C:\EDIdEv\Examples\HIPAA\5010\VbNet\vbNet_Gen835X221A1\Form1.vb Imports Edidev.FrameworkEDI
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1 Imports Edidev.FrameworkEDI 1 Public Class Form1 Private Sub btngenerate_click(byval sender As System.Object, ByVal e As System.EventArgs) Handles btngenerate.click Dim oedidoc As edidocument Dim oschemas As edischemas Dim ointerchange As New ediinterchange Dim ogroup As New edigroup Dim otransactionset As New editransactionset Dim osegment As New edidatasegment Dim nproviders As Integer Dim nprovidercounter As Integer Dim nclaimpayments As Integer Dim nclaimpaymentcounter As Integer Dim nservicecounter As Integer Dim nservices As Integer Dim spath As String = AppDomain.CurrentDomain.BaseDirectory Dim sedifile As String = "835_5010X221A1.X12" Dim sseffile As String = "835_005010X221A1.SemRef.EVAL0.SEF" 'CREATES OEDIDOC OBJECT oedidoc = New edidocument 'THIS MAKES CERTAIN THAT FREDI ONLY USES THE SEF FILE PROVIDED, AND THAT IT DOES 'NOT USE ITS BUILT IN STANDARD REFERENCE TABLE TO GENERATE THE EDI FILE. oschemas = oedidoc.getschemas oschemas.enablestandardreference = False 'ENABLES FORWARD WRITE, AND INCREASES BUFFER I/O TO IMPROVE PERFORMANCE oedidoc.cursortype = DocumentCursorTypeConstants.Cursor_ForwardWrite oedidoc.property(documentpropertyidconstants.property_documentbufferio) = 200 'SET TERMINATORS oedidoc.segmentterminator = "~" oedidoc.elementterminator = "*" oedidoc.compositeterminator = ":" 'LOADS THE SEF FILE oedidoc.loadschema(spath + sseffile, 0) 'CREATES THE ISA SEGMENT ediinterchange.set(ointerchange, oedidoc.createinterchange("x", "005010")) edidatasegment.set(osegment, ointerchange.getdatasegmentheader) osegment.dataelementvalue(1) = "00" 'Authorization Information Qualifier osegment.dataelementvalue(2) = " " 'Authorization Information osegment.dataelementvalue(3) = "00" 'Security Information Qualifier osegment.dataelementvalue(4) = " " 'Security Information osegment.dataelementvalue(5) = "ZZ" 'Interchange ID Qualifier osegment.dataelementvalue(6) = "SENDER_ID " 'Interchange Sender ID osegment.dataelementvalue(7) = "ZZ" 'Interchange ID Qualifier osegment.dataelementvalue(8) = "REVEIVER_ID " 'Interchange Receiver ID osegment.dataelementvalue(9) = "020617" 'Interchange Date osegment.dataelementvalue(10) = "1816" 'Interchange Time osegment.dataelementvalue(11) = "^" 'Repetition Separator osegment.dataelementvalue(12) = "00501" 'Interchange Control Version Number osegment.dataelementvalue(13) = " " 'Interchange Control Number osegment.dataelementvalue(14) = "0" 'Acknowledgment Requested osegment.dataelementvalue(15) = "T" 'Usage Indicator osegment.dataelementvalue(16) = ":" 'Component Element Separator 'CREATES THE GS SEGMENT
2 edigroup.set(ogroup, ointerchange.creategroup("005010x221a1")) edidatasegment.set(osegment, ogroup.getdatasegmentheader) osegment.dataelementvalue(1) = "HP" 'Functional Identifier Code osegment.dataelementvalue(2) = "SENDER_ID " 'Application Sender's Code osegment.dataelementvalue(3) = "RECEIVER_ID" 'Application Receiver's Code osegment.dataelementvalue(4) = " " 'Date osegment.dataelementvalue(5) = "1816" 'Time osegment.dataelementvalue(6) = "206" 'Group Control Number osegment.dataelementvalue(7) = "X" 'Responsible Agency Code osegment.dataelementvalue(8) = "005010X221A1" 'Version / Release / Industry Identifier Code 2 'CREATES THE ST SEGMENT editransactionset.set(otransactionset, ogroup.createtransactionset("835")) edidatasegment.set(osegment, otransactionset.getdatasegmentheader) osegment.dataelementvalue(1) = "835" 'Transaction Set Identifier Code osegment.dataelementvalue(2) = "1234" 'Transaction Set Control Number 'BPR BEGINNING SEGMENT FOR PAYMENT ORDER/REMITTANCE ADVICE edidatasegment.set(osegment, otransactionset.createdatasegment("bpr")) osegment.dataelementvalue(1) = "C" 'Transaction Handling Code osegment.dataelementvalue(2) = "150000" 'Monetary Amount osegment.dataelementvalue(3) = "C" 'Credit/Debit Flag Code osegment.dataelementvalue(4) = "ACH" 'Payment Method Code osegment.dataelementvalue(5) = "CTX" 'Payment Format Code osegment.dataelementvalue(6) = "01" '(DFI) ID Number Qualifier osegment.dataelementvalue(7) = " " '(DFI) Identification Number osegment.dataelementvalue(8) = "DA" 'Account Number Qualifier osegment.dataelementvalue(9) = "123456" 'Account Number osegment.dataelementvalue(10) = " " 'Originating Company Identifier osegment.dataelementvalue(12) = "01" '(DFI) ID Number Qualifier osegment.dataelementvalue(13) = " " '(DFI) Identification Number osegment.dataelementvalue(14) = "DA" 'Account Number Qualifier osegment.dataelementvalue(15) = "98765" 'Account Number osegment.dataelementvalue(16) = " " 'Date 'TRN TRACE edidatasegment.set(osegment, otransactionset.createdatasegment("trn")) osegment.dataelementvalue(1) = "1" 'Trace Type Code osegment.dataelementvalue(2) = "12345" 'Reference Identification osegment.dataelementvalue(3) = " " 'Originating Company Identifier ''REF Receiver Identification 'edidatasegment.set(osegment, otransactionset.createdatasegment("ref")) 'osegment.dataelementvalue(1) = "EV" ' Reference Identification Qualifier (128) 'osegment.dataelementvalue(2) = "A1B2C3D4E5" ' Reference Identification (127) ''REF Version Identification 'edidatasegment.set(osegment, otransactionset.createdatasegment("ref(2)")) 'osegment.dataelementvalue(1) = "F2" ' Reference Identification Qualifier (128) 'osegment.dataelementvalue(2) = "A1B2C3D4E5" ' Reference Identification (127) edidatasegment.set(osegment, otransactionset.createdatasegment("dtm")) osegment.dataelementvalue(1) = "405" 'Date/Time Qualifier osegment.dataelementvalue(2) = " " 'Date '1000A PAYER IDENTIFICATION 'N1 NAME edidatasegment.set(osegment, otransactionset.createdatasegment("n1\n1")) osegment.dataelementvalue(1) = "PR" 'Entity Identifier Code osegment.dataelementvalue(2) = "INSURANCE COMPANY OF TIMBUCKTU" 'Name 'N3 ADDRESS INFORMATION edidatasegment.set(osegment, otransactionset.createdatasegment("n1\n3")) osegment.dataelementvalue(1) = "1 MAIN STREET" 'Address Information
3 'N4 GEOGRAPHIC LOCATION edidatasegment.set(osegment, otransactionset.createdatasegment("n1\n4")) osegment.dataelementvalue(1) = "TIMBUCKTU" 'City Name osegment.dataelementvalue(2) = "AK" 'State or Province Code osegment.dataelementvalue(3) = "89111" 'Postal Code 3 'REF REFERENCE IDENTIFICATION edidatasegment.set(osegment, otransactionset.createdatasegment("n1\ref")) osegment.dataelementvalue(1) = "2U" 'Reference Identification Qualifier osegment.dataelementvalue(2) = "999" 'Reference Identification ''PER Payer Business Contact Information 'edidatasegment.set(osegment, otransactionset.createdatasegment("n1\per")) 'osegment.dataelementvalue(1) = "CX" ' Contact Function Code (366) 'osegment.dataelementvalue(2) = "PayerName" ' Name (93) 'osegment.dataelementvalue(3) = "TE" ' Communication Number Qualifier (365) 'osegment.dataelementvalue(4) = " " ' Communication Number (364) ''PER Payer WEB Site 'edidatasegment.set(osegment, otransactionset.createdatasegment("n1\per(2)")) '(2) is the segment incremented by instance (not position in schema) 'osegment.dataelementvalue(1) = "IC" ' Contact Function Code (366) 'osegment.dataelementvalue(2) = "WebberName" ' Name (93) 'osegment.dataelementvalue(3) = "TE" ' Communication Number Qualifier (365) 'osegment.dataelementvalue(4) = " " ' Communication Number (364) '1000B PAYEE IDENTIFICATION 'N1 NAME edidatasegment.set(osegment, otransactionset.createdatasegment("n1\n1")) osegment.dataelementvalue(1) = "PE" 'Entity Identifier Code osegment.dataelementvalue(2) = "REGIONAL HOPE HOSPITAL" 'Name osegment.dataelementvalue(3) = "XX" 'Identification Code Qualifier osegment.dataelementvalue(4) = " " 'Identification Code nproviders = 2 nprovidercounter = 1 '2000 HEADER NUMBER Do While nprovidercounter <= nproviders 'LX ASSIGNED NUMBER edidatasegment.set(osegment, otransactionset.createdatasegment("lx\lx")) osegment.dataelementvalue(1) = "110212" 'Assigned Number 'TS3 TRANSACTION STATISTICS edidatasegment.set(osegment, otransactionset.createdatasegment("lx\ts3")) osegment.dataelementvalue(1) = " " 'Reference Identification osegment.dataelementvalue(2) = "11" 'Facility Code Value osegment.dataelementvalue(3) = " " 'Date osegment.dataelementvalue(4) = "1" 'Quantity osegment.dataelementvalue(5) = " " 'Monetary Amount (Total Claim Charge osegment.dataelementvalue(13) = " " 'Monetary Amount (Total MSP Payer osegment.dataelementvalue(15) = " " 'Monetary Amount (Total Non Lab Charge 'TS2 TRANSACTION SUPPLEMENTAL STATISTICS edidatasegment.set(osegment, otransactionset.createdatasegment("lx\ts2")) osegment.dataelementvalue(1) = " " 'Monetary Amount (Total DRG osegment.dataelementvalue(2) = " " 'Monetary Amount (Total Federal Specific osegment.dataelementvalue(4) = "56.82" 'Monetary Amount (Total Disproportionate Share osegment.dataelementvalue(5) = "197.69" 'Monetary Amount (Total Capital osegment.dataelementvalue(6) = "4.23" 'Monetary Amount (Total Indirect Medical Education nclaimpayments = 1 nclaimpaymentcounter = 1
4 '2100 CLAIM PAYMENT INFORMATION Do While nclaimpaymentcounter <= nclaimpayments 4 Number) 'CLP CLAIM LEVEL DATA edidatasegment.set(osegment, otransactionset.createdatasegment("lx\clp\clp")) osegment.dataelementvalue(1) = "666123" 'Claim Submitter's Identifier (Patient Control osegment.dataelementvalue(2) = "1" 'Claim Status Code osegment.dataelementvalue(3) = " " 'Monetary Amount (Total Claim Charge osegment.dataelementvalue(4) = " " 'Monetary Amount (Claim Payment osegment.dataelementvalue(6) = "MA" 'Claim Filing Indicator Code osegment.dataelementvalue(7) = " " 'Reference Identification osegment.dataelementvalue(8) = "11" 'Facility Code Value osegment.dataelementvalue(9) = "1" 'Claim Frequency Type Code 'CAS CLAIMS ADJUSTMENT edidatasegment.set(osegment, otransactionset.createdatasegment("lx\clp\cas")) osegment.dataelementvalue(1) = "CO" 'Claim Adjustment Group Code osegment.dataelementvalue(2) = "45" 'Claim Adjustment Reason Code osegment.dataelementvalue(3) = " " 'Monetary Amount 'NM1 INDIVIDUAL OR ORGANIZATIONAL NAME edidatasegment.set(osegment, otransactionset.createdatasegment("lx\clp\nm1")) osegment.dataelementvalue(1) = "QC" 'Entity Identifier Code osegment.dataelementvalue(2) = "1" 'Entity Type Qualifier osegment.dataelementvalue(3) = "JONES" 'Name Last or Organization Name osegment.dataelementvalue(4) = "SAM" 'Name First osegment.dataelementvalue(5) = "O" 'Name Middle osegment.dataelementvalue(8) = "HN" 'Identification Code Qualifier osegment.dataelementvalue(9) = " A" 'Identification Code 'MIA MEDICARE INPATIENT ADJUDICATION edidatasegment.set(osegment, otransactionset.createdatasegment("lx\clp\mia")) osegment.dataelementvalue(1) = "0" 'Quantity osegment.dataelementvalue(4) = " " 'Monetary Amount edidatasegment.set(osegment, otransactionset.createdatasegment("lx\clp\dtm")) osegment.dataelementvalue(1) = "232" 'Date/Time Qualifier osegment.dataelementvalue(2) = " " 'Date (Claim Statement Period Start) edidatasegment.set(osegment, otransactionset.createdatasegment("lx\clp\dtm(2)")) osegment.dataelementvalue(1) = "233" 'Date/Time Qualifier osegment.dataelementvalue(2) = " " 'Date (Claim Statement Period End) 'QTY QUANTITY edidatasegment.set(osegment, otransactionset.createdatasegment("lx\clp\qty")) osegment.dataelementvalue(1) = "CA" 'Quantity Qualifier (Covered Actual) osegment.dataelementvalue(2) = "8" 'Quantity nservices = 0 nservicecounter = 1 '2110 SERVICE PAYMENT INFORMATION Do While nservicecounter <= nservices ' Service Information (SVC) osegment = otransactionset.createdatasegment("lx\clp\svc\svc") Charge ' Composite Medical Procedure Identifier (C003) osegment.dataelementvalue(1, 1) = "HC" ' Product/Service ID Qualifier (235) osegment.dataelementvalue(1, 2) = "12345" ' Product/Service ID (234) osegment.dataelementvalue(1, 3) = "26" ' Procedure Modifier (1339) osegment.dataelementvalue(2) = "166.5" ' Monetary Amount (782) (Line Item
5 osegment.dataelementvalue(3) = "30" ' Monetary Amount (782) (Line Item Provider Payment osegment.dataelementvalue(4) = "" ' Product/Service ID (234) osegment.dataelementvalue(5) = "1" ' Quantity (380) ' Date/Time Reference (DTM) edidatasegment.set(osegment, otransactionset.createdatasegment("lx\clp\svc\dtm")) osegment.dataelementvalue(1) = "472" ' Date/Time Qualifier (374) (Service) osegment.dataelementvalue(2) = " " ' Date (373) 5 Adjustment) ' Claims Adjustment (CAS) edidatasegment.set(osegment, otransactionset.createdatasegment("lx\clp\svc\cas")) osegment.dataelementvalue(1) = "OA" ' Claim Adjustment Group Code (1033) (Other osegment.dataelementvalue(2) = "23" ' Claim Adjustment Reason Code (1034) osegment.dataelementvalue(3) = "136.5" ' Monetary Amount (782) (Adjustment ' Reference Identification (REF) edidatasegment.set(osegment, otransactionset.createdatasegment("lx\clp\svc\ref")) ' Syntax Rule: At least one of 02 and 03 is required. osegment.dataelementvalue(1) = "1B" ' Reference Identification Qualifier (128) osegment.dataelementvalue(2) = "43285" ' Reference Identification (127) Actual) ' Monetary Amount (AMT) edidatasegment.set(osegment, otransactionset.createdatasegment("lx\clp\svc\amt")) osegment.dataelementvalue(1) = "B6" ' Amount Qualifier Code (522) (Allowed osegment.dataelementvalue(2) = "150" ' Monetary Amount (782) End Sub End Class nservicecounter = nservicecounter + 1 Loop 'nservicecounter nclaimpaymentcounter = nclaimpaymentcounter + 1 Loop 'nclaimpaymentcounter nprovidercounter = nprovidercounter + 1 Loop 'nprovidercounter 'display EDI file MessageBox.Show(oEdiDoc.GetEdiString(), sedifile) 'TRAILING SEGMENTS ARE AUTOMATICALLY CREATED WHEN FREDI COMMITS (SAVES) 'THE EDIDOC OBJECT INTO AN EDI FILE. oedidoc.save(spath + sedifile) 'DESTROYS OBJECTS osegment.dispose() otransactionset.dispose() ogroup.dispose() ointerchange.dispose() oschemas.dispose() oedidoc.dispose()
C:\EDIdEv\Examples\HIPAA\5010\VbNet\vbNet_Gen834X220A1\Form1.vb Imports Edidev.FrameworkEDI
Imports Edidev.FrameworkEDI 1 Public Class Form1 Private Sub btngenerate_click(byval sender As System.Object, ByVal e As System.EventArgs) Handles btngenerate.click Dim oedidoc As edidocument Dim oschemas
C:\EDIdEv\Examples\HIPAA\5010\VbNet\vbNet_Gen837X222A1\Form1.vb Imports Edidev.FrameworkEDI
Imports Edidev.FrameworkEDI 1 Public Class Form1 Private Sub btngenerate_click(byval sender As System.Object, ByVal e As System.EventArgs) Handles btngenerate.click Dim oedidoc As edidocument Dim oschemas
C:\EDIdEv\Examples\HIPAA\5010\VbNet\vbNet_Gen277X214\Form1.vb Imports Edidev.FrameworkEDI
Imports Edidev.FrameworkEDI 1 Public Class Form1 Private Sub btngenerate_click(byval sender As System.Object, ByVal e As System.EventArgs) Handles btngenerate.click Dim oedidoc As edidocument Dim oschema
namespace csharp_gen837x223a2 { public partial class Form1 : Form { public Form1() { InitializeComponent(); }
using System; using System.Collections.Generic; using System.ComponentModel; using System.Data; using System.Drawing; using System.Text; using System.Windows.Forms; using Edidev.FrameworkEDI; 1 namespace
namespace csharp_gen277x214 { public partial class Form1 : Form { public Form1() { InitializeComponent(); }
using System using System.Collections.Generic using System.ComponentModel using System.Data using System.Drawing using System.Text using System.Windows.Forms using Edidev.FrameworkEDI 1 namespace csharp_gen277x214
namespace Gen837X222A1 { public partial class Form1 : Form { public Form1() { InitializeComponent(); }
using System; using System.Collections.Generic; using System.ComponentModel; using System.Data; using System.Drawing; using System.Text; using System.Windows.Forms; using Edidev.FrameworkEDI; 1 namespace
// Specify SEF file to load. edischema oschema = oedidoc.loadschema(spath + sseffilename, SchemaTypeIDConstants. Schema_Standard_Exchange_Format);
using System; using System.Collections.Generic; using System.ComponentModel; using System.Data; using System.Drawing; using System.Linq; using System.Text; using System.Windows.Forms; using Edidev.FrameworkEDIx64;
string spath; string sedifile = "277_005010X228.X12"; string sseffile = "277_005010X228.SemRef.EVAL0.SEF";
using System; using System.Collections.Generic; using System.ComponentModel; using System.Data; using System.Drawing; using System.Text; using System.Windows.Forms; using Edidev.FrameworkEDI; 1 namespace
C:\EDIdEv\Examples\HIPAA\5010\VbNet\vbNet_Tran834X220A1\Form1.vb Imports Edidev.FrameworkEDI
Imports Edidev.FrameworkEDI 1 Public Class Form1 Private Sub btntranslate_click(byval sender As System.Object, ByVal e As System.EventArgs) Handles btntranslate.click Dim oedidoc As edidocument Dim oschemas
private string sconnection = ConfigurationManager.ConnectionStrings["Development"].ConnectionString
![private string sconnection = ConfigurationManager.ConnectionStrings[Development].ConnectionString](/thumbs/93/114318968.jpg "private string sconnection = ConfigurationManager.ConnectionStrings[Development].ConnectionString")
using System; using System.Configuration; using System.Collections.Generic; using System.ComponentModel; using System.Data; using System.Data.SqlClient; using System.Drawing; using System.Text; using System.Windows.Forms;
private string sconnection = ConfigurationManager.ConnectionStrings["Development"].ConnectionString
![private string sconnection = ConfigurationManager.ConnectionStrings[Development].ConnectionString](/thumbs/93/114318966.jpg "private string sconnection = ConfigurationManager.ConnectionStrings[Development].ConnectionString")
using System; using System.Configuration; using System.Collections.Generic; using System.ComponentModel; using System.Data; using System.Data.SqlClient; using System.Drawing; using System.Text; using System.Windows.Forms;
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// Specify SEF file to load. oschema = (edischema) oedidoc.loadschema(spath + sseffilename, SchemaTypeIDConstants. Schema_Standard_Exchange_Format);
using System; using System.Collections.Generic; using System.ComponentModel; using System.Data; using System.Drawing; using System.Linq; using System.Text; using System.Windows.Forms; using Edidev.FrameworkEDI;
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