO2 BPR16 CHK IS EFT EFF DT STHDR 503 TRNO1 TYPE CD STHDR 503 TRNO2 CHK EFT TRAC NR STHDR S15 SEO2 TCN L1000A SO1 N102 LAST ORG NM L1000A SO1 N104 PREM RECVR ID CD OVL FED TAX ID NR L1000B SO1 N102 PAYR NM L1000B SO1 N104 PAYR ID OVL FED TAX ID NR L2000B 501 ENTO1 ASGND NR L2000B 501 ENTO4 RECVR INDVDL ID OVL EMPLY ID NR L2100B IL 501 NM103 INDVDL LNAME L2100B IL 501 NM104 INDVDL FNAME L2100B IL 501 NM109 INDVDL ID OVL INSRD ID NR L2300B 501 RMRO2 INS REMTNC REF NR OVL HEALTH INS POLCY NR L2300B 501 RMRO4 PREM AMT Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 77 BIN 834 Table This BIN table holds mappings matching that of a minimal 5010 834 A1 EDI file For additional possible mappings see the CGIF reference HTML file in the C chiapas docs CGIF folder Column Name Data Type BIN PK INT PK BIN ID INT OEISA 501 ISAO2 OVL NO AUTH OEISA 501 ISAO4 SEC PASSWD OEISA 501 15 06 SENDR ID OVL MUTLY DEFND ID OEISA 501 5 RECVR ID OVL MUTLY DEFND ID OEISA 501 5 09 DT OEISA SO1 ISA10 TM OEISA 501 ISA11 REPTN SEPRTR OEISA SO1 ISA12 VERSN NR OEISA SO1 I
85. R 2 CHIAPAS EDI TECH PpI 273801950 000020 CLM 000011 200 11 B 1 Y A Y Y 000021 DTP 472 RD8 20120121 20120121 000022 SBR S 01 GR00786 13 000023 NM1 IL 1 DOE JOHN T JR MI XXX1 000024 NMI DN 1 000025 REF G2 123 000026 NM1 P3 1 000027 REF G2 1234 000028 NM1 77 2 000029 REF G2 111111 000030 SBR T 02 GR00787 13 000031 NM1 IL 1 DOE2 JOHN2 T JR MI XXX2 000032 NM1 DN 1 000033 REF G2 5123 000034 NM1 P3 1 000035 REF G2 51234 000036 NM1 77 2 000037 REF G2 1111112 000038 LX 1 000039 SV3 AD D2150 200 000040 SE 158 100000000 lt gt The SegPool Display is responsible for displaying both the segments within the SegPool object as well as the Log Register Normally messages are associated with specific segments so the default mode is to display both simultaneously as shown here However the SegPool and Messages can each be viewed in isolation by switching to other tabs Menu Options This section describes the menu bar options at the top of the window Session Load Session Loads a previously saved session Save Session This feature lets you save the settings within the Data 1 0 panel to a file that can later be restored There is also a default winstate file within the Chiapas bin directory that represents the default state of these settings it can be overwritten so that every time Chiapas Studio is launched these settings are loaded at the beginning of the
86. REATN_TIM gt 0917 lt BGN04_TS_CREATN_TIM gt lt BGN08_ACTN_CD gt RX lt BGN08_ACTN_CD gt lt so2 gt lt L1000A gt lt 501 gt lt N102_PLAN_SPONSR_NM gt CHIAPAS EDI TECH lt N102_PLAN_SPONSR_NM gt lt N104_SPONSR_ID_OVL_FED_TAX_ID_NR gt 273801950 lt N104_SPONSR_ID_OVL_FED_TAX_ID_NR gt lt 501 gt lt L10004 gt L1000B lt 501 gt INCO NM TETI E LIN 102 TINGO NM gt 15A02 NFO OVL NO AUTH ID SAMPL SENDRID ISA06 SENDR JD OVL MUTLY DEFND ID 5 08 RECVR 10 OVL MUTLY DEFND JD SAMPL RECVRID ISA08 RECVR 10 OVL MUTLY DEFND ID Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 6 Now press the Flat HKey button that is present within the HKey Register tab This will transform the HKey register to the Flat register Press the Flat tab within the Flat HKey Register pane and the Flat register is displayed Flat HKey Set Row col Display gt Fiat me 1 Ti OEISA 501 15 2 AUTH OVL NO AUTH Sei ISAe4 SEC OVL PASSHD 501 15406 SENDR ID OVL MUTLY DEFND ID 501 15468 RECVR ID MUTLY DEF Ts SAMPL_SENDRID SAMPL_RECVRID SAMPL SENDRID SAMPL RECVRID SAMPL SENDRID SAMPL RECVRID SAMPL SENDRID SAMPL RECVRID SAMPL SENDRID SAMPL RECVRID SAMPL SENDRID SAMPL RECVRID SAMPL SENDRI
87. RTR OEISA SO1 ISA12 VERSN NR OEISA SO1 ISA13 ICN OEISA SO1 ISA14 ACK REQ OEISA SO1 ISA15 USG IND OEISA SO1 ISA16 SUBELE SEP OEISA 503 IEAO2 ICN GSHDR 501 4502 APP SENDR CD GSHDR 501 6503 APP RECVR CD GSHDR 501 6504 DT GSHDR 501 6505 TM GSHDR 501 6506 GCN 65 S03 GEO2 GCN STHDR SO1 STO2 CONTRL NR STHDR 502 BHTOS3 REF ID STHDR 502 BHTO4 TS CREATN DT STHDR 502 BHTO5 TS CREATN TIM STHDR 506 5 02 Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Data Type INT PK INT Purpose Primary Key Identity Foreign key to the BIN LOG table Page 70 L2000A SO1 HLO1 HIERCHCL ID NR L2100A 501 NM103 SOURC LAST ORG NM OVL NON ENTY L2100A 501 NM109 SOURC PRIMRY OVL PAYR ID L2200A SO1 TRNO2 NFO SRC APPLCTN TRAC ID L2200A 502 DTPO3 DT TM PERD OVL RECVD D8 L2200A S03 DTPO3 NFO SRC PROCSS DT OVL PROCSS D8 L2000B L2000B L2000B L2100B SO1 HLO1 HIERCHCL ID NR 501 HLO2 ID NR 501 HLO4 HIERCHCL CHILD CD 501 NM103 RECVR LAST ORG NM OVL NON PERSN L2100B 501 NM109 SOURC PRIMRY ID OVL ETIN L2200B 501 TRNO2 CLM TRANSCTN BATCH NR L2200B 502 STCO1 01 HLTH CR CLM STATS CAT CD L2200B 502 STCO1 02 CR CLM STATS CD L2200B 502 STCO2 STATS EFF DT L2
88. SA13 ICN OEISA SO1 ISA14 ACK REQ OEISA SO1 ISA15 USG IND OEISA SO1 ISA16 SUBELE SEP OEISA 503 IEAO2 ICN GSHDR 501 4502 APP SENDR CD GSHDR 501 6503 APP RECVR CD GSHDR 501 6504 DT GSHDR 501 6505 TM GSHDR 501 6506 Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Purpose Primary Key Identity Foreign key to the BIN LOG table Page 78 GSHDR 501 6508 VERS ID CD GSHDR 503 GEO2 STHDR 501 STO2 CONTRL NR STHDR 501 STO3 REFNC STHDR 502 TS PURPS CD STHDR SO2 BGNO2 TS REF NR STHDR 502 3 TS CREATN DT STHDR 502 BGNO4 TS CREATN STHDR 502 8 CD STHDR S10 SEO2 TCN L1000A SO1 N102 PLAN SPONSR NM L1000A SO1 N104 SPONSR ID OVL FED TAX ID NR L1000B SO1 N102 INSR NM L1000B SO1 N104 INSR ID CD OVL FED TAX ID NR L2000 SO1 INSO1 MEM IND L2000 SO1 INSO2 INDVDL REL CD L2000 SO1 INSO3 MAINTNC TYPE CD L2000 501 INSO5 BENFT STATS CD L2000 501 INSO8 EMPLYMNT STATS CD L2000 SO2 REFO2 SUB ID OVL SUB NR L2000 S03 REFO2 MEM POLCY NR OVL GRP POLCY NR L2000 504 REFO2 SUPP ID OVL CLIENT REPRTNG CATGRY L2000 505 DTPO3 STATS EFF DT OVL ELIG BEGN D8 Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 79 L2100A 501 NM103 MEM OVL PERSN L2100A SO1 NM104 M
89. SAMPL CLAIM DTL DTL ON HDR CLAIM ID DTL CLAIM ID CLAIM ID ID MEM ID PATNT ACCT FAC TYP CD PRI DIAG CD SEC DIAG CD STATUS ADJUDCTN DT CLAIM ID nok N Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 9 On the previous page we saw member and provider information and above we can see a mock claims table that will be encoded to a file There is a single SOL View with the chiapasData database that can be used to send data directly to a new 837 Professional file vw Export 837P The difficulty with using the view directly to create EDI files is that SOL Server does not guarantee that the ORDER BY clauses will function correctly within Views To address this there is a stored procedure included within the chiapasData that will work to ensure that the output of any CGIF formatted table will be properly ordered and that claims line items and so on will be grouped together correctly Here are the sequence of steps necessary to go from this sample export view to an EDI file 1 Within Chiapas Studio click on the Flat tab on the left Data I O pane and then select the Table to Flat radio button and type in EXEC USP ORDEREDI vw Export 837P within the Table textbox Flat HKey SegPool Log DB Table CSV Excel Flat To Table Execute Table to Flat Merge DB Type SQL Server Data Source Data Source Database chiapasData Trusted
90. SE Registers and Runtime Environment 26 CHIAPAS STUDIO INTERFACE 28 Register IntOntmatloli u 28 Da VO 29 Flat HKey Register Pane nennen enne nn ennrnn intr sse tn 36 Mapping Interface ete entente 37 SegPool Register Interface 38 EST ce 38 41 SCHEDULER INTERFACE uuu u 45 TEGHNICAL REFERENCE 50 CORE DATABASE SCHEMA 51 AUTOMATION STORAGE SCHEMA a 57 Flat BIN 57 un maana 58 XML StOFaB68 oed p chet tue tree utes esed 59 SAMPLE OBJECT SCHEMA side serment ue enne i 96 SEED 103 SEED FILES u ll l Ete oe bet cages 103 ETI ExDOrtiVi WS u au d cokes pete niue dre 103 WORKFLOW erg inis 105 ina 106 CGateMsSB RE
91. TH DT DATE Birth Date GENDER VARCHAR 1 Gender ADD1 VARCHAR 75 Address Line 1 ADD2 VARCHAR 75 Address Line 2 CITY VARCHAR 50 City STATE VARCHAR 2 State ZIP_CD VARCHAR 20 Zip Code PHONE NR VARCHAR 20 Phone Number Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 100 SAMPL MEM ELIG Table This table stores sample member enrollment span information Column Name Data Type Purpose MEM ELIG ID INT PK Unique Member Eligibility Identifier MEM ID INT Foreign Key to the Member table STATUS VARCHAR 10 Eligibility status FROM DT DATE Eligibility From Date TO DT DATE Eligibility To Date Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 101 SAMPL PROVIDER Table The table stores a number of mock providers Column Name PROV ID TAX ID NPI ID COMPANY NM FIRST NM LAST NM ADD1 ADD2 CITY STATE ZIP CD CONTACT NM WORK PH EMAIL Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Data Type INT PK VARCHAR 15 VARCHAR 12 VARCHAR 50 VARCHAR 20 VARCHAR 20 VARCHAR 75 VARCHAR 75 VARCHAR 50 VARCHAR 2 VARCHAR 20 VARCHAR 50 VARCHAR 50 VARCHAR 50 Purpose Unique Provider Identifier Federal Tax ID National Provider Identifier Company Name First Name Last Name Address Line 1 Address Line 2 City State ZIP Code Contact Name Work Phone Email Page 102 SEED TRANSACTIONS Chiapas ED
92. X Patient Gender M for Male F for Female CLAIM ID Claim Identifier a 10 digit number CLINIC ID Clinic Location Identifier a 1 digit number indicating the clinic where services were rendered 1 PB Clinic Felix Location 101 Cat Street Anytown CA 00001 2 PB Clinic Jelly Facility 303 Peanut Butter Ave Anytown CA 00001 3 PB Clinic Unlit Lab 1000 Mad Scientist Way Anytown CA 00001 DX Diagnosis Code with Dot Code Example V72 83 SERVICE CODE 1 HCPCS Service Code for Service Rendered Example 99213 SERVICE DATE 1 Date Service was Rendered in the format YYYY MM DD Example 2014 07 06 SERVICE CHARGE 1 Service Charge Amount in the format NNNN NN Example 1234 56 SERVICE CODE 2 Second Service Rendered SERVICE DATE 2 SERVICE CHARGE 2 Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 139 SERVICE CODE 3 SERVICE DATE 3 SERVICE CHARGE 3 SERVICE CODE 4 SERVICE DATE 4 SERVICE CHARGE 4 CSV Sample Third Service Rendered Fourth Service Rendered 2014 07 06 STEW MARNEY 111 22 9999 976 GINGERBREAD LN APT 6 ANYTOWN CA 00001 1962 03 01 F 8980153154 1 V72 83 99213 2014 p7 01 142 00 mw uw nn me mej ma 2014 07 06 KNIFE MACK 111 22 9000 123 WHITTLEBIRD ST ANYTOWN CA 00001 1973 07 16 M 8980153155 2 302 89 55
93. Y MI 111229999 000022 N3 976 GINGERBREAD LN APT 6 000023 NA ANYTOWN CA 00001 Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 148 000024 DMG D8 19620301 F 000025 HL 4 1 22 0 000026 SBR P 18 CT 000027 NM1 IL 1 SUNDAE DEVIN MI 111228000 000028 N3 842 TURBAN DR 000029 NA ANYTOWN CA 00001 000030 DMG D8 19700114 M 000031 SE 29 100000000 000032 GE 1 1 000033 IEA 1 100000000 This time we see a more substantial but still far from compliant or a valid EDI file transaction with the 2000B loops repeating once for each of the subscribers presented within the data file This test validates we have achieved Deliverable 1 E View vw Export FBN Deliverable 1 F Within the raw EDI file there are three distinct sets of Claim Header information across for data rows We cannot count on there being one claim for every subscriber so we will need to do a similar SELECT DISTINCT statement and then join it to the existing Subscriber extract We add this clause to the end of the View syntax INNER JOIN SELECT DISTINCT CLAIM ID REPLACE DX DX LAST NAME FIRST NAME REPLACE SSN SSN FROM BIN FBN CLM ON SUB LAST NAME CLM LAST NAME AND SUB FIRST NAME CLM FIRST NAME AND SUB SSN CLM SSN Notice that we remove the dots from the Diagnosis Code and the dashes from the SSN neither is accepted by HIPAA syntax conventions Extracting the
94. YMMDD L2010BA 504 DMGO3 GENDR CD L2010BB 501 NM103 PAYR NM OVL NONPRSN L2010BB 501 NM109 PAYR ID OVL PAYR ID L2010BB 502 301 ADRS LIN Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 94 L2010BB SO3 N401 CITY NM L2010BB 503 N402 PAYR STAT PROVNC CD L2010BB 503 03 PAYR POSTL ZON ZIP CD L2300 501 CLMO1 PATNT CONTRL NR L2300 501 2 TOTL CLM CHG AMT L2300 501 CLMO5 01 PLAC SVC CD 2300 501 CLMO5 03 CLM FREQNCY CD OVL PLAC SVC CODS PROF DENTL L2300 501 CLMO6 PROV SUPLR SIGNTR IND L2300 501 CLMO7 ASGNMNT PLAN PARTCPTN CD L2300 501 CLMO8 BENFTS ASGNMNT CERT IND 2300 501 CLMO9 RELS CD L2300 S43 HIO1 02 DIAG CD OVL ICD9CM PRINCPL DIAG L2300 S43 HIO2 02 DIAG CD OVL ICD9CM DIAG L2310B 501 NM103 LAST ORG NM OVL NONPRSN ENTY L2310B 503 2 RENDRNG PROV 2ND ID OVL PROV COMRCL NR L2400 501 1 01 ASGND NR L2400 502 SV101 02 PROC CD OVL HCPCS CD L2400 502 SV102 LIN ITM CHG AMT L2400 502 SV104 SVC UNT CT OVL UNT L2400 502 SV107 01 DIAG CD POINTR L2400 S11 DTPO3 SVC DT OVL SVC D8 Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 95 SAMPLE OBJECT SCHEMA SAMPL CLAIM HDR SAMPL CLAIM SAMPL CLAIM ADJ i CLAIM ID if CLAIM DTL ID lt if CLAIM ADJ ID i PROV ID 1 41 CLAIM ID f i CLAIM DTL ID MEM ID Fr 25 SAMPL MEMBER SAMPL MEM ELIG SAMPL PROVIDER I i PROV ID i MEM_ID In order to demonstrate
95. _Connection true EXEC USP ORDEREDI vw t 837P Table 2 Press Execute 3 Next press the HKey tab on the Flat HKey Register pane and then press the Flat HKey button Flat Flat eris gt we D 4 This will effectively pull the Flat Register into the HKey register The HKey tab will show a representation of the HKey in XML form Since the HKey is now loaded we need to press the ENCODE button in the lower left hand area of the screen to translate the HKey to the SegPool register Flat 0078x000019 bii ES Decode Error Count 20080 SegPool 0909090909 Lock HIG Page Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 10 5 The SegPool Register will now be loaded with an EDI transaction The only remaining step is to save the SegPool register to a new file via the Data I O Pane Click on the SegPool tab of the Data I O pane then the File sub tab Select the SegPool to File radio button check the CR and LF check boxes to ensure the resulting file will have CR LF formatting enter in a filename and press EXECUTE Flat HKey Log 999 Ack to File File to SegPool yr iF L Scrub PHI SegSep EleSep SubEleSep At this point a new file called tutorial_837p txt will appear in the C chiapas directory Starting from raw data located within the SAMPL tables of the chiapasData database we loaded the raw data via a stored procedure that guaran
96. a simple 834 file and we decoded it to an HKey and then stored it as database tables with a prefix of X The tables would be called XOEISA XGSHDR XSTHDR XL1000A XL1000B XL2000 and XL2100A Each row in each table would have be uniquely identified with the KEY ID field The PAR KEY ID would point to the KEY ID field of the parent table as shown below XML DB Tables XML 9 XML To HKey EE O HKey to XML XML File This interface provides XML transport for the HKey register For an example of the CGIFXML2 format Chiapas EDI Enterprise uses see the chapter on the Chiapas Gate Intermediate Format Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 32 XML to HKey Radio button to select loading the HKey from XML HKey to XML Radio button to select saving the HKey to XML XML File Textboxto indicate the XML filename Double clicking in the window will bring up an Open File or Save File dialog Execute This will carry out the indicated operation SegPool Register Interfaces This tab presents an interface for loading HIPAA transaction EDI files from and to the SegPool register File File 999 Ack 2 SegPool to File Execute File to SegPool CR LF Scrub PHI SegPool File C NchiapasNsampleNseed_834 txt SegSep EleSep SubEleSep This interface allows you to adjust the formatting of the file including the Segment Separator Element
97. abase chiapasData Trusted_ Connection true WHERE TSRC_ID 13 Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 3 4 To configure and start the background automation service Press Start gt Right Click on Computer select Manage Go to Configuration Services Right click Properties on ChiapasService Switch to the LogOn tab then fill in the Log On As information with login and password information for an account with Administrator permissions Return to the General Tab press Start to start running the automation service UPDATES Chiapas EDI Technologies Inc distributes the installer to registered clients via a Secure FTP server It is necessary to have a SecureFTP client in order to access your specific account on the server one is included with Chiapas EDI Enterprise within the C chiapas bin folder called WinSCP The site to access the server is sftp chiapas edi org Login information is provided to you along with your Chiapas EDI Enterprise license Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 4 QUICK START GUIDE This Quick Start Guide is oriented to quickly accessing three core features of the Chiapas EDI Enterprise product Decoding Encoding and the built in automation pipelines Decoding is focused on taking one of the included sample HIPAA files through the steps of converting it to a database table Encoding focuses on con
98. able field can be filled with one of the following Atable name SELECT statement EXEC stored procedure statement that returns a dataset Note that SELECT should be followed by ORDER BY clauses in order to guarantee proper ordering of the incoming data Also if a SELECT or EXEC clause is used it is case sensitive so they should be all CAPS Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 29 Execute This carries out a simple store or load operation as indicated by the radio buttons When the operation is set to save data to database to SQLite and SQL Server databases the Execute option will create the destination table if it doesn t exist Then the data is then shuttled to the destination via a series of INSERT statements If there are fields in the register that don t exist in an existing destination table the operation will fail As shown above in the Table description when data is being loaded to the Flat register a variety of SOL Server data sources is supported Merge This is a store only button that only functions on SQLite and SQL Server destinations If there are fields present on the register not present in the destination table then these fields will be logged as Unmerged Mapping error messages to the Log and these fields will be omitted from the INSERT statements allowing the operation to succeed ForceMerge This is a store only button that only functions for SQL Server destinations I
99. acts as an indexto the other thirteen tables in the CGIF Flat storage system The BIN ID primary key is a foreign key to the other tables Column Name Data Type Purpose BIN ID INT PK Primary Key Identity BIN FILENAME VARCHAR 300 EDI Filename BIN RECV DATE DATETIME Timestamp when the log entry was created BIN TYPE VARCHAR 20 EVENT ID INT Foreign key to the EVENTS table for the reference to the event that spawned this BIN LOG record Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 61 BIN 270 Table This BIN table holds mappings matching that of a minimal 5010 270 A1 EDI file For additional possible mappings see the CGIF reference HTML file in the C chiapas docs CGIF folder Column Name Data Type BIN PK INT PK BIN ID INT M1 OEISA 501 ISA02 OVL NO AUTH OEISA 501 5 4 SEC OVL PASSWD OEISA 501 15 06 SENDR ID OVL MUTLY DEFND ID OEISA 501 5 RECVR ID OVL MUTLY DEFND ID OEISA 501 5 09 DT OEISA SO1 ISA10 TM OEISA SO1 ISA11 REPTN SEPRTR OEISA SO1 ISA12 VERSN NR OEISA SO1 ISA13 ICN OEISA SO1 ISA14 ACK REQ OEISA SO1 ISA15 USG IND OEISA SO1 ISA16 SUBELE SEP OEISA 503 IEAO2 ICN GSHDR 501 4502 APP SENDR CD GSHDR 501 6503 APP RECVR CD GSHDR 501 6504 DT GSHDR 501 6505 TM GSHDR 501 6506 GSHDR 501 6508 VERS ID CD GSHDR 503 GEO2 STHDR 501 STO2 CONTRL NR STHDR SO2
100. apas EDI Technologies Inc All Rights Reserved Page 84 GSHDR 501 6506 GSHDR 501 6508 VERS ID CD GSHDR 503 GEO2 STHDR SO1 STO2 CONTRL NR STHDR 502 BHTO1 STRUCTR CD STHDR 502 BHTO2 TS PURPS CD STHDR 502 BHTO3 ORGNTR APLCTN TRANSCTN ID STHDR 502 BHTO4 TS CREATN DT 5 502 BHTO5 TS CREATN TIM STHDR 502 BHTO6 CLM ENCNTR ID STHDR 506 5 02 L1000A 501 NM103 SUBMTR LAST ORG NM NONPRSN L1000A 501 NM109 SUBMTR ID OVL NR L1000A SO2 PERO2 CONTCT NM L1000A 502 PERO4 COMM NR OVL TELPHN L1000B 501 NM103 RECVR NM OVL NONPRSN ENTY L1000B 501 NM109 PRIMRY ID OVL ETN NR L2000A SO1 HLO1 HIERCHCL ID NR L2010AA 501 NM103 LAST ORGL NM OVL NONPRSN L2010AA SO2 N301 BILNG PROV ADRS LIN L2010AA 503 401 BILNG PROV CITY NM L2010AA 503 N402 STAT PROVNC CD L2010AA 503 N403 POSTL ZON ZIP CD Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 85 L2010AA 504 REFO2 ID OVL EMPLYR ID NR L2000B SO1 HLO1 HIERCHCL ID NR L2000B SO1 HLO2 HIERCHCL PARNT ID NR L2000B 501 HLO4 HIERCHCL CHILD CD L2000B SO2 SBRO1 PAYR RESP SEQNC NR CD L2000B SO2 SBRO2 INDVDL REL CD L2000B SO2 SBRO9 CLM FILNG IND CD L2010BA SO1 NM103 SUB LNAME OVL PERSN L2010BA SO1 NM104 SUB FNAME L2010BA SO1 NM109 PRIMRY ID OVL MEM ID NR L2010BA SO2 N301 ADRS LIN L2010BA 503
101. apas Studio are dedicated to providing a live view of the information contained within the Flat and HKey registers Because these displays are memory and processor intensive they will not work to display data files larger than 10 MB Even if the displays do not function the engine is still generally able to carry out functions on the registers normally HKey Register Flat HKey Fine Fn m CGIFXML2Root T1 A lt OEISA gt S01 5 02 AUTH OVL NO AUTH ISA02 AUTH OVL NO ISA04 SEC OVL PASSWD ISA04 SEC OVL PASSWD lt 15 06 SENDR ID OVL MUTLY DEFND ID SAMPL SENDRID ISA06 SENDR ID OVL MUTLY DEFND 1 15 08 RECVR ID OVL MUTLY DEFND ID SAMPL RECVRID ISA08 RECVR ID OVL MUTLY DEFND ID lt ISA09_DT gt 120810 lt ISA09_DT gt lt ISA10_TM gt 0914 lt ISA10_TM gt ISA11 REPTN SEPRTR gt lt ISA11_REPTN_SEPRTR gt lt ISA12_VERSN_NR gt 00501 lt ISA12_VERSN_NR gt lt ISA13_ICN gt 100000000 lt ISA13_ICN gt lt ISA14_ACK_REQ gt 0 lt ISA14_ACK_REQ gt lt ISA15_USG_IND gt P lt ISA15_USG_IND gt ISA16 SUBELE gt lt 15 16 SUBELE SEP S01 lt GSHDR gt S01 GS02 APP SENDR CD SENDR 10 6502 APP SENDR CD 6503 APP RECVR CD gt RECVR_ID lt GS03_ APP RECVR CD lt GS04_DT gt 20120810 lt GS04_DT gt 6505 TM gt 0914 lt GS05 gt 6506 GCN 1 GS06 GCN 6508 VERS ID CD 005010X220A1 GS08 VERS ID CD l
102. aracter segment code for the header segment Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 18 for example the CLM segment in 837 transactions only occurs for the 2300 Claim Information loop and nowhere else in the transaction More commonly however there is an element that qualifies the header segment and thus the loop Although not specifically called out in the Implementation Guides generally the first element for most loops and the third element for Hierarchical Level HL segment code loops uniquely define the loop When Chiapas EDI Enterprise decodes a file it is these qualifiers that guide it to find the right loop in which to place the encoded information Segments are units of business information that make up a loop Each segment is ordered within the loop by position and is either unique by the segment code or by the segment code and a qualifier element located within the segment For example REF and DTP segments always have a qualifier element in the first element position that uniquely identify that segment within the loop Elements are the individual parts of the segment sub divided by the element separator defined by the first segment in the file In certain situations an element can be further sub divided into composite elements which is divided by another separator character defined within the first segment in the file Overloads is a concept specific to the CGIF format and represents a way o
103. ars in a certain directory This will be set up as a LOCAL UPLOAD trigger within the Chiapas EDI environment Second the file should be translated to EDI as described in Requirement 1 and placed in another directory Deliverable 2 A We will assume that the PB Clinic IT department is able to get the legacy CSV to the Chiapas EDI server directory C chiapas pipeline 913 CSVLegacy 01 in csv A new trigger will be set up to move the file to C chiapas pipeline 13_CSVLegacy 2_in_csv Then a SQL Server BULK INSERT process will propagate this raw file to an internal database table on the chiapasData database Deliverable 2 B The raw file should be inserted to a table called BIN FBN and follow the schema of the CSV file Deliverable 2 C The data will then be translated and pushed into the BIN 837P using a new BIN ID Then a new trigger is established to create a new outbound EDI file in the following directory C chiapas pipeline 13_CSVLegacy 3 out edi Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 141 Technical Implementation scratch First from within SSMS we create a new version of the tables SELECT TOP INTO PROD TRAD PARTNER FROM SAMPL TRAD PARTNER SELECT TOP INTO PROD PROVIDER FROM SAMPL PROVIDER As Chiapas EDI Enterprise already contains an 837P EDI export path it is far easier to alter the existing ETL scripts than it is to create all of them from
104. asData Trusted Connection Flat HKey SegPool Log File 999 Ack O SegPool to File Execute File to SegPool CR LF Scrub PHI SegPool File C lt hiapas sample seed_834 txt SegSep EleSep SubEleSep 3 The SegPool File textbox is defaulted to the seed_834 txt sample eligibility transaction Press Execute to load it The file is loaded into the SegPool Register Pane SegPool Msgs SegPool Msgs 000001 ISA 00 15 ZZ SAMPL 000002 GS BE SENDR ID RECVR ID 20120810 0914 1 X 005 000003 ST 834 100000000 005010x220A1 000004 BGN 00 100000000 20120810 0917 RX 000005 N1 P5 CHIAPAS EDI TECH FI 273801950 000006 N1 IN DOOLITTLE HOSPITAL FI 123400001 000007 INS Y 18 030 A FT 000008 REF 0F 987654320 000009 REF 1L BASICHEALTHCAREPLAN 000010 REF 17 100001 000011 DTP 356 D8 20120101 000012 NM1 IL 1 BURGER JOHN 000013 PER IP HP 4155551200 000014 N3 123 A ST 000015 N4 SAN FRANCISCO CA 94117 000016 DMG D8 19800707 M 000017 INS Y 18 030 A FT 000018 REF 0F 987654321 000019 REF 1L BASICHEALTHCAREPLAN 000020 REF 17 200001 000021 DTP 356 D8 20120101 000022 NMI IL 1 FILET STEVE 000023 PER IP HP 4155551201 000024 N3 222 B ST 000025 N4 SAN FRANCISCO CA 94117 000026 DMG D8 19700404 M The DECODE button in the lower left area is responsible for transforming the SegPool Register the HKey Register Pre
105. ata Source Select the source from which to copy data A Data source 2 Flat File Source General Select a file and specify the file properties and the file format Columns Advance File name c Users VAdministratorDesktop DAT A cs Browse 21 Preview Locale English United States T Unicode Code page 1252 ANSI Latin l Format Delimited Text qualifier Header row delimiter Header rows to skip o Column names in the first data row Column Mappings oa Source C Users Administrator Desktop DATA csv Destination dbo BIN FBN essa Delete rows in destination table m Append rows to the destination table V Enable identity insert Mappings Source Destination Type Nullable Precision Scale Column 0 FILE DATE varchar F 200 Column 1 LAST_NAME varchar 200 Column 2 FIRST NAME varchar F 200 Column 3 SSN varchar lv 200 Column 4 ADDRESS varchar F 200 Column 5 CITY varchar iv 200 Column 6 STATE varchar F 200 Column 7 ZIP_CODE varchar 200 Column R RIRTH varchar 200 y Source column Column 24 string DT STR 50 OK Cancel 1 View vw Export FBN Deliverables 1A 1B At this stage we now have data in the BIN FBN table the PROD PROVIDER table and the PROD TRAD PARTNER table Now we will adapt the existing vw Export 837P to tie data sources CREATE VIEW dbo vw Export FBN AS SELECT ISA02 ISA04 ISA06 SENDR
106. ata Activity Current Datestamp Current Timestamp Value set in the Encounter Data Activity Value set in the Encounter Data Activity ICN Value set in the Encounter Data Activity right padded with zeros 0 Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 117 ISA16 GS01 GS02 GS03 GS04 GS05 GS06 GS07 GS08 STO2 STO3 BHT04 BHTOS SEO1 5 2 GEO1 GE02 IEA01 IEA02 HL01 HL02 HL03 HL04 LX01 Value set in the SegPool Value set according to specification Sender Code Value set in Encounter Data Activity Receiver Code Value set in Encounter Data Activity Current Datestamp Current Timestamp GCN Value set in the Encounter Data Activity X Value set according to specification TCN Value set in the Encounter Data Activity Value set according to specification Current Datestamp Current Timestamp Calculated Segment Count TCN Value set in the Encounter Data Activity Calculated Transaction Count GCN Value set in the Encounter Data Activity Calculated Group Count ICN Value set in the Encounter Data Activity Indexed according to situation Indexed according to situation 20 21 22 or 23 Chiapas Gate will fill in for a 1 for when HL03 20 and a 0 for when HLO3 23 User must supply 0 or 1 according to the presence of children HL loops Incremented according to situation When the Encode operation successfully completes the
107. ata Source Data Source string Prefix These characters act as a prefix to the loop names Export View This button will create SQL Server database view called vw_HKey_ lt prefix gt that will link all of these tables together into a CGIF Flat compatible format Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 31 Execute For loading the HKey from DB Tables the engine will first load in the prefix OEISA table and use the first column specification prefix tag to derive the specification It will then attempt to load all loops defined for that specification from the database tables Assuming the data is properly formatted the HKey will be loaded Although this operation is far more complex that loading a CGIF Flat to the Flat register and then transforming it to the HKey directly loading the HKey from tables like this also means there are time and performance advantages as CGIF Flat has a large amount of duplicated data For saving the HKey to DB Tables the engine will automatically create all of the tables properly prefixed as specified and populate them with data The KEY ID is a unique row identifier for each row the PAR KEY ID field is a reference to the KEY ID of the parent loop table When the PAR KEY ID repeats for multiple rows this means that there are multiple iterations of that loop for a particular parent loop such as service lines to claims Example Supposing we had
108. ation from a given path stored in a string variable Path GetFileNameWithoutExtension lt variable gt Gets only the filename without the extension from a path given in a string variable Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 44 SCHEDULER INTERFACE This interface is dedicated to creating and maintaining the Triggers that underlay the automation system It is capable of displaying the execution history as well as the message log trail of each event that has been executed Furthermore it allows triggers to be set up with the following criteria Run workflow at a set poll interval Run workflow at a scheduled poll period on specific days of the week date ranges or months Run workflow in response to new files appearing in an archive directory Run workflow in response to files appearing to an upload directory where they are then moved to a different directory and processed with an optional file renaming function Run workflow in response to new files appearing in a remote SecureFTP folder These triggers are maintained as part of the automation system as described in the Workflow Interface section and detailed in the Technical Reference section To switch to the Scheduler Interface launch ChiapasStudio C chiapas bin chiapasstudio exe pull down the Window menu option and select Scheduler Interface A note about polls The ChiapasService polls the chiapasData database for active trigge
109. atures of Chiapas Studio Contextual error highlighting on the SegPool window Provided the registers do not exceed certain size thresholds Chiapas Studio will display the data contained within each of the three registers All register I O interfaces are directly accessible For a visual identification of the different areas of the Studio interface see the beginning of the Quick Start Guide This overview will go into more depth and enumerate the full functionality of the Studio interface Register Information Flat Encode HKey eee s Decode Error Count 9999 SegPool HIG Page Flat The current status of the Flat register The four digit number displays the number of columns with the second number displaying the number of rows HKey The number of loops stored in the HKey register Error Count The number of messages stored in the Log register SegPool The number of segments stored in the SegPool register HIG Page When working in the Flat Register pane clicking on individual mappings will also set the HIG Page value here This is the page reference in the related original HIPAA Implementation Guide where that element is defined Encode This translates a loaded HKey register to the SegPool register Decode This translates a loaded SegPool regiser to the HKey register Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page
110. ave a header row Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 108 Flat Excel File File Path CGIF Flat Excel file to create xls and xlsx file types supported Flat Excel File File Path CGIF Flat Excel file to load 5 and xlsx file types supported These actions export or import the Flat register in the form of an Excel spreadsheet The filename extension used will determine if the file is an old style Excel 97 format file or the newer Excel 2003 file format Note that the older Excel format is very restrained in its ability to store larger files HKey XML File File Path CGIFXML2 file to create HKey XML File File Path CGIFXML2 file to load This loads and saves the HKey register in CGIFXML2 format HKey XML File Legacy File Path CGIFXML file to create HKey XML File Legacy File Path CGIFXML file to load This is an older legacy XML type that is being phased out of the product in favor of the more flexible CGIFXML2 data type HKey DB Tables DB Type SQL Server Data Source Valid SQL Connection String Prefix Character prefix for the HKey storage tables This command creates a set of discrete database tables where each loop is stored as a separate table Numeric fields KEY ID and PAR KEY ID link child loop tables to their parents with the root parent ISA table having no PAR KEY ID set The character s indicated in the Prefix will be inserted
111. before each loop table name HKey DB View DB Type SQL Server Data Source Valid SQL Connection String Prefix Character prefix for the HKey storage tables This command can only be run immediately following another CGateTransfer of HKey DB Tables above It will create a SQL View called VW HKEY Prefix on the database indicated within the connection string The resulting dataset of the SOL View is the Flat projection of the hierarchical data the same as pressing the HKey Flat button on Chiapas Studio HKey DB Tables DB Type SQL Server Data Source Valid SQL Connection String Prefix Character prefix for the HKey storage tables Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 109 This command loads the HKey with hierarchical data as if it was generated in the HKey DB Tables function above The specification will be obtained via the first mapping in the ISA table and then each of the loops possible for that specification will be queried on the target SQL Server and loaded to the internal HKey register SegPool File File Path EDI file to create SegPool File File Path EDI file to load This action imports and exports the SegPool register Note that any formatting options you d like to set on a generated EDI file need to be set prior to the Encode activity SegPoolAck File File Path 999 File to Create SegPoolAck File File Path 999 File to Load
112. ble click on it and it will automatically install all components to the C drive under the C chiapas directory If the Evaluation Version is downloaded via the Chiapas EDI website both Google Chrome and Internet Explorer will give warnings about running downloaded executable files these warnings should be overridden Note that Chiapas EDI Enterprise is a silent installer and does not give any feedback if the install process is successful this is normal Next launch the database installer located at C NchiapasNdbNSQLPkgChiapasData exe 3 Follow the instructions to add the chiapasData SQL database to the SQL Server instance This contains all of the tables necessary for Chiapas EDI s automation system as well as the mock healthcare data and SQL Views for creating new outbound transactions The chiapasData database is crucial for the automation aspects of Chiapas EDI Enterprise Chiapas EDI Enterprise uses the following file to locate this database when starting up C chiapas bin cnnstr txt NOTE If the destination server is not the local default instance you will need to execute two steps a Update the connection string on the filesystem at C chiapas bin cnnstr txt b Update the embedded connection string within the data shuttle trigger located within the chiapasData database If you are running SQLEXPRESS the following SQL will update the connection string UPDATE TSRC SET TSRC DATAO1 Data Source SQLEXPRESS Dat
113. built in to the chiapasData database to put this value into a HIPAA compliant format SELECT HIPAA NUMBER SUM CONVERT MONEY SERVICE CHARGE 1 CONVERT MONEY SERVICE CHARGE 2 CONVERT MONEY SERVICE CHARGE 3 CONVERT MONEY SERVICE CHARGE 4 FROM BIN FBN WHERE CLAIM ID CLM CLAIM ID 12300 501 2 TOTL CLM CHG AMT After altering the vw Extract FBN view again with the updated syntax and refreshing in Chiapas Studio the extra zeroes are gone and the sums are in a compliant syntax 000027 CLM 8980153155 205 11 B 1 Y A Y Y 000028 HI BK 30289 View vw Export FBN Deliverable 1 G Now we are almost finished with this ETL extract to convert the data into HIPAA compliant syntax For the final step we need to split the four Service Line groups so that they appear as separate rows on the extract Adding after the CLM clause INNER JOIN SELECT CLAIM ID SERVICE CODE 1 CD SERVICE DATE 1 DT SERVICE CHARGE 1 CH FROM BIN FBN UNION SELECT CLAIM ID SERVICE CODE 2 CD SERVICE DATE 2 DT SERVICE CHARGE 2 CH FROM BIN FBN UNION SELECT CLAIM ID SERVICE CODE 3 CD SERVICE DATE 3 DT SERVICE CHARGE 3 CH FROM BIN FBN UNION SELECT CLAIM ID SERVICE CODE 4 CD SERVICE DATE 4 DT SERVICE CHARGE 4 CH FROM BIN FBN SVC ON SVC CLAIM ID CLM CLAIM ID AND SVC CD lt gt This logic will ensure that the Service Lines will be rearranged to a row by row fashion Now for the values in the SEL
114. c aca c eec ee Ee vox UE Pere dre pee rentes ER Te EX TEN Tee Ee Edu edt 126 CGateCledrRegister nane esu 130 tud aetate det Ba ees 130 CGateMerge eU eri I I aS IIR E Ee Taie 131 mean eo a ttes 131 CGateXFEROpensSessiOn 5 eere tasa den etre ren Rea ee een ten REN 132 CGateXFERGIOSeSSeSSIOR 2 2 1 cti ee U L L y g Ous aR L S AW Q u aku Susa 132 nest a a kas 132 u 133 CGateXFERDeleteFile 4 2 nkuna 133 CGateXEERGetDirectoryFiles tre e nent P al AA 133 CGateS nd 2 134 CGatelOGoDyFile 5 A oett tette dci ie 136 CGatelODeleteFile rci nee Y i Sae RE 136 CGatelODIirectO ry RC RE K6 em 136 CGateRu nShell 3 ette er e t e Rr 136 CGateR nsShell2 Ee e nee init QUT a eet e Mateo te 137 SOLUTION WORKBOOK vit ree eit hte e iet e Ie tua ie iei de tee a daa dette 138 SOLUTION Legacy Data to 837P Claim EDI Files 138 BUSINESS Requirements ngu e p
115. ch for this situation and the better approach would be to work with CGIFXML2 format Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 23 CGIFXML2 Format This format is about encoding EDI file information into a hierarchical format known as XML XML is a very well known format in the Information Service field because it has both flexibility and the traction of many professionals having familiarity with it Furthermore XML format can lend itself more efficiently to a certain number of scenarios 1 Free Form EDI Data CGIF Flat lends itself strongly to scenarios where all known data elements are planned in advance via Companion Guides shared between trading partners When processing data in bulk however it may be difficult to arrive at a fixed database schema for all of the information you may need to work with By storing XML in database tables the information within the original EDI file can be re queried according to different business requirements without having to reprocess the EDI files 2 Enterprise Data Mapping There are certain scenarios where data will exist in the enterprise system that may be difficult to translate to the special column names that CGIF Flat requires One such example is the Other Subscriber Information mentioned in the example above where there can be ten iterations of the elements within the 2320 loop and furthermore additional elements recorded in the child loops In CGIF Flat all o
116. ch is available via the CGateQuery activity After the workflow completes execution the CGateContext activity sends any errors or messages that were generated to the database Note The State object is engineered to handle a single transaction or file at a time It is capable of running both encode and decode operations but should not be used with looping structure activities to process more than one file at a time Chiapas EDI Enterprise is capable of processing multiple files via concurrent workflows and the automation system Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 105 CGateTransfer DB Type Parameters DataArg01 string Anm Enter a VB expressior DataArgO string Arg 02 Enter a Vikoxp esston DBType string TransferType string Error Messages ErrLog ErrLog objects can only output to CSV or Database data cannot be bulk loaded into an ErrLog object The ErrLog CNN commands require 2 arguments for a Database endpoint or 1 argument for a CSV file endpoint ErrLog objects are limited to FlatCSV or Flat Database type data endpoints Error during storaging of ErrLog to Database Error occurred while writing the CSV file Flat Flat objects are limited to Table CSV or Excel endpoints The Flat commands require 2 arguments for a Database endpoint or 1 argument for a CSV file endpoint Error during storaging of Flat to Database Error during loading of Flat fro
117. d and mapped 1000B Deliverable 1 C Values for the Billing Provider 2010AA need to be established and mapped 2010AA Deliverable 1 D 2000B Values for 2000B SBR segment need to be established and mapped Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 140 Deliverable 1 E 2010BA The data fields for LAST NAME FIRST NAME SSN ADDRESS STATE CITY ZIP CODE BIRTH DATE and SEX need to be mapped to the correct elements in the 2010BA Subscriber loop All values will need to be in the correct format for EDI files Deliverable 1 F 2300 The Implementation Guide states a number of Claim Header fields are required These can be defaulted according to certain business practices the fields CLAIM ID CLINIC ID and DX will need to be mapped to the 2300 loop while allowing for the possibility that the same claim could repeat on multiple lines Deliverable 1 G 2400 SERVICE CODE 1 SERVICE DATE 1 SERVICE CHARGE 1 will need to be mapped to Loop 2400 Service Line with the remaining three service field groups being mapped to additional service lines Because Service Lines can span multiple source file rows Requirement 2 Automation should be in place to translate the CSV file to the new format Assessment This requirement can be broken down into two discrete sets of deliverables First we will need to set up a new trigger to begin the workflow when a new CSV file appe
118. d be copied directly from the session as shown within the WinSCP manager C chiapas bin winscp exe When saving the session make sure to select the option to Save Password so that the session has all the information necessary to log into the SecureFTP server The protocol will be defaulted to SecureFTP In order to utilize WinSCP sessions configured for FTP add FTP prefix here to the SessionName argument note this prefix should not be present within the actual WinSCP session name it is only used to prefix the session name when using this activity NOTE FTP is not a natively encrypted protocol Sending unencrypted PHI through the Internet is a critical HIPAA violation so exercise extreme caution when using this option CGateXFERCloseSession Parameters None Error Messages Session is already closed Purpose This activity closes an opened WinSCP session This should be placed in the Finally clause of a Try Catch Finally activity to ensure that all opened sessions are properly closed even if an exception occurs during an operation CGateXFERPutFile Parameters FileName string RemoteFileName string Error Messages Session is not open XFER_PutFile failed Error with PutFile Exception during PutFile operation Purpose This activity will upload a local file in FileName to a remote directory with the filename specified in RemoteFileName All transfers will tak
119. d previously the loop iteration counter can be applied to loops that are only allowed to repeat once this is a special situation where the iteration counter actually belongs to the parent loop For example if we examine Loop 2320 in 5010 837 Other Subscriber Information in the HIPAA Implementation Guide we would observe that it can repeat up to ten times It has nine child loops each of which can iterate only once each This loop is itself a child of the 2300 Claim Information loop so we could consider all information present within these loops to be associated with a single claim If we have two entries of the 2320 loop and each iteration conveys an ID in the 2330C Other Payer Attending Provider the two mappings for the 2330C State License Number associated with each iteration of the parent 2320 loop would appear like this L2330C 802 REF02 2ND OVL STAT LICNS NR L2330C 102 802 REF02 2ND OVL STAT LICNS NR Note CGIF Flat lends itself well to a large variety of situations with one notable exception In certain circumstances a large 835 file may contain many hundreds or thousands of repeating PLB elements in certain financial situations As Chiapas EDI cannot map these on a per row basis they do not tie directly to a claim or service line it must map these laterally as separate columns As the column count could actually exceed the column limits supported by SQL Server then CGIF Flat would not be a feasible approa
120. d within relational databases where information is stored in columns and rows on data elements specific to that enterprise Without common implementation guides trading partners evolve a patchwork of proprietary protocols to meet their business requirements The purpose and role of the implementation guides is to standardize the definitions of all data elements so that all healthcare entities use a single common language for standard transactions The Chiapas Gate Intermediate Format or CGIF represents the syntax that Chiapas EDI uses to identify HIPAA elements and assign human understandable names to them It is subdivided into two parts CGIF Flat This implementation encodes HIPAA EDI elements in a flat column row tabular format This is the form used for SQL tables and CSV files CGIFXML2 This is the implementation used to encode HIPAA EDI elements in the XML format Before either of these representations can be understood it is important to be familiar with the HIPAA Implementation Guides and how transactions are arranged by loops segments and elements GENERAL CONCEPTS Loops represent a bundle of information that is unique within a transaction They are arranged in a hierarchical structure so that one loop may have one or more child loops Each child loop begins with a mandatory header segment that is unique among all of the children loops belonging to that parent Certain loops can be uniquely identified just with the 2 3 ch
121. ded to the ErrLog The DestCnn connection string may be either TriggerDB or the name of an opened database connection The DestTable is the name of an existing database table CGateForceMerge Parameters DestCnn string DestTable string Error Messages CGateForceMerge Exception Unmerged Mapping Max Columns Reached Purpose This activity is functionally similar to the CGateMerge activity with one crucial difference instead of generating messages when there are Flat fields missing from the destination table it will actually carry out ETL data operations to add the missing fields to the destination table prior to the INSERT statements This guarantees that the destination tables will always be able to completely store incoming transactions but also means that the destination table schema is not fixed and could grow over time Only the first 1020 columns will be merged as SQL Server is limited to 1024 columns DestCnn connection string may be either TriggerDB or the name of an open database connection DestTable is the name of a table that must already exist Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 131 CGateXFEROpenSession Parameters SessionName string Error Messages Failed to Open Named Session Purpose This activity opens a previously setup WinSCP session Only one session can be open at a time The session name shoul
122. dure we ve just created is expecting both a file name and an EVENT ID The filename is passed as the first argument within the automation The EVENT ID is available via the CGateQueryState activity However we will need two string variables to hold these values so to start with we click on the CGateContext click Variables and add these two values Name Variable type strEventlD String strFileName String Create Variable Next we populate the variables we need in order to execute the stored procedure The CGateArg activity will load the automation filename into the strFileName variable CGateContext 3 CGateArg strFileName CGateState ArgO1 To CGateState Arg02 To CGateState Arg03 To CGateState Arg04 Next we put in a CGateQueryState activity and fill in the Properties Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 155 Misc DisplayName CGateQueryState Query EVENT ID Result strEventID Finally we add in CGateCNNSQLExec activity and fill in the Properties Because we created the Stored Procedure on the chiapasData database that is part of the automation environment we do not need to open up a new SQL Connection we reference this aways on connection with the name TriggerDB CNNName TriggerDB CNNSQL EXEC USP PROCESS CSV strEventID strFileName Then we save the whole thing as CSVLegacy xaml to th
123. e RR 138 DAS Pa vi 140 Technical Implementation i reise iani oisi dederas 142 INTRODUCTION Chiapas EDI Enteprise pronunciation Ch i A pas is an integration middleware platform focused on healthcare Specifically it focuses on the EDI transaction sets that HIPAA law mandates the way enterprises can exchange healthcare information professional and institutional billing enrollment eligibility remittances and so on Just as healthcare is a complex business undertaking here in the United States this is reflected in the EDI transactions sets some of them requiring hundreds of pages to define The technology underlying Chiapas EDI began development in 2002 and was licensed commercially in 2003 as Chiapas EDI Version 1 In 2005 this product was completely open sourced where today it has an active following In 2010 a new company was formed around a complete rewrite of the core technology and the Chiapas EDI 2012 product was the result The main design goal of this product was to make these transactions as accessible as possible to enterprises at all levels and judging by the solid demand for this product and the ability of our customers to quickly meet their business requirements we are happy to say this goal was completely met Chiapas EDI s ability to easily transform between EDI and database tables made it very straightforward to implement new EDI trading partners For Chiapas EDI E
124. e ess than the elapsed time specified by the interval within a Scheduled Event Name of the trigger Trigger Data 01 This value varies according to the Trigger type SCHEDULED EVENT Last Execution Time SQL TRIGGERED EVENT SQL Connection String LOCAL UPLOAD DIRECTORY EVENT Polling directory for files LOCAL ARCHIVE DIRECTORY EVENT Polling directory for new files Trigger Data 02 This value varies according to the Trigger type SCHEDULED EVENT XML representation of the Schedule dialog SQL TRIGGERED EVENT Database type LOCAL UPLOAD DIRECTORY EVENT Directory to place uploaded files prior to processing Trigger Data 03 SQL TRIGGERED EVENT SQL to run against the specified database connection a result of Integer 1 or VARCHAR 1 will fire the trigger Trigger Data 04 Reserved for future expansion Trigger Data 05 Setting this to the value SERIAL will prevent concurrent Workflow execution a new workflow instance will only be launched if the previous instance has completed execution Timestamp when the trigger was created Page 52 EVENTS Table This table stores events as they occur across various stages and are the mechanism by which the background automation Worker Processes are set to execute workflows There are three methods to execute a Workflow 1 Set a trigger on the Scheduler The scheduler can execute a workflow to run according to four triggering criteria SQL result timed and scheduled interval and
125. e C chiapas Waml directory Finally we return to the Scheduler Interface and set the Workflow to the newly created workflow file C chiapas xaml CSVLegacy xaml Then click on Enabled and SAVE To test we simply drag our sample CSV file into the O1 in csv directory It should disappear and then we can validate the BIN LOG and BIN FBN rows SELECT FROM BIN LOG SELECT FROM BIN FBN This validates that Deliverables 2 A and 2 B are fulfilled Deliverable 2 C The automation infrastructure bundled with Chiapas EDI is focused on making certain standard operations fairly straightforward including the task of exporting an EDI file present within the BIN tables In order to re use this functionality we will need to create a new BIN ID and use the vw Export FBN view we created earlier to populate the BIN 837P table Earlier we used the vw Export FBN to test our mappings as a direct input to Chiapas EDI As it does not link to the BIN ID it is only capable of returning all of the billing information in the BIN FBN table at once and is therefore more of a testing resource than a production ready component This SQL logic can be used as an INSERT statement into the BIN 837P with some minor modifications however First we ll need to make some alterations to the receiving BIN 837P table to ensure it can receive all of the fields ALTER TABLE BIN 837P ADD STHDR 501 5 3 IMPLMNTN GUID VERSN NM VARCHAR 200 ALTER TABLE BIN 837P AD
126. e place in BINARY mode Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 132 CGateXFERGetFile Parameters FileName string RemoteFileName string Error Messages Session is not open XFER_PutFile failed Error with GetFile Exception during GetFile operation Purpose This activity downloads a remote file RemoteFileName to the local filesystem with the given filename All transfers will take place in BINARY mode CGateXFERDeleteFile Parameters RemoteFileName string Error Messages Session is not open XFER DeleteFile failed Deletion Failure Delete Failure Delete Failure file doesnt exist Purpose This activity deletes the file indicated in RemoteFileName from the remote SecureFTP server CGateXFERGetDirectoryFiles Parameters RemoteDirectory string FileList string Error Messages CGateXFERGetDirectoryFiles Exception Purpose This activity retrieves a directory of files in the specified directory and records the filenames in the specified string variable FileList Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 133 CGateSendMail Parameters EMailBody string EMailReceiver string EMailSender string EMailSubject string SMTP Host string Port integer SMTP_SSL string SMTP Username string Error Messages
127. eates a new BIN_LOG entry It should be created on the chiapasData database CREATE PROCEDURE USP PROCESS CSV EVENT_ID INT FN VARCHAR 200 AS BEGIN Clone the BIN FBN table to a new temp table DECLARE SQL VARCHAR MAX TMP_ID INT SET SQL SELECT TOP INTO TEMP CONVERT VARCHAR EVENT_ID FROM BIN FBN ALTER TABLE TEMP CONVERT VARCHAR ID DROP COLUMN BIN ID EXEC SQL Bulk Insert the CSV legacy data SET SQL BULK INSERT TEMP CONVERT VARCHAR EVENT_ID FROM FN WITH FIELDTERMINATOR ROWTERMINATOR An UPDATE TEMP Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 154 CONVERT VARCHAR 9EVENT ID SET FILE DATE REPLACE FILE DATE EXEC SQL Create new BIN_LOG entry and insert the data into the BIN_FBN table BEGIN TRAN INSERT INTO BIN_LOG BIN_FILENAME BIN_RECV_DATE BIN_TYPE EVENT_ID SELECT FN GETDATE BIN_FBN EVENT_ID SET TMP_ID SCOPE_IDENTITY COMMIT TRAN SET SQL INSERT INTO BIN_FBN SELECT CONVERT VARCHAR TMP_ID FROM TEMP CONVERT VARCHAR EVENT_ID DROP TABLE TEMP CONVERT VARCHAR EVENT_ID EXEC SQL END Now to tie everything together We ve created a trigger already but without a Workflow it has no function Open Chiapas Studio and switch to the Workflow Interface and create a new workflow The Stored Proce
128. ection This activity has been optimized for concurrent execution with potentially dozens of workflows executing SQL commands and contending for resources simultaneously in the following ways Automatic Rollbacks Any SQL command that leaves the connection in an uncommitted transaction will be automatically rolled back As a result all SQL Execution activities need to be transaction isolated they cannot begin a transaction in one activity and then COMMIT it another activity This prevents deadlocked SQL processes from leaving a lock on SQL Server resources Ifthe SQL command raises an unhandled exception the activity will retry the SQL until it is does not raise an exception or for four additional times whichever comes first Each retry attempt will be flagged as an error in the MSGLOG along with the source code of the SQL statement Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 121 These features increase the reliability of executing SQL Server stored procedures in a high load environment If there are unhandled exceptions within the SQL code being executed however be aware that this code could be consecutively re executed for up to five iterations CGateCNNSQLExecScript Parameters CNNName string CNNSQL string Error Messages CGateCNNSQLExecScript Exception This does not contain the specified named connection There was an exception raised while exec
129. ed Page 112 CGateAckGenerate Parameters None Error Messages None Purpose This activity loads the SegPoolAck register after a CGateXltDecode activity decodes a file Chiapas EDI Enterprise s 999 implementation is very simple of the header information present within the SegPool is reversed receiver becomes sender If the file was able to be completely parsed without critical parsing errors a Success acknowledgment is generated for each of the transactions encountered in the SegPool f the file encountered a critical decoding error a rejection indicating only the errored transaction and errored segment is generated Creating new 999s 1 SegPoolis loaded earlier in workflow 2 Decode operation is executed 3 CGateAckGenerate activity loads the SegPoolAck register depending on the outcome of the Decode operation 4 CGateTransfer sends the SegPoolAck register to an EDI file CGateAckTA1Generate Parameters None Error Messages None Purpose This activity loads the SegPoolAck register after a CGateXltDecode activity decodes a file Chiapas EDI Enterprise sTA1 implementation is very simple Every ISA IEA loop is acknowledged with a single TA1 segment It will list A if there were no critical errors during decode or R if there were Creating new 5 5 SegPool is loaded earlier in workflow 6 Decode operation is executed 7 CGateAckTA1Generate activity
130. eturns a recordset that meets the following conditions Only the columns that were originally present within the file should be returned Since the same BIN table could be used for both 4010 and 5010 files it is responsible for sending only the columns that actually stored data for that BIN ID The specification tag should always be the first column returned The rows should be in a consistent order for example claims and service lines should be aggregated together properly Since SOL Views are not engineered to obey ORDER BY clauses a stored procedure must be used to return the dataset in proper order The USP ORDEREDI is alternate method of generating properly sorted CGIF Flat data but is not plugged directly into the BIN system Instead this procedure represents a way of guaranteeing proper sorting of CGIF Flat data sources such as the vw Export views included in the database SQL Server views cannot order the resultset unless the ORDER BY clause is external to the view for example SELECT FROM vw Export 834 ORDER BY L2000 SO2 REFO2 SUB ID OVL SUB NR but stored procedures can guarantee proper order This stored procedure will generate an ORDER BY clause suitable for the transaction being extracted and return the data in sorted order XML Storage In this system Chiapas EDI Enterprise workflows store data directly to SQL tables as CGIFXML2 formatted rows The XML can be queried directly by SQL Server or another workflow can regene
131. f a minimal 5010 277 EDI file For additional possible mappings see the CGIF reference HTML file in the C chiapas docs CGIF folder Column Name BIN PK BIN ID PO OEISA 501 ISA02 OVL NO AUTH OEISA 501 ISAO4 SEC NO SEC OEISA 501 15 06 SENDR ID OVL MUTLY DEFND ID OEISA 501 5 RECVR ID OVL MUTLY DEFND ID OEISA 501 5 09 DT OEISA 501 ISA10 TM OEISA SO1 ISA11 REPTN SEPRTR OEISA SO1 ISA12 VERSN NR OEISA SO1 ISA13 ICN OEISA SO1 ISA14 ACK REQ OEISA SO1 ISA15 USG IND OEISA SO1 ISA16 SUBELE SEP OEISA 503 IEAO2 ICN GSHDR 501 4502 APP SENDR CD GSHDR 501 6503 APP RECVR CD 65 501 504 DT GSHDR 501 6505 TM GSHDR 501 6506 GCN 65 S03 GEO2 GCN STHDR SO1 STO2 CONTRL NR 5 501 STO3 VERS RELS INDSTRY ID STHDR SO2 BHTO1 STRUCTR CD STHDR 502 BHTO3 ORGNTR TRANSCTN ID STHDR 502 BHTO4 TS CREATN DT Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Data Type INT PK INT Purpose Primary Key Identity Foreign key to the BIN LOG table Page 68 STHDR 502 BHTO5 TS CREATN TIM STHDR 504 SEO2 L2000A SO1 HLO1 HIERCHCL ID NR L2100A 501 NM103 PAYR NM OVL NONPRSN L2100A 501 NM109 PAYR ID OVL PAYR ID L2000B SO1 HLO1 HIERCHCL ID NR L2000B SO1 HLO2 HIERCHCL PARNT ID NR L2000B 501 HLO4 HIERCHCL CHILD CD L2100B 501
132. f abstracting away the housekeeping of knowing which qualifier value defines which business value Qualifier elements are actually metadata or data that describes data and thus should be considered as part of the protocol and not having any business value by itself For example let s say that within a hypothetical transaction there exists a loop 2900 where the 2 segment is a REF segment that can encode five different IDs according to the qualifier in the first element REF Element 01 REF Element 02 AB Shoe Size AC Shoe Weight AD Shoe Color In an EDI file based on this fictional specification these two segments define both a shoe size and weight REF AB 8 5 REF AC 3 0 In CGIF Flat Format the information would be represented like so 12900 502 2 SHOE ID OVL SHOE 512 12900 502 2 SHOE ID OVL SHOE 8 5 3 0 In CGIFXML2 Format the information would be projected in this way lt L2900 gt 802 lt REFO2 SHOE ID OVL SHOE SIZ gt 8 5 lt REFO2 SHOE ID OVL SHOE SIZ gt lt REFO2 SHOE ID OVL SHOE WGT gt 3 0 lt REF02 SHOE ID OVL SHOE WGT gt 802 L2900 Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 19 CGIF Flat The most fundamental difference between the CGIFXML2 and CGIF Flat formats are how they handle iterations n CGIF Flat this is complicated because the Implementation Guides define a number of segments
133. f the possible mappings would be cumbersome compared to encoding this information in CGIFXML2 CGIFXML2 mappings are quite similar to the CGIF Flat mappings except that they are split to be more in line with the hierarchical structure of XML Furthermore although loop qualifiers are used on loops iteration counters are not used in the CGIFXML2 naming convention Instead the loop or segment information simply repeats as it would in the EDI file The root node of a CGIFXML2 file is called CGIFXML2Root and ends with an underscore and two digit specification addenda tag similar to the first mapping in CGIF Flat Then both loops and segment references define specific node nesting levels so that the metadata name surrounding the actual data will comprise only of the following components Segment Code amp Element Identifier X Element Repeat Counter gt Composite Element Identifier gt Element Abbreviation gt OVL Qualified Overload Abbreviation gt Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 24 Here is an example of a CGIFXML2 file that defines eligibility for a single person This is not a valid file as most fields have been omitted in order to emphasize the structure CGIFXML2Root T1 lt OEISA gt S01 ISA02 AUTH OVL NO AUTH ISA02 AUTH OVL NO AUTH lt S01 gt lt GSHDR gt S01 GS02 APP SENDR CD SENDR ID GS02
134. f there are fields present on the register not present in the destination table then Chiapas EDI Enterprise will execute a series of SQL ALTER TABLE commands to add the missing columns to the destination table prior to inserting the data allowing the operation to succeed without omitting any information CSV Interface DB Table CSV Excel Flat to CSV Execute O CSV to Flat CSV File Flat to CSV Radio button to select exporting the Flat register to CSV format CSV to Flat Radio button to select importing data from a CSV file to the Flat register CSV File Text box for the full path and filename of the CSV file Double clicking on the window will bring up an Open File or Save File dialog depending on the radio button set Execute Carries out the operation Note that CGIF Flat formatted CSV files obey the following rules First line contains column header All elements including column headers are surrounded by double quotes and comma separated Excel Interface DB Table CSV Excel Flat to Excel Execute 2 Flat from Excel Excel File Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 30 Flat to Excel This will save the Flat register to an Excel spreadsheet Flat from Excel This will load the Flat register from the first worksheet of an Excel spreadsheet Excel File This is the filename of the Excel spreadsheet Double clicking in the window will bring up
135. ge 89 L2000B SO1 HLO1 HIERCHCL ID NR L2000B SO1 HLO2 HIERCHCL PARNT ID NR L2000B 501 HLO4 HIERCHCL CHILD CD L2000B SO2 SBRO1 PAYR RESP SEQNC NR CD L2000B SO2 SBRO2 INDVDL REL CD L2000B SO2 SBRO9 CLM FILNG IND CD L2010BA SO1 NM103 SUB LNAME OVL PERSN L2010BA SO1 NM104 SUB FNAME L2010BA SO1 NM109 PRIMRY ID OVL MEM ID NR L2010BA SO2 N301 ADRS LIN L2010BA 503 401 CITY NM L2010BA 503 N402 STAT CD L2010BA 503 N403 SUB POSTL ZON ZIP CD L2010BA S04 DMGO2 BIRTH DT OVL DT CCYYMMDD L2010BA 504 DMGO03 GENDR CD L2010BB 501 NM103 PAYR NM OVL NONPRSN ENTY L2010BB 501 NM109 PAYR ID OVL PAYR ID L2010BB SO2 N301 ADRS LIN L2010BB 503 N401 CITY NM L2010BB 503 N402 STAT CD L2010BB 503 N403 PAYR POSTL ZON ZIP CD L2300 SO1 CLMO1 PATNT CONTRL NR L2300 501 CLMO2 TOTL CLM AMT Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 90 12300 501 CLMOS5 01 FACLTY TYPE CD L2300 501 CLMO5 03 CLM FREQNCY CD OVL FORM BIL TYPE L2300 501 CLMO7 ASGNMNT PLAN PARTCPTN CD L2300 501 CLMO8 BENFTS ASGNMNT CERT IND 12300 501 CLMO9 RELS CD L2300 503 DTPO3 STATMNT FROM TO DT OVL STATMNT RD8 L2300 SO6 CL101 ADMSN TYPE CD L2300 506 CL102 SOURC CD L2300 SO6 CL103 PATNT STATS CD L2300 S26 HIO1 02 PRINCPL DIAG CD OVL ICD9CM PRINCPL DIAG L2300 S31 HIO1 02 OTHR DIAG OVL
136. ger will not be saved until the Save button is pressed Polling Info Tab New Delete Save Trigger Info Polling Info Schedule Info Event History C Scheduled Poll Data01 Data02 SQL Triggered Poll Cnn String DB Type T Query Local Upload File Poll Local UL Dir Timestamp Dest Dir 7 Local Archive File Poll Archive Dir Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 46 Chiapas EDI Enterprise supports several trigger types Scheduled Poll When this is selected the Schedule Info tab is enabled and you are able to select a custom polling schedule for this trigger that can make it run at different intervals and at different dates More information on this is covered in the Schedule Info Tab section SQL Triggered Poll This polling mechanism allows you to drive workflow execution from a database query If a 1 result is returned from the query the trigger is fired It requires the following information do not use quotes when entering information to the these text boxes Cnn String Database connection string This is a database connection string with which to run the specified query Query Query to run An expression like SELECT 1 will always fire the trigger whereas an expression like SELECT 0 never will DB Type Database type Local Upload File Poll ChiapasService will scan the specified directory for any files If any files are f
137. h a snapshot of the data Changing the data and mappings does not directly affect the Flat register the Flat and Set buttons are used to actually update the internal register Set This button propagates the mapping indicated in the Mapping Interface to the currently selected column within the Flat interface Row This will clone the current row and insert a duplicate Row This will remove the currently selected row Col This will insert a new Unmapped column You must manually Set it to a valid mapping before this can be used with the Chiapas Gate engine for encoding Col Removes the currently selected column Display This toggles the interface to display the entire mapping name in each column or to keep them fixed length and display only the first 15 character or so of each column gt Flat This button updates the Flat register from the interface HIG If the HIPAA Implementation Guides have been properly configured with Chiapas Studio then this will launch a PDF Reader application and open the HIG to the correct page for the currently selected mapping within the Flat interface Mapping Interface I I I A PA S Specification 5010_834_A1 v ee 5010 Benefit Enrollment and Maintenance Loop 2100A MEMBER NAME IL Insured or Subscriber Segment 04 N4 Member City State ZIP Code Iteration Element 02 Member State Code Sub Element Overload CGIF Reference L2100A_IL_S04_N402_STAT_CD The map
138. he database type SQL Server and the connection is associated with the given name Database connections should be opened after they are defined here used and then closed There is a default open connection that does not need to be defined opened or closed TriggerDB This points to the chiapasData database and is available in every workflow CGateCNNOpen Parameters CNNName string Error Messages CGateCNNOpen Exception This does not contain the specified named connection There was an exception raised while opening the named connection Purpose This opens the specified connection Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 120 CGateCNNClose Parameters CNNName string Error Messages CGateCNNClose Exception This does not contain the specified named connection There was an exception raised while closing the named connection Purpose This closes the specified connection All opened connections should be closed before the completion of the workflow CGateCNNSQLExec Parameters CNNName string CNNSQL string Error Messages CGateCNNSQLExec Exception This does not contain the specified named connection There was an exception raised while executing the SQL on the named connection Retrying SQL Purpose This command will execute an arbitrary SQL command as defined in CNNSQL on the specified conn
139. hin a single container called a CGateContext Activity This is a Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 42 custom sequence which can hold a stack of Activities they will be executed in order from top to bottom The Context activity contains the Chiapas EDI Enterprise state object the CGateContext activity cannot be nested in other contexts and must be the root activity in the workflow The right pane displays any specific information associated with a selected activity For Chiapas EDI Enterprise activities that do not present a specific interface any specific variables or settings will be accessible here Workflow Tutorial To really explore how to use the Workflow Studio let s construct a simple workflow step by step from scratch In this example we will load in one of the sample file HIPAA files decode it and export the results to a CSV file in the C chiapas directory Open the Workflow Studio When you first launch Chiapas Studio select Window from the top menu options and select Workflow Interface Create a new workspace Select File from the menu options and then select New Workflow 2 CGateContext 2 CGateTransfer Acton DB Type Arg 01 Enter a VB expre n Arg 02 Er r Click on the CGateTransfer activity listed under the CGateCore category in the toolbox on the left then hold and drag the cursor to blank area in the CGateCo
140. icating the Exit Code ShellCmd A string representing the full path and filename of the shell command to execute ShellArgs A string storing any command line arguments for the shell command Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 136 CGateRunShell2 Parameters ShellCmd string ShellArgs string ShellOutput string Error Messages CGateRunShell2 Exception Exit Code Purpose This acitivity will execute an arbitrary shell command and wait for its completion If the command returns a non zero exit code a message is added to the ErrLog indicating the Exit Code If there is any console output it will be stored in the variable provided in the ShellOutput box ShellCmd A string representing the full path and filename of the shell command to execute ShellArgs A string storing any command line arguments for the shell command ShellOutput A string for storing any console output generated by the shell command Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 137 SOLUTION WORKBOOK Up to this point the manual has covered the theory and operation behind the different components of the platform In this section we will review actually putting them together to fulfill actual business requirements and in so doing exercise different aspects of the technology This workbook will describes a single complex business scenario and
141. in Defined Transaction Set Segment Not in Proper Sequence Segment Has Data Element Errors Implementation NOT USED Segment Present Implementation Dependent Segment Missing Implementation Loop Occurs Under Minimum Times Implementation Segment below Minimum Use Implementation Dependent NOT USED Segment Present Mandatory Data Element missing Conditionally Required Data Element Missing Too Many Data Elements Data Element is Too Short Data Element is Too Long Invalid Character in Data Element Invalid Code Value Invalid Date Invalid Time Exclusion Condition Violated Too Many Repetitions Too Many Components Implemented NOT USED Data Element Present Implementation Too Few Repetitions Implementation Pattern Match Failure Implementation Dependent NOT USED Data Element Present Code Value Not Used in Implementation Implementation Dependent Data Element Missing Purpose This activity translates the SegPoolAck register into a series of human readable error messages associated with segments in the SegPool and writes them to the log registers These messages can later be reviewed to determine the cause of integrity issues Loading 999s 1 SegPoolis loaded earlier in workflow 2 SegPoolAck File operation on this activity loads the 999 CGateAckParse will parse out the messages where they will be placed in the MSGLOG table when the workflow completes Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserv
142. interface to accessing nearly all of the major 1 0 functions of the platform Most of the 1 0 operations from the Data 1 0 tab of ChiapasStudio can be performed within this single activity This activity has a designer interface that switches according to context to make it easier to use the various operations ErrLog Register This activity will send all errors and messages generated so far in this workflow to either a database table or CSV file All errors are automatically sent to the MSGLOG table upon completion of the workflow therefore this activity is useful when running workflows directly from the Workflow Studio or when debugging workflows that generate critical errors that disrupt the normal logging system Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 107 ErrLog DB Table DB Type Database Type Data Source Valid Connection String Data Table This is the name of a database table where Chiapas EDI Enterprise will send the ErrLog register It must follow the schema of the MSGLOG table within the chiapasData database ErrLog CSV File File Path Name of the file to create Flat Register These actions load or save the Flat register Flat DB Table DB Type Database Type Data Source Valid Connection String Data Table Destination table to receive Flat register This action exports a loaded Flat register to a database table If the database type selected is SQLite or SQL Serve
143. irectory is less than 1000 Column Data Type Purpose Name FILE ID INT PK Primary Key Identity TSRC ID INT Foreign key to the TSRC row associated with an archive trigger FILE NM VARCHAR 250 File name of the file Note that as the trigger is linked to a specific directory this filename does not contain path information Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 56 AUTOMATION STORAGE SCHEMA Automation Storage Tables BIN LOG BIN 270 BIN ID BIN PK BIN_ID BIN_271 BIN PK BIN_ID BIN_276 BIN BIN ID BIN 277 BIN PK BIN ID Worker Process L SQL USP BULK TEMP TABLE L SQL USP PROCESS PENDS BIN 277CA BIN BIN ID BIN 278 REQ BIN PK BIN ID FSTOR PENDS BIN 278 RESP PEND ID BIN PK BIN_ID EVENTS BIN_XML EVENT ID XML ID EVENT ID Worker Process Activity CGateHKeyToXMLDB Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved BIN_820 BIN BIN ID BIN 834 BIN BIN ID BIN 835 BIN BIN ID BIN 837D BIN BIN ID BIN 837I BIN BIN ID BIN 837P BIN BIN ID SQL USP FETCH CULLED BIN Activity CGateHKeyFromXMLDB Page 57 The Automation Storage Schema is described on the previous page This storage system has the capability to store supported EDI files in two different formats Flat
144. it obtains it from the XML STOR XML data storage column in the BIN XML table To trigger this workflow you will need to directly insert into the EVENTS table INSERT INTO EVENTS EVENT OWNER TSRC ID EVENT DATAO1 EVENT 2 SELECT 1 11 1 filename edi Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 15 012 EncodeFromBINDB Directories 01 out edi EVENT Parameters EVENT DATAO1 Table name View name or Stored Procedure to source CGIF Flat data EVENT 2 Filename of the file to create within the output directory This is another passive pipeline that will accept a generalized source of CGIF Flat formatted information and create an outbound EDI file Here are some examples of creating outbound files Example 1 Retrieve a file placed into the BIN system with a BIN ID of 1 ensure proper sorted order of elements and then store it to the output directory as filename edi INSERT INTO EVENTS EVENT OWNER TSRC ID EVENT DATAO1 EVENT DATAO2 SELECT 1 12 EXEC USP FETCH CULLED BIN 1 filename edi Example 2 Retrieve the contents of vw Export 837P ensure properly sorted order and store it on the output directory as filename edi INSERT INTO EVENTS EVENT OWNER TSRC ID EVENT DATAO1 EVENT DATA 2 SELECT 1 12 EXEC USP ORDEREDI vw Export 837p filename edi Although sourcing directly from a view is possible it is recommended you use the stored procedures to properl
145. l and Flat registers This translation process is completely black boxed nothing about it can be managed directly by the user The only way to influence the behavior of the translation process is by managing the data fed into it The HKey register has three bi directional interfaces to end user systems XML CGIFXML2 formatted XML files stored on the filesystem XML DB CGIFXML2 formatted XML stored in database tables SQL DB The HKey register can also interact with database tables directly with a database table representing a single loop and all tables are tied together with local and foreign keys Flat The Flat register is usually the easiest way business customers can interact with EDI It is the least efficient in terms of memory storage as every row must contain every mapping for the whole EDI file but also often the easiest to create and maintain for a variety of scenarios Each mapped element is represented via a fixed non user definable column name that describes the loop segment and element positioning These column names are quite verbose and can be over sixty characters in length The first mapped element name also contains a special prefix that defines the specification associated with the mappings Log Chiapas EDI Enterprise keeps an active record of all errors and user generated messages in the Log Register Specifically if an error occurs during decoding or encoding it will be recorded here SegPoolAck This i
146. laim Status Response 5010 Health Care Services Review Request for Review 5010 Health Care Services Review Response 5010 Payroll Deducted and Other Group Premium Payment for Insurance Products 5010 820X Health Insurance Exchange Related Payments 5010 Benefit Enrollment and Maintenance 5010 Health Care Claim Payment Advice 5010 Health Care Claim Dental 5010 Health Care Claim Institutional 5010 Health Care Claim Professional CRIT ERR This returns true if the critical error flag has been set on the ErrLog register ERR CT Count of ErrLog messages ERR LOG All ErrLog messages compiled into a single string value FLAT COL CT Number of columns present within the Flat register FLAT ROW CT Number of rows present within the Flat register SEG CT Number of segments present within the SegPool register SPEC NM Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 128 SPEC NM SEG SPEC NM These query strings will interrogate the currently loaded specification string associated with each of the three registers after a load operation Return Value Meaning 4010_270 BIN Health Care Eligibility Benefit Inquiry 270 4010_270_A1 BIN Addenda 1 4010_271 BIN Health Care Eligibility Benefit Inquiry Response 271 4010_271_A1 BIN Addenda 1 4010_276 BIN Health Care Claim Status Request 276 4010_276_A1 BIN Addenda 1 4010_277 BIN Health Care Claim Status Response 277
147. le within a text editor Files with critical decode errors will be redirected to the Err directory 002 CullLF Directories 01 in edi 02 out edi 03 err edi EDI files dropped into the input directory will be reprocessed so that the output is stripped of CR LFs which is format most clearinghouses prefer Files with critical decode errors will be redirected to the Err directory 003 ScrubPHI Directories 01 in edi 02 out edi 03 err edi EDI files dropped into the input directory will be decoded and re encoded with most Protected Health Information stripped out and replaced with randomized data This includes most dates and personal name and address information The files will still need to be checked manually to verify that PHI is removed never assume that this process makes a file safe to transmit on open networks 004 DecodeToCSV Directories 01 in edi 02 out csv 03 done edi 04 err edi EDI files placed in the input directory will be decoded and transformed to comma delimited CGIF Flat CSV files in the output directory The CSV files will have column headers and all data elements and column names will be surrounded by double quote characters Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 13 005 DecodeToXML Directories 01 in edi 02 out xml 03 done edi 04 err edi Input files will be decoded and then transformed to XML files on the output directory 006 DecodeToXMLDB Directories 01 i
148. lement Error Messages CGateHKeyToXElement Exception Purpose This activity loads a supplied XElement variable referenced in the System Xml Ling library with an XML document representing the currently loaded HKey register Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 116 CGatexltEncode Parameters None Error Messages Invalid CGIF Mapping The Encoder was unable to initialize for the encoding process This is can be caused by mandatory loops that do not have any supplied data mappings for example HL loops If this is the case make sure HLO4 Child Code is supplied for HL loops Purpose This activity transforms the loaded HKey register to the SegPool register effectively encoding a new EDI file from the supplied data It will attempt to encode all required elements and segments if a required element is not supplied from the HKey register it will default that element with whitespace The following elements may be defaulted by the Encoder engine Defaulted Element ISA01 ISA02 5 3 ISAO4 ISA05 ISA06 ISAO7 ISA08 ISA09 ISA10 ISA11 ISA12 ISA13 ISA14 ISA15 Defaulted Value 00 Whitespace 00 Whitespace Sender Qual Value set in the Encounter Data Activity Sender ID Value set in the Encounter Data Activity Receiver Qual Value set in the Encounter Data Activity Receiver ID Value set in the Encounter D
149. m These three registers are said to be equivalent meaning they can translate freely data between them without loss of data If an incoming EDI file has integrity errors however this can cause Chiapas EDI Enterprise to omit some elements or segments as it tries to translate the file although these events will always be flagged in the notification log Chiapas EDI Enterprise is purposefully lenient when decoding incoming files as long as it has sufficient information to parse the basic structure of the file it will keep on parsing even as it flags any syntax violations it encounters However Chiapas EDI Enterprise does not execute any transformations on the data all internal information is in string format that appears exactly as it does within the EDI file and it is up to the user to translate dates into the 8 digit format suitable for EDI such as 20140625 SegPool This register is a simple representation of a stream of segments Depending on the direction of the workflow it serves to receive data before saving to a new EDI file or accepting the contents of an existing file for further processing later on It can be directly translated to and from the HKey register Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 26 HKey This register is Chiapas EDI Enterprise s internal hierarchical storage mechanism for EDI information and it can accept data or send data in both directions with the SegPoo
150. m Database The destination file already exists The source file does not exist Error during storaging of Flat to CSV Error during loading Flat from CSV Error during storaging of Flat to Excel Error during loading Flat from Excel HKey HKey objects are limited to HKey Tables amp XML endpoints Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 106 The HKey connector command requires one parameter for an XML File endpoint two arguents for HKey DB Tables or three arguments for an HKey DB endpoint There was a problem storing the HKey to an XML file There was a problem loading the HKey from an XML file There was a problem loading the HKey from HKey DB Tables There was a problem loading the HKey from the XML DB table There was a problem saving the HKey to HKey DB Tables There was a problem saving the HKey to an XML DB Table SegPool SegPool objects are limited to SegPool SegPoolAck file endpoints SegPoolAck operations need a concurrently loaded SegPool object on which to function spawning an empty SegPool SegPool objects require 1 argument Specification cannot be determined from the file transfer failed SegPool Load error Invalid ISA GS headers specification cannot be determined There was a problem loading the SegPool SegPoolAck from the file endpoint There was a problem saving the SegPool SegPoolAck to a file endpoint Purpose This single activity provides an
151. n the password needs to be saved Help Help System This will bring up the online documentation based on the active window Set HIG Bindings Chiapas Studio can link directly to the HIPAA Implementation Guides to pull up a page associated with any mapped element These guides are copyrighted controlled materials and not included with the Chiapas EDI Enterprise distribution they must be purchased directly from Washington Publishing Corporation wpc edi com This feature works only with the initially published 4010 and 5010 PDFs that were not corrected with the Addenda Type in the path to the file with each associated specification In the picture below each PDF is present along with the original PDF filename for that specification Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 39 a Window HIG Setttings oam 5010 278 REQ 5010 278 RESP Spec Filename 4010 270 CAchiapas hig X092 pdf 4010 271 CAchiapas hig X092 pdf 4010 276 CAchiapas hig X093 pdf 4010 277 CAchiapas hig X093 pdf 4010 278 REQ 598 C chiapas hig X094 pdf 4010 278 C chiapas hig X094 pdf 4010 820 CAchiapas hig X061 pdf 4010 834 CAchiapas hig X095 pdf 4010 835 CAchiapas hig X091 pdf 4010 837D CAchiapas hig X097 pdf 4010 8371 CAchiapas hig X096 pdf 4010 837P C chiapas hig X098 pdf 5010 270 CAchiapas hig x279 pdf 5010 271 Ca chiapas hig x279 pdf 5010 276 CAchiapas hig x212 pdf 5010_277 CAchiapas hig x212 pdf
152. n account supplied in SMTP Username SMTP Port Server port to connect to Common values are 25 or 587 SMTP SSL This should be set to true for SSL encrypted SMTP logins false otherwise SMTP Username Login credential used when logging into the SendMail server Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 135 CGatelOCopyFile Parameters CopyFrom string CopyTo string Error Messages Exception during CGatelOFileCopy Purpose This activity copies the file specified in CopyFrom and copies it to the path and filename indicated in the CopyTo parameter This activity can be combined with the CGatelODeleteFile to move a file CGatelODeleteFile Parameters DeleteFile string Error Messages Exception during CGatelODeleteFile Purpose This activity deletes the specified file CGatelODirectory Parameters DirectoryPath string ResultFiles string Error Messages Exception during CGatelOEnumbDirectory Purpose This activity retrieves the list of files in the given directory to the string array variable CGateRunShell Parameters ShellCmd string ShellArgs string Error Messages CGateRunShell Exception Exit Code Purpose This acitivity will execute an arbitrary shell command and wait for its completion If the command returns a non zero exit code a message is added to the ErrLog ind
153. n edi 02 done edi 03 err edi Input files will be decoded and then imported to the chiapasData dbo BIN XML destination table which will contain both the CGIFXML2 formatted XML file as well as the EVENT ID for reference 007 DecodeToBINDB Merge Directories 01 in edi 02 done edi 03 err edi Input files will be decoded and placed into the BIN tables via the Merge activity The BIN tables follow the format of the seed 5010 files any fields present within the decoded file that are not present within the destination table will trigger an Unmerged Mapping error message that identifies the missing data NOTE This workflow uses a Delayed Write functionality Therefore the best way to validate the data operation is fully complete is to check the FSTOR PENDS table to ensure the data is successfully written 008 DecodeToBINDB ForceMerge Directories 01 in edi 02 done edi 03 err edi Input files will be decoded and placed into the BIN tables via the ForceMerge activity The BIN tables follow the format of the seed 5010 files any fields present within the decoded file that are not present within the destination table will cause the new fields to be added to the destination tables so that there is no data loss Note that this is not enabled for concurrent execution due to schema locks placed on the database tables when the workflow runs files will be processed one at a time NOTE This workflow uses a Delayed Write functionality Therefore
154. ng the trigger When the trigger is fired the service inserts a new entry into the EVENTS table with all the information needed to start the event This includes the filename of the file that launched the trigger the ID of the trigger and a 1 in the EVENT OWNER field In the meantime the background Worker Processes are continuously scanning the EVENTS table for new events with an EVENT OWNER of 1 When the process finds such an EVENT it attempts to take ownership of the event When the event is successfully owned by the process it goes on to handle it Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 41 All triggers have an associated workflow an XAML workflow file stored on the filesystem the distribution automation workflows are placed in C chiapas xaml The Worker Process loads the XAML file and then executes it while passing arguments to the workflow that are specific to that event When the workflow is complete the Worker Process will automatically write all log messages to the MSGLOG table and also update the status of the event to one of the following states COMPLETE NO LOGS The event completed normally but did not generate any messages COMPLETE WITH MESSAGE LOGS The event completed and logged some messages CRITICAL ERROR SEE MESSAGE LOGS There was a critical error during execution which was logged as a message THREAD ABORT ERROR SEE C CHIAPAS ERRLOG FILE There are certain
155. nimal necessary code needed to create a HIPAA compliant transaction by translating the view away from the SAMPL data tables and to a backend enterprise system new outbound transactions can be made quickly All of the ETL extracts have the following in common ISA GS ST envelope section The first section of all of the ETL views is dedicated to providing valid data for the envelopes and correct mappings for the transactions they are in One important point to note is that Chiapas EDI Enterprise is capable of generating certain mappings like timestamps and segment counts automatically If the mapping is not supplied to the encoder and the encoder has a default value to place there then that mapping will be automatically handled by the encoder engine Transaction Body The second section is dedicated to all of the specific mapped elements for a minimal implementation of each transaction set Here the member provider and claim tables are used as a data source for dummy information Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 103 Two views deserve special mention vw Export 835 generates a valid 835 remittance file with the use of a base view that organizes claims services and adjustments This base view is referenced several times one to generate aggregate sums and the other as the row data source for the extract The actual vw Export 835 ETL view then uses this information to project valid 835 elements
156. nt Services SSMS connect to the chiapasData database and open a new query window Run the following query SELECT TOP 10 FROM SAMPL MEMBER E Resuts a Messages MEM ID FIRST NM LAST NM SSNID _ BIRTH DT GENDER ADD ADD2 CITY STATE ZIP CD PHONE NR 1 f1 JOHN BURGER 987654320 19800707 M 123AST NULL SANFRANCISCO 94117 4155551200 2 ER STEVE FILET 987654321 19700404 M 222BST NULL SANFRANCISCO CA 94117 4155551201 w LAWRENCE HAM 987654322 1950 0404 M 987CST NULL SANFRANCISCO 394117 4155551202 4 4 JAKE NOODLES 987654323 19600303 M 654DST NULL SANFRANCISCO CA 94117 4155551203 5 5 ABIGAIL STROGANOFF 987654324 19900808 F 123EST NULL SANFRANCISCO 94117 4155551204 r DELORES PEAS 987654325 1970 0404 F 222FST NULL SANFRANCISCO CA 94117 NULL Zaal PENELOPE HASHBROWNS 987654326 19600303 F 333957 NULL SANFRANCISCO 394117 4155551205 8 8 EDWIN PASTA 987654327 1980 10 10 M 444HST NULL SANFRANCISCO CA 94117 NULL 9 9 LARRY SANDWICH 987654328 20000101 M 5551ST NULL SANFRANCISCO CA 94117 4155551206 10 10 NAOMI BREAD 987654329 1950 0404 F 123JST NULL SANFRANCISCO 94117 4155551207 Now here s to view the roster of providers included in the mock data SELECT TOP 10 FROM SAMPL PROVIDER E Resa Messages PROV ID TAX ID NPI ID COMPANY NM FIRST LAST ADDI ADD2 CITY STATE ZIP CD CONTACT NM 5 Wn Now to bring up the mock claims information SELECT FROM SAMPL CLAIM HDR HDR INNER JOIN
157. nterprise we are committed to improving all areas of previous versions according to customer feedback and requests A particular focus for this release are the enterprise users who approach EDI as a business intelligence data source as opposed to an operation data feed To summarize the improvements we ve made for this new release Improved Data Analytics capabilities o The new XML encoder and decoder engines allow a completely new development path for working with EDI transactions that lends itself well to large scale analytics and reporting For enterprises dealing with hundreds of different trading partners and many different EDI formats XML translation capability offers distinct benefits when compared to the Chiapas EDI 2012 flat SQL table translation path Completely new out of the box capabilities o Chiapas EDI Enterprise has over a dozen workflows that are running as soon as the platform is installed These workflows are based off of Chiapas EDI s custom extensions to Microsoft s Windows Workflow Foundation 4 technology so they are ready to be tailored at will o Acompletely new implementation of the BIN system means that Chiapas EDI Enterprise now stores data for all supported transactions o Chiapas EDI now has the capability to store lossless representations of the original EDI file in the BIN system Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 1 Improved Support Options o Every licen
158. ntext container in the center of the screen Release the mouse button This will result in adding the CGateTransfer activity to the workflow as shown above and to the right Now set the options on the CGateTransfer activity Some activites have designers which are dynamic interfaces with visual options to set on the activity itself In this case when the SegPool lt File action is selected unused options will disappear Action SegPool lt File File Path C chiapas sample seed_ 834 txt Next add the CGateXltDecode activity by dragging the icon from the left toolbox to the gray bar underneat the CGateTransfer activity No options need to be set for this activity Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 43 Next add the CGateHKeyToFlat activity Finally add another CGateTransfer activity with the following options Action Flat CSV File File Path C chiapas 834 out csv The result will appear like this 5 CGateContext Now run the workflow by going to the Debug menu at the top of the screen and select Start Debugging After a moment the file _ 834 out csv should appear in the C chiapas directory which is a Wil CGatelransfer CGIF Flat representation of the 834 sample file used in the example Action SegPool File v Normally Workflows will start with a CGateArg activity to load some local variables from the automation environment and then use FilePath C chiapas
159. oCSV xaml LOCAL UPLOAD DIRECTORY EVENT Pipeline 3 scrubPHI chiapas xaml Pipeline 003 ScrubPHI xaml LOCAL UPLOAD DIRECTORY EVENT Pipeline ee2 cullLF chiapas xaml1 Pipeline_ 2_CullLF xaml Pipeline 1_SetLF 1 1 8061 SetLF xaml no A LOCAL UPLOAD DIRECTORY EVENT This view is obtained from the Scheduler Interface within ChiapasStudio to access it select the pulldown Window menu and select Scheduler Interface The first ten triggers are active meaning that the ChiapasService is actively polling stimuli to see if a new event should be launched The last two are passive meaning that they need to be started by directly inserting into the EVENTS table and not via ChiapasService directly Note that there is a directory naming convention all directories within the pipeline start with two or three zero padded number digits When in a pipeline it s clear which directory is the starting point A brief overview of the purpose and function of the twelve pipelines follows Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 12 001 SetLF Directories 01 in edi 02 out edi 03 err edi EDI files that are dropped into the input directory will be reprocessed to the output so that every segment ends with carriage return and line feed characters making them easily viewab
160. og Register Interface Chiapas EDI Enterprise does not support loading a Log into the register its purpose is to be a write only record of events that occur during the translations In Chiapas Studio 2014 you have the option of writing the log out to a file at any time This register tracks all messages and errors that can occur during encode or decode processes including critical integrity errors or more minor syntax errors Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 34 DB Table DB Table CSV og to DB Table Execute DB Type Data Source DB Type Database type to receive the Log register Data Source Connection string to the receiving database Table Name of the table to receive the Log register Execute Exports the Log register to a database table The database format follows that of the MSGLOG table included in the chiapasData database that is part of the distribution which is covered in the Technical Reference If the table does not exist it will be created CSV DB Table CSV 9 og to CSV File Execute CSV File CSV File CSV file to create when exporting the register Execute Exports the Log register to a CSV file It also will follow the field naming convention of the MSGLOG table Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 35 Flat HKey Register Pane The central two windows of Chi
161. on prefixes 4010_276 Loop Identifier C1 4010 276 A1 DO 4010 277 This short sequence identifies the Loop the element belongs _D1 4010 277 A1 to The outer envelope is identified as OEISA the GS EO 2 4010 278 REQ envelope is identified as GSHDR and the ST envelope 2 4010278 Transaction Set is identified as STHDR A close examination eee MESI of the CGIF documentation would reveal some loops that are mE not explicitly identified Within the Implementation Guides G1 4010 820 1 these serve to address certain special situations that can HO 4010 834 occur in the EDI files H1 4010 834 A1 10 4010 835 Loop Iteration Counter or Qualifier 11 4010_835_ 1 10 4010 837D In an earlier example we specified that the 2900 loop we A 4010 837D defined in our example has a maximum repeat count of five KO 4010 837l iterations Because this is below the threshold of 24 K1 4010 837 A1 iterations this loop cannot be a row trigger However the LO 4010_837P data still needs to be preserved in the encoding system To L1 4010_837P_A1 handle this situation CGIF uses an iteration prefix to uniquely MO 5010 270 identify elements belonging to specific loop iterations M1 5010 270 A1 NO 5010 271 L2900 S02 REF02 SHOE ID OVL SHOE SIZ N1 5010_271_A1 L2900 I02 S02 REF02 SHOE ID OVL SHOE SIZ 00 5010 276 12900 103 502 REF02 SHOE ID OVL SHOE 517 PO 5010 277 P5 5010 277CA Loop iteration counters like this are only used in l
162. ontention under certain heavy load conditions with many workflows inserting data into the same destination table SQL Server will timeout or deadlock some of the processes There is no issue with SQL Server accepting data from many dozens of sources into temp tables however so this method is used to increase the reliability of the automation environment The Merge workflow will pull in all data from the incoming file that matches the mappings present within the BIN table Elements that are present in the incoming file and not mapped within the receiving BIN table will be flagged as an error message This can be thought of as lossy EDI storage where the emphasis is on a fixed table schema as opposed to guaranteeing all of the incoming fields will be stored The ForceMerge workflow is similar to the Merge workflow but is also focused on making sure all data is captured When an incoming file presents new mappings that are not stored in the destination tables the USP PROCESS PENDS stored procedure will add these new fields to the destination table Note that this workflow is not appropriate for certain 835 files having more than a dozen PLB segments the large amount of mappings they generate can overload the architectural limits of SOL Server Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 58 The USP FETCH CULLED BIN stored procedure is the primary way to extract CGIF Flat tables out of the BIN tables It r
163. oops where P7 5010 824 the header segment is not qualified meaning the initial Qo 9010 278 REQ header segment is qualified by two or more values If it is RO 5010 278 RESP then the qualifier on the header segment replaces the role of 50 5010_820 the loop iteration counter S1 5010 820 A1 ios 3010 820X L2900 XZ REF02 SHOE ID OVL SHOE SIZ TO 5010 834 L2900 XY REF02 SHOE ID OVL SHOE SIZ 5010 834 A1 UO 9010 835 Note that some loops have single iteration child loops In this U1 5010 835 A1 case the iteration counter carries over to the child loops so VO 5010 837D that the child loop mappings are properly associated with the v 1 SOLO D correct iteration of the parent loop v2 5010 837D A2 wo 5010 8371 5010 837 w2 5010 837 A2 5010 837P x 5010 837P A1 Page 21 Segment Reference This is an S followed by a zero prefixed two digit number that identifies the segment within the loop with S01 being the first segment in the loop The numbering sequence can be affected by Addenda inserting segments into the middle of the loop in this way a small Addenda change can radically affect the mappings used for encoding and decoding These changes are always called out in the CGIF Addenda documentation Segment Code amp Element Identifier This component represents the 2 3 digit Segment Code as well as the two digit zero prefixed element position for the mapping being described
164. opped once it is successfully processed Destination Table name The name of the destination table located on the chiapasData database f the temp table has fields not present in the destination table and this is a ForceMerge workflow the PROCESS PENDS procedure will add the missing fields to the destination table Timestamp when this table entry was created Timestamp when this table entry was completed This field represents the status of the Delayed Write operation NEW This is the initial status of the operation where the temporary table is created but not yet populated with data READY This is the status of a Merge Decode workflow and signifies that the temporary table has been populated with data and is ready to be inserted back to the destination table On completion the status is updated to DROP FORCE This is the status of a ForceMerge Decode workflow and signifies that the temporary table has been populated with data If there are fields present within the TEMP table missing in the destination table they will be added in prior to the insert operation On completion the status is updated to DROP DROP This tells the automation system that the data has been inserted and the temp table can be dropped Once this is done the status changes to DONE DONE This signifies the operation is fully complete Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 60 BIN LOG Table This table
165. ound they are immediately moved to the Destination directory optionally renamed and then the trigger is executed with the new path and filename passed as an argument Local UL Dir The source directory to look for new files Dest Dir The destination directory to place the new file If the file already exists or ChiapasService is unable to move the file to the new location the event will not fire Timestamp Setting this option will rename the file to include a fourteen digit timestamp in the format lt year gt lt month gt lt day gt lt hour gt lt minute gt lt second gt when it gets moved to the Destination Directory A file named Filename txt would become filename 20140626200801 txt Note The trigger is only fired when and if the file can be successfully moved to the Destination directory If another process is uploading a new file and it is locked it will not be touched by the automation system until the file has completed transferring Local Archive File Poll The background service will poll the directory specified in the Archive Directory textbox every polling interval and compare the files with the entries for this trigger in the FSTOR FILES table in the chiapasData database Any new files found will trigger a new event and also insert a new entry in the FSTOR FILES table Note that this directory should not accumulate too many files more than a thousand files could impact the functionality of the Automation ser
166. ping interface has two functions For existing mappings selected in the Flat pane it displays verbose information about all the components of that mapping Otherwise it presents an interface for discovering mappings When entering new mappings it s important to follow this sequence Loop Segment Element and Sub Element The selection of one combo box dynamically changes the contents in the next combo box in sequence so it is important to select the boxes in order from top to bottom This interface is meant for reference only the authoritative source for CGIF Reference mappings are the HTML files residing in the C chiapas docs CGIF directory Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 37 SegPool Register Interface SegPool Msgs SegPool Msgs 000001 ISA 00 FOO Saco REA ZZ SAMPL SENDE 000002 GS HC SENDR ID RECVR ID 20121009 1352 1 X 005 000003 ST 837 100000000 005010X224A2 000004 BHT 0019 00 745351 20121009 1352 CH 000005 NM1 41 2 DOOLITTLE HOSPITAL 46 123400001 000006 PER IC CHIAPAS EDI TE 4154699607 000007 NM1 40 2 CHIAPAS EDI TECH 46 273801950 000008 HL 1 20 1 000009 NM1 85 2 CHIAPAS EDI TECH 000010 N3 126 CARDENAS AVE 000011 N4 SAN FRANCISCO CA 941320000 000012 REF EI 273801950 000013 HL 0 1 22 0 000014 SBR P 18 CI 000015 NM1 IL 1 CHEESE KIRK MI 000011 000016 N3 999 K ST 000017 N4 SAN FRANCISCO CA 94117 000018 DMG D8 19700202 M 000019 NM1 P
167. r the destination table will be created if it doesn t exist Then all rows of the Flat object will be inserted If the table previously exists and there is a mismatch between the schemas for the Flat register and the data table then no rows will be inserted and an error will be logged Flat DB Table DB Type Database Type Data Source Valid Connection String Data Table SQL Tableset source This action loads the Flat register from a CGIF Flat formatted database table source It will accept a database table a SELECT SQL statement or a stored procedure that is prefixed by EXEC Some examples vw Export 8371 SELECT FROM vw Export 834 ORDER BY L2000 S04 REFO2 SUPP ID OVL CLIENT REPRTNG CATGRY EXEC USP ORDEREDI vw Export 834 Note Chiapas EDI Enterprise relies on data being sorted prior to it being supplied to the encoder engine In the above examples the first View cannot guarantee properly sorted rows so that claims are aggregated together correctly The second example does some simple sorting but this may not be sufficient in a production environment The third example uses a built in stored procedure that automatically sorts the CGIF Flat data in the correct order Flat CSV File File Path CGIF Flat CSV file to create Flat CSV File File Path CGIF Flat CSV file to load These actions export or import the Flat register in the form of a CSV file All values will be surrounded by double quotes and comma separated and will h
168. r to data insertion If the table does not exist it will be created first Then all Flat rows will be transformed to SQL Insert statements executed on the destination table If the CNNReplace flag is not set this activity will generate an error if fields within the Flat register are not present in the destination table CGateCNNFlatFromTable Parameters CNNName string CNNTable string Error Messages CGateCNNFlatFromTable Exception This does not contain the specified named connection There was an exception raised while transferring the table view to the internal Flat object Purpose This activity imports the Flat register from the specified SQL table on the indicated connection The CNNTable may be a table name a SELECT statement or a stored procedure if the string begins with EXEC If the stored procedure executed leaves an uncommitted transaction it will be rolled back and flagged as an error Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 123 CGateCNNFetchDT Parameters CNNName string CNNTable string Result System Data DataTable Error Messages CGateCNNFetchDT Exception This does not contain the specified named connection There was an exception raised while obtaining a DataTable from the named connection Purpose This activity will load a table SQL SELECT statement or stored procedure preceded by EXEC in all caps supplied in
169. rate the EDI file from the XML storage bin The BIN XML system does not utilize the BIN LOG table but instead The workflow that decodes files into the BIN XML is Pipeline 006 DecodeToXMLDB It will automatically insert the correct EVENT ID into BIN XML table along with the CGIFXML2 rendition of the EDI file To retrieve this data the manually triggered workflow Pipeline 011 EncodeFromXMLDB will create new EDI files from the BIN XML table Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 59 FSTOR PENDS Table This table helps orchestrate the delayed write architecture behind the two Flat Table Decoder Pipelines This architecture ensures multiple Workers are never trying to insert into the same SQL database table by sending all data to temporary tables and having a single serial pipeline handle the actual final data insertions This table records the Source temp table and the Destination production table where the data will be shuttled Column Name PEND ID EVENT ID BIN ID TEMP TBL DEST TBL CREATE DATE FINISH DATE STATUS Data Type INT PK INT INT VARCHAR 200 VARCHAR 200 DATETIME DATETIME VARCHAR 50 Purpose Primary Key Identity Foreign key to the EVENT table of the event that created this entry Foreign key to the BIN LOG table for the specific file being handled Temporary Table name generally it will called TEMP followed by the EVENT ID This table will get dr
170. rs every second and has an internal log it uses to keep track of the last time every active trigger was polled When the Poll Interval in seconds has been exceeded it will proceed to check the poll Active Triggers All Triggers Pending Events TSRC ID TSRC TYPE TSRC NAME TSRC WF FILENAME LOCAL UPLOAD DIRECTORY EVENT Pipeline 610 EncodeFromXML 1 1 010 1 1 1 009 EncodeFromCSV xaml LOCAL UPLOAD DIRECTORY EVENT Pipeline 8_DecodeToBINDB_ForceMerge C chiapas xaml Pipeline 08 DecodeToBINDB ForceMerge xam LOCAL UPLOAD DIRECTORY EVENT Pipeline 807 DecodeToBINDB Merge C chiapas xaml Pipeline_ 07_DecodeToBINDB_Merge xaml C chiapas xaml Pipeline_ 86_DecodeToXMLDB xaml C chiapas xaml Pipeline_ 05 DecodeToXML xaml LOCAL UPLOAD DIRECTORY_EVENT Pipeline 803 ScrubPHI C chiapas xaml Pipeline_ 04 DecodeToCSV xaml LOCAL UPLOAD DIRECTORY EVENT Pipeline 602 cullLF C chiapas xaml Pipeline_ 3_ScrubPHI xaml LOCAL UPLOAD DIRECTORY EVENT Pipeline 001 SetLF C chiapas xaml Pipeline 002 CullLF xaml C chiapas xaml Pipeline 001 SetLF xaml New Delete Save Trigger Info Polling Info Schedule Info Event History Name Pipeline 001 SetLF V Enabled Poll Interval 15 Workflow File CAchiapaswamhPipeline 001 SetLF xaml Copyright 2015 Chiapas
171. s a representation of a 999 Acknowledgment message since it works in conjunction with the SegPool register it needs a separate space Chiapas EDI Enterprise has a basic capability of generating 999 messages if a file is received and decoded without critical error it will generate a 999 message accepting every transaction that was transmitted If decoding stopped on a critical error Chiapas EDI Enterprise will generate a 999 message indicating where the error was encountered This 999 can then be returned to the trading partner The purpose of a 999 message is generally as an automatic mechanism for showing the transaction was accepted by the trading partner Chiapas Studio also has a capability of parsing an incoming 999 against an EDI file so that the 999 Messages are attached to specific lines in the EDI file Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 27 CHIAPAS STUDIO INTERFACE Chiapas Studio serves three purposes Function as a development and testing area to work with the translation engine and see immediate feedback Develop and debug automation workflows Create new automation triggers and see the results of previous workflow executions These three areas are accessed between three separate interfaces accessed via the pulldown Window menu at the top of the screen The main Studio is a workspace for directly accessing the engine interface features and to test your transformations Some fe
172. se of Chiapas EDI 2012 or Chiapas EDI Enterprise now comes with a number of hours of direct phone and development support in addition to our next business day Email Service Level Agreement so that our clients are assured they have a fully supported solution Improved Documentation o Probably the most significant and tangible improvement over Chiapas EDI 2012 is a heavy emphasis on real world examples in the documentation so that developers and analysts get a clear picture of what they need to do and how to get there Given all of the feedback from our clients as well as the powerful new features in this release we feel confident that healthcare business communications has never been easier than it is now WHO IS THIS PRODUCT FOR Chiapas EDI Enterprise is oriented towards MIS professionals and analysts who have some experience with core EDI concepts such as outer and inner envelopes segments elements and so on Healthcare experience and knowledge of important concepts such as HIPAA compliance encryption requirements safeguarding Protected Healthcare Information are very important for everyone who works with healthcare information Developers and analysts working with Chiapas EDI Enterprise should have basic knowledge of how to install and set up Microsoft SQL Server versions 2008 and above If one wants to customize the default workflows then a knowledge of Windows Workflow Foundation 4 as well as the NET 4 0 environment is important
173. segment which can repeat up to ten times Furthermore Claim Notes are divided into a number of categories including Medications Diagnosis Description Durable Medical Equipment Supplies and so on In CGIF any information that is Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 22 qualified by a value in a preceding element is called an overload and all overloads have their own discrete mapping These mappings would reference the first three occurrences of a Claim Note segment containing information on Durable Medical Equipment Supplies L2300 S24 NOTO2 TEXT OVL DME SUPLS L12300 S24 NOTO2 102 TEXT OVL DME SUPLS 12300 824 NOTO2 103 TEXT OVL DME SUPLS Scenario 2 Qualified Loops The TPA Broker Name Loop 1000C within the 4010 834 Eligibility specification is an example of a qualified loop It contains a definition for Broker or Sales Office element 1 containing BO on the header segment and Third Party Administrator element 1 containing TV on the header segment To define both the name and the required Broker Identification Code for both of these items of information the following four mappings should be used L1000C BO 501 N102 BROKR NM L1000C BO S01 N104 TPA BROKR ID OVL FEDRL TAXPYR ID NR L1000C TV S01 N102 BROKR NM L1000C TV 501 N104 TPA BROKR ID OVL FEDRL TAXPYR ID NR Scenario 3 Other Subscriber Information As state
174. situations that will stop the normal execution of the workflow These include low memory conditions on the server or if the workflow spawns an external shell process that crashes and does not execute normally The cause of the error will be written to disk to the C chiapas as a time stamped ERRLOG text file Note Workflows handle a single file at a time A single launch of the Worker Process should not decode or encode files within a loop as the internal state object was designed to handle only a single encode and decode operation at a time However with many Worker Processes running simultaneously it is quite possible to process large volumes of files in a short time depending on the speed of the server and the number of available cores Using the Workflow Studio Pipeline 001 SetLFxaml s x mmm The Workflow Studio is a re hosted Workflow Designer based on Windows Workflow Foundation 4 0 and is designed to support the creation testing and deployment of Chiapas EDI Enterprise workflows The left pane is the toolbox and contains all of the Activities that are supported in this environment They are added to the main window area via a drag and drop interface the small gray bars we see between the activities in the above screenshot are areas where new activities can be inserted This middle pane is the workspace and the main work area for developing workflows All Chiapas EDI Enterprise workflows are contained wit
175. ss it now Next press the HKey tab within the Flat HKey Register pane in order to see an XML representation of the HKey register Flat HKey Flat lt Hey Flat gt Hey CGIFXML2Root OEISA S01 5 2 AUTH OVL AUTH ISA04 SEC OVL PASSWD ISA06 SENDR 10 OVL MUTLY _SEC_NFO_OVL_PASSWD gt lt ISA09_DT gt 120810 lt 15A09_DT gt lt ISA10_TM gt 0914 lt ISA10_TM gt lt ISA11_REPTN_SEPRTR gt lt ISA11_REPTN_SEPRTR gt lt ISA12_VERSN_NR gt O0501 lt ISA12_VERSN_NR gt lt ISA13_ICN gt 100000000 lt 15A13_ICN gt lt ISA14_ACK_REQ gt 0 lt ISA14_ACK_REQ gt lt ISA15_USG_IND gt P lt ISA15_USG_IND gt lt ISA16_SUBELE_SEP gt lt ISA16_SUBELE_SEP gt lt S01 gt lt GSHDR gt lt S01 gt lt GS02_APP_SENDR_CD gt SENDR_ID lt GS02_APP_SENDR_CD gt lt GS03_APP_RECVR_CD gt RECVR_ID lt GS03_APP_RECVR_CD gt lt GS04_DT gt 20120810 lt GS04_DT gt lt GS05_TM gt 0914 lt GS05_TM gt lt GS06_GCN gt 1 lt GS06_GCN gt lt GS08_VERS_ID_CD gt 005010X220A1 lt GS08_VERS_ID_CD gt lt 501 gt STHDR lt 501 gt STO2 CONTRL NR 100000000 STO2 CONTRL NR lt STO3_IMPLMNTN_CONVNTN_REFNC gt 005010X220A 1 lt STO3_IMPLMNTN_CONVNTN_REFNC gt lt 501 gt lt 502 gt lt BGN01_TS_PURPS_CD gt 00 lt BGN01_TS_PURPS_CD gt lt BGN02_TS_REF_NR gt 100000000 lt BGN02_TS_REF_NR gt lt BGN03_TS_CREATN_DT gt 20120810 lt BGN03_TS_CREATN_DT gt lt BGN04_TS_C
176. t Element Terminator character of the current SegPool object Sub Element Terminator of the current SegPool object Short name of the specification set on the State register This is affected by load operations on the Flat or HKey registers 4010 270 4010 271 4010 276 4010 277 4010 278 REQ 4010 278 RESP 4010 820 4010 834 4010 835 4010 837D 4010 837I 4010 837P 5010 270 5010 271 5010 276 5010 277 5010 277CA 5010 278 REQ 5010 278 RESP 5010 820 5010 820X 5010 834 5010 835 5010 837D 5010 837I 5010 837P Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 127 SPEC LONG Long name of the currently loaded specification This is affected by load operations on the Flat or HKey registers 4010 Health Care Eligibility Benefit Inquiry 4010 Health Care Eligibility Benefit Response 4010 Health Care Claim Status Request 4010 Health Care Claim Status Response 4010 Health Care Services Review Request 4010 Health Care Services Review Response 4010 Payroll Deducted and Other Group Premium Payment for Insurance Products 4010 Benefit Enrollment and Maintenance 4010 Health Care Claim Payment Advice 4010 Health Care Claim Dental 4010 Health Care Claim Institutional 4010 Health Care Claim Professional 5010 Health Care Eligibility Benefit Inquiry 5010 Health Care Eligibility Benefit Response 5010 Health Care Claim Acknowledgment 5010 Health Care Claim Status Request 5010 Health Care C
177. t S01 gt lt STHDR gt 5017 STO2 CONTRL NR 100000000 STO2 CONTRL STO3 IMPLMNTN CONVNTN REFNC 005010X220A1 STO3 IMPLMNTN CONVNTN REFNC S01 S02 BGNOi TS PURPS CD 00 BGNO1 TS PURPS CD BGNO2 TS REF NR 100000000 BGNO2 TS REF BGNO3 TS CREATN DT 20120810 BGNO3 TS CREATN DT M This tab displays information about a loaded HKey register As described in a previous section the HKey storages hierarchical business information and is an intermediary between the SegPool register for interacting with HIPAA files and the Flat register for interacting with databases The information is displayed on screen in the form of an XML file There are two controls that allow for translating the register to or from the Flat register Flat lt HKey This button translates the HKey to the Flat register Flat HKey This button loads the HKey from the Flat register Flat Register Flat HKey Set Rows Row Col pisi gt Fut OEISA 581 ISAB2 OETSA 501 15484 SE OFISA 501 15486 SE OFISA 561 15405 RE 501 15409 DT 501 ISAIO OFISA Sel 15411 RE OFISA Sel 5412 OFISA 561 15413 IC 247777290909 779757777 a SAMPLSENDRID _ SANPL_RECVRID _ 120818 n 9 sai SENDRID saw RecvRID 120810 esa e SAMPL SENDRID SAMPL RECVRID 129810 esa 9 P SAMPL SENDRID SAMPL RE
178. tee proper sort order and used the ChiapasStudio interface to travel the data to a HIPAA compliant EDI transaction This concludes the encoding tutorial Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 11 AUTOMATION Chiapas EDI Enterprise includes twelve pipelines as part of the normal distribution A pipeline in Chiapas EDI Enterprise is defined as a process that accepts data inputs and produces data output and is capable of running concurrently In Chiapas EDI Enterprise there is a single service ChiapasService that runs in the background and handles all orchestration by listening for triggers When a trigger condition is met it will insert a new row into the EVENTS table With the base licensing tier of Chiapas EDI Enterprise there are two WorkerProcess programs also running in the background that poll for new incoming EVENTS When one is found the WorkerProcess attempts to take ownership and if successful processes it Chiapas EDI Enterprise uses Microsoft Windows Workflow Foundation 4 0 WWF 4 with custom proprietary extensions to make the features of the technology accessible via drag and drop interface dialogs that are stacked and turned into workflows When the workflow finishes execution the WorkerProcess automatically sends any notifications or error messages to the MSGLOG table and updates the event to complete In this way the orchestration is cleanly separated from the pipeline execution Should a
179. termediate Format As there are significant complexities embedded in the Implementation Guides CGIF is designed to be capable enough of handling any valid HIPAA file yet simple to be accessible to healthcare business analysts and developers Once a business analyst becomes familiar with associating CGIF elements with the corresponding HIPAA elements the process of decoding incoming EDI messages becomes much simpler Once the logistics of the actual decoding or encoding is worked out using the front end Chiapas Studio the developer can then use the library of included automation components to create business processes that are hands free processes that run with no manual user intervention Chiapas Studio is covered in the second chapter of the User Reference and the automation components are covered in the third chapter Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 17 CHIAPAS GATE INTERMEDIATE FORMAT To understand how this technology functions it s first necessary to review the fundamental structure of any HIPAA transaction and how these structures are used in modern healthcare communications At the highest level of organization all HIPAA transactions are grouped by specifications These specifications are defined in the HIPAA Implementation Guides and sold and published by the Washington Publishing Corporation WPC on behalf of the ASC X12 organization They are divided into two categories 4010 and 5010
180. the automation system would be constantly trying to catch up and get further behind Therefore it s important to be aware of how the system works so that the values can be set correctly Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 48 Note All workflows are executed concurrently unless a database value is changed on the TSRC table to enabled serial execution TSRC DATAO5 There is no way to set this directly from the interface Events History Tab This shows the trigger history Clicking on one of the events will populate the log screen on the right which shows all of the messages generated from the Workflow during the execution of the event This will allow you to easily see the reasons behind any Critical Errors that may have occurred during workflow execution Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 49 TECHNICAL REFERENCE This part of the manual is dedicated to explaining the automation aspects of the platform including Core Database Schema Workflow Activities The Core Database Schema describes the structure and function of all objects within the chiapasData distribution database and how they are used in conjunction with the Automation system to encode decode and store EDI information The SQL database views used to generate the Seed files are also described in depth The Workflow Activities section includes all of the Chiapas EDI Enterprise native Activi
181. the information within the file Premature End of File Unknown specification encountered Exception during parsing Composite element exceeds that maximum allowed by the HIPAA Implementation Guide Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 119 Purpose This activity translates a loaded SegPool register to the HKey register The decoding engine will flag for all errors it encounters but will not stop the decode process unless there was a critical syntax error that prevented the decoder engine from parsing the remainder of the file Orphaned qualifier identifier pairs will be flagged as an error and then ignored if they are not critical to decoding The decoder engine will detect and flag Level 1 and 2 SNIP integrity errors Parse errors will be flagged as a critical error care should be taken to poll the CRIT ERR value from within the CGateQueryState activity to ensure that the workflow does not attempt to do further work on an HKey that was not loaded due to the critical error CGateCNNAdd Parameters CNNDataSource string CNNDBType string CNNName string Error Messages CGateCNNAdd Exception Purpose This activity registers a named data source with the state object associated with the CGateContext activity Other CGate I O activities can refer to this connection by name alone The CNNDataSource parameter contains the connection string the DB Type contains t
182. the process of encoding different specifications Chiapas EDI Enterprise stores mock member claims and provider data in sample tables included with the distribution database These tables represent mock claims services adjustments members enrollments and providers that can be used in different ways to generate sample files This data supports the vw Export ETL views included with the distribution database so that there is a built in pathway to creating any of the 13 EDI transactions quickly This data combined with the ETL views provide a fixed starting point for a developers wishing to create outbound transactions from their own enterprise data Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 96 SAMPL CLAIM HDR Table This table stores mock Claim header level data Column Name CLAIM ID PROV ID MEM 10 PATNT ACCT NR FAC TYP CD PRI CD SEC DIAG CD STATUS ADJUDCTN DT Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Data Type INT PK INT INT VARCHAR 50 VARCHAR 2 VARCHAR 10 VARCHAR 10 VARCHAR 10 DATE Purpose Unique Claim Identifier Foreign Key to Provider table Foreign Key to Member table Patient Account Number Facility Type Code Primary Diagnosis Code Secondary Diagnosis Code Claim Adjudication Status Claim Adjudication Date Page 97 SAMPL CLAIM DTL Table This table stores mock Claim Detail data with a foreign key to the SAMPL CL
183. ties included with the distribution Windows Workflow Foundation 4 is a Microsoft technology oriented towards designing processes using a graphical user environment Chiapas EDI Enterprise contains all of the tools needed to create and maintain these processes It should be noted that certain WWF 4 features such as Workflow Persistence and bookmarking are not supported Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 50 CORE DATABASE SCHEMA When the background automation service ChiapasService first starts up it loads the contents of the file C chiapas bin cnnstr txt and uses that as the NET connection string to the chiapasData database This database has several purposes Store all automation objects including triggers events messages and the filename pool used to find new files appearing in an Archive trigger directory Provide the infrastructure necessary for the built in automation scripts for storing or retrieving supported HIPAA EDI transactions This includes all of the BIN tables as well as all of the stored procedures Provides the objects necessary for creating compliant EDI transactions from mock up backend data sources This includes sample data tables holding completely fictitious subscribers claims services and providers Data is present to create compliant transactions for twelve EDI transactions using only a minimal set of mapped elements Automation Schema TSRC EVENTS MSGLOG
184. tners use to generate automated notifications about the status of an incoming file Generally 999 s indicate whether the file has been rejected at an EDI syntax level or that the file has been successfully parsed and is accepted for further processing The 999 does not communicate information about the status of a claim or any specific business context Chiapas EDI 2012 can generate a 999 after a Decode event either a simple 999 Acceptance record will be created if the file parsed without major errors or it will be Rejected for a serious integrity violation For incoming 999 messages Chiapas EDI 2012 can apply the 999 against an existing loaded SegPool and generate messages that can be displayed alongside the segments in the SegPool display allowing you to see which segments triggered the errors that were listed within the 999 Parse 999 This will load a 999 file and add messages to the active Message Log that will be displayed in the SegPool pane Generate 999 This will generate a basic 999 acknowledgment file indicating Accepted when a Decode event is able to parse a file or Rejected in the case of a serious integrity error Execute This will save a 999 file that was previously generated via the Generate 999 function or it will load in 999 Transaction Acknowledgment file that was generated from a clearinghouse ACK 999 File The file to be saved or loaded Double clicking here will bring up an Open File or Save File dialog L
185. ure of any CGIF Flat field All of these components are separated by an underscore character brackets indicate fields that are only present depending on the situation All of the valid CGIF Flat references are compiled into the HTML Reference guides that are present in the c chiapas docs CGIF directory Here are the components of a CGIF Flat mapping lt Specification Prefix gt Loop Identifier Loop Iteration Counter or Qualifier gt S Segment Reference Segment Code amp Element Identifier X Element Repeat Counter gt Composite Element Identifier gt Segment Repeat Counter gt Element Abbreviation gt OVL Qualified Overload Abbreviation gt Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 20 Specification Transaction Set Addenda Level Specification Prefix Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved AO 4010 270 This is applicable only to the very first mapping supplied to A1 4010 270 A1 Chiapas EDI or generated from the same This two digit code BO 4010_271 identifies both the specific transaction being used as well as B1 4010_271_A1 the Addenda Here is a list of the specificati
186. useful to handle ad hoc tasks as well as test encoding and decoding processes For automated processes Chiapas EDI has an automation platform built upon a Microsoft technology called Windows Workflow Foundation 4 0 Chiapas EDI Enterprise has a basic implementation of this platform that focuses on short mainly sequential workflows with enough logic to handle error handling and messaging Each workflow is composed of a number of Activities which are basic units of functionality Chiapas EDI Enterprise supplies 41 proprietary Activities in addition to 15 basic flow control activities These Chiapas Activities cover all of the functionality present within the package including support for external shell commands database interaction SecureFTP and File transfers Automation Architecture ChiapasService Worker Process chiapasData File System Triggers TSRC EVENTS lt MSGLOG To understand the function of the workflows it is first necessary to understand the Automation system Every installation of Chiapas EDI Enterprise sets up a background service called ChiapasService When the service is first started it launches a number of background Worker Processes depending on licensing teir Then the service continuously scans the TSRC table for trigger conditions The two main trigger conditions are UPLOAD directory scans and ARCHIVE directory scans where new files that appear in certain directories meet the criteria for firi
187. using the built in function fx HIPAA NUMBER to convert database monetary numbers into HIPAA compliant number formatting vw Sample 270 XML is a demonstration of using SQL Server XML generation syntax to create a CGIFXML2 view of the 270 sample data This XML can be saved to a file and imported to the HKey via Chiapas Studio or imported via the XML Decode workflow Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 104 WORKFLOW ACTIVITIES CGateContext 1 CGateContext Parameters None Error Messages None Purpose This activity is the main container for all other Chiapas EDI activities It is defined as a special Sequence activity to add more Activities inside they need to be dragged over the grey rectangles inside CGateContext activities cannot be nested you cannot place one CGateContext inside of another Furthermore all of the other defined Chiapas EDI activities must be placed within a CGateContext container placing one outside of a CGateContext will result in an error The CGateContext stores the State of the Chiapas engine and holds a single instance of all registers A single instance of the CGateContext activity can be used for both a single Encode and Decode operation When the workflow is initially run it creates a new state object and opens a connection to the chiapasData database named TriggerDB The Worker Process passes an single argument the EVENT 10 whi
188. uting the SQL on the named connection Retrying SQL Script Purpose This command loads a SQL text file from disk and executes it It follows the same conventions as the CGateCNNSQLExec command CGateCNNSQLGetScalar Parameters CNNName string CNNSQL string Result object Error Messages CGateCNNSQLGetScalar Exception Purpose This activity will execute a SQL query against a connection and then store the result into the variable specified in the Result parameter The variable should be of type object Like other SQL Execution functions it will attempt the scalar query up to five times If all of these attempts result in a SQL Exception the returned value will be set to null If the query is successful but returns a database null value the object variable will be set to System DBNull Value Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 122 CGateCNNFlatToTable Parameters CNNName string CNNReplace string CNNTable string Error Messages CGateCNNFlatToTable Exception This does not contain the specified named connection There was an exception raised while transferring the flat object to the table on the named connection Purpose This activity exports the contents of the Flat register to the indicated table on the named connection If the CNNReplace variable is set to lowercase true the table will be dropped prio
189. verting some of the included mock healthcare data to a new HIPAA file This covers the most basic usage patterns of Chiapas EDI Both of these examples start with launching Chiapas Studio located at the following path C chiapas bin ChiapasStudio exe Before we proceed further we should identify the functional areas of the ChiapasStudio interface Chiapas EDI Studio y Window Help ES Flat Hk CHIAPAS EDI TECHNOLOGIES INC egPool Msgs SegPool Msgs Flat SegPool Log DB TablP CSV Excel eeeexeeeoo eee eeee 999999 Mapping Interface Data 1 0 Pane Register Information Flat HKey Register Message Area SegPool Register A basic operation of Chiapas EDI 2012 is the ability to convert arbitrary 4010 or 5010 EDI files to database tables This section will guide you through the process step by step 1 Open ChiapasStudio C chiapas bin chiapasstudio exe you may need to run as Administrator 2 the front screen you should see the Data 1 0 Pane default to the Flat tab Click the SegPool tab Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 5 Flat HKey og DB Table CSV Excel O Flat To Table Beane 9 Table to Flat ForceMerge Merge DB Type SQL Server Dat Data Source in true Table vw Export 834 Source Database chiap
190. vice Note In contrast to the Local Upload File Poll partially downloaded files such as ending in a part extension will fire this trigger For this reason only fully completed files should be moved to an archive triggered directory or an activity at the beginning of the workflow should check the filename for validity Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 47 Schedule Info Tab This allows you to set the trigger schedule on a specific schedule repeating at a set interval of seconds minutes or hour Furthermore you can filter the schedule by Day of Week specific months and start end times for daily schedules and begin end dates for longer term schedules All of these are treated as conditions that are individually checked during the main workflow trigger timer When the event is triggered the current timestamp is placed in the TSRC 1 field within the row for that trigger If this field is a null or empty string then the automation will try to trigger the event at the next polling interval that matches all of the criteria specified in the window Triggerinfo Polinginfo Schedule Info Event History Nee Dee see Here is a breakdown of the various schedule Interval Trigger Types filters In order for the event to fire all options Run Always Interval 1 Day of Week that are filled in will need to be true for the Second Interval Monday Friday Start Time 10 48 00 AM event
191. we established in the previously deliverable into a fully automated solution This section walks us through these deliverables one step at a time Deliverable 2 A Deliverable 2 B The first thing we must do is set up the automation infrastructure necessary to process the incoming legacy file into a new EDI file First we create the folders off the of pipeline directory on the C drive cd c chiapas pipeline mkdir 013 CSVLegacy cd 013 CSVLegacy mkdir 01 in csv mkdir 02 in csv mkdir 03 out edi Next we set up a LOCAL UPLOAD trigger that will pull new CSV files from the 01 directory to the 02 directory and then process a workflow on that file We open Chiapas Studio and select the pulldown Window Scheduling Interface then press the NEW button to create a new trigger Selecting the newly created trigger in the All Triggers tab we enter in a name of Legacy CSV Process and and press SAVE Then we go to Polling Info and enter in the following information Local Upload File Poll Local UL Dir CAchiapas pipeline 013_CSVLegacy 01_in_csv Dest Dir C chiapas pipeline 013_CSVLegacy 02_in_csv Then we press SAVE We cannot enable the automation until we have the Workflow set up and prior to that we need the ability to import the data from the legacy CSV text file into a database The following Stored Procedure does the following Accepting the EVENT_ID and a filename it copies the data in the CSV file and cr
192. y sort the data before the Chiapas EDI engine accepts it 013 LargeFileDecodeToBINDB Merge Directories 01 in edi 02 done edi 03 err edi This is a serial workflow that processes one file at a time and will merge it into the BIN similar to the Pipeline 007 workflow This pipeline has been optimized for very large file sizes larger than 100 Megabytes to minimize memory consumption and data transfers to the database Unlike the Pipeline 007 workflow this will completely load the BIN table by the completion of the workflow Copyright 2015 Chiapas EDI Technologies Inc All Rights Reserved Page 16 USER REFERENCE This chapter will cover the essential functions of Chiapas EDI Enterprise beginning with an in depth tour of the different parts of Chiapas Studio and proceeding through the core functions of scheduling and automation It will cover the Chiapas Gate Intermediate Format which is the core naming convention and technology that Chiapas EDI uses to translate between EDI files and XML and Flat tables The main objective of this section is to give the user an understanding of the fundementals of EDI translation and how Chiapas EDI can be used in a variety of business scenarios involving EDI files What is Chiapas EDI Enterprise In simplest terms Chiapas EDI Enterprise is a Windows based ANSI X12 4010 5010 middleware EDI platform Middleware refers to a category of software where the main purpose is to bridge enterprise systems with

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