// Specify SEF file to load. edischema oschema = oedidoc.loadschema(spath + sseffilename, SchemaTypeIDConstants. Schema_Standard_Exchange_Format);

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1 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; 1 namespace csharp_gen820x306 public partial class frmgen820x306 : Form public frmgen820x306() InitializeComponent(); private void btngenerate_click(object sender, EventArgs e) string spath = AppDomain.CurrentDomain.BaseDirectory; // Create the top level application object "edidocument". edidocument oedidoc = new edidocument(); // This makes certain that Framework EDI only uses the SEF file provided, // and that it does not use its built in Standard Reference table to generate // the EDI document edischemas oschemas = oedidoc.getschemas(); oschemas.enablestandardreference = false; // The FORWARD WRITE cursor increases the performance of processing the EDI // document (see Technical Note 3 below). oedidoc.cursortype = DocumentCursorTypeConstants.Cursor_ForwardWrite; // Terminators have to be specified. oedidoc.segmentterminator = "~13:10"; oedidoc.elementterminator = "*"; oedidoc.compositeterminator = "!"; string sedifilename = "820_005010X306.X12"; string sseffilename = "820_005010X306.EVAL0.SEF"; // Specify SEF file to load. edischema oschema = oedidoc.loadschema(spath + sseffilename, SchemaTypeIDConstants. Schema_Standard_Exchange_Format); (I07) // Creates the Interchange Control Header segment (ISA). ediinterchange ointerchange = oedidoc.createinterchange("x", "005010"); edidatasegment osegment = ointerchange.getdatasegmentheader(); osegment.set_dataelementvalue(1, 0, "00"); // Authorization Information Qualifier (I01) osegment.set_dataelementvalue(2, 0, " "); // Authorization Information (I02) osegment.set_dataelementvalue(3, 0, "00"); // Security Information Qualifier (I03) osegment.set_dataelementvalue(4, 0, " "); // Security Information (I04) osegment.set_dataelementvalue(5, 0, "ZZ"); // Interchange ID Qualifier (I05) osegment.set_dataelementvalue(6, 0, "SENDER ID "); // Interchange Sender ID (I06) osegment.set_dataelementvalue(7, 0, "ZZ"); // Interchange ID Qualifier (I05) osegment.set_dataelementvalue(8, 0, "RECEIVER ID "); // Interchange Receiver ID osegment.set_dataelementvalue(9, 0, "010101"); osegment.set_dataelementvalue(10, 0, "0101"); osegment.set_dataelementvalue(11, 0, ":"); osegment.set_dataelementvalue(12, 0, "00501"); // Interchange Date (I08) // Interchange Time (I09) // Repetition Separator (I65) // Interchange Control Version Number (I11) osegment.set_dataelementvalue(13, 0, " "); // Interchange Control Number (I12)

2 osegment.set_dataelementvalue(14, 0, "0"); osegment.set_dataelementvalue(15, 0, "T"); osegment.set_dataelementvalue(16, 0, "!"); // Acknowledgment Requested (I13) // Usage Indicator (I14) // Component Element Separator (I15) 2 (124) // Creates the Functional Group Header segment (GS). edigroup ogroup = ointerchange.creategroup("005010x306"); edidatasegment.set(ref osegment, ogroup.getdatasegmentheader()); osegment.set_dataelementvalue(1, 0, "RA"); // Functional Identifier Code (479) osegment.set_dataelementvalue(2, 0, "APP SENDER"); // Application Sender's Code (142) osegment.set_dataelementvalue(3, 0, "APP RECEIVER"); // Application Receiver's Code osegment.set_dataelementvalue(4, 0, " "); // Date (373) osegment.set_dataelementvalue(5, 0, " "); // Time (337) osegment.set_dataelementvalue(6, 0, "1"); // Group Control Number (28) osegment.set_dataelementvalue(7, 0, "X"); // Responsible Agency Code (455) osegment.set_dataelementvalue(8, 0, "005010X306"); // Version / Release / Industry Identifier Code (480) // TRANSACTION SET ID 820 Payment Order/Remittance Advice (1705) // Creates the Transaction Set header segment (ST). editransactionset otransactionset = ogroup.createtransactionset("820"); edidatasegment.set(ref osegment, otransactionset.getdatasegmentheader()); osegment.set_dataelementvalue(1, 0, "820"); // Transaction Set Identifier Code (143) osegment.set_dataelementvalue(2, 0, "0001"); // Transaction Set Control Number (329) osegment.set_dataelementvalue(3, 0, "005010X306"); // Implementation Convention Reference // // Financial Information (BPR) edidatasegment.set(ref osegment, otransactionset.createdatasegment("bpr")); // Syntax Rule: If any of 12 or 13 are present, then all are required. // Syntax Rule: If 14 is present, then 15 is required. osegment.set_dataelementvalue(1, 0, "I"); // Transaction Handling Code (305) osegment.set_dataelementvalue(2, 0, "310"); // Monetary Amount (782) osegment.set_dataelementvalue(3, 0, "C"); // Credit/Debit Flag Code (478) osegment.set_dataelementvalue(4, 0, "ACH"); // Payment Method Code (591) osegment.set_dataelementvalue(5, 0, "CCP"); // Payment Format Code (812) osegment.set_dataelementvalue(12, 0, "01"); // (DFI) ID Number Qualifier (506) osegment.set_dataelementvalue(13, 0, " "); // (DFI) Identification Number (507) osegment.set_dataelementvalue(14, 0, "DA"); // Account Number Qualifier (569) osegment.set_dataelementvalue(15, 0, "98765"); // Account Number (508) osegment.set_dataelementvalue(16, 0, " "); // Date (373) // Reassociation Trace Number (TRN) edidatasegment.set(ref osegment, otransactionset.createdatasegment("trn")); osegment.set_dataelementvalue(1, 0, "3"); // Trace Type Code (481) osegment.set_dataelementvalue(2, 0, "78905"); // Reference Identification (127) // Exchange Assigned Qualified Health Plan Identifier (REF) string sreffld1 = ""; if (sreffld1!= "") edidatasegment.set(ref osegment, otransactionset.createdatasegment("ref")); osegment.set_dataelementvalue(1, 0, "38"); // Reference Identification Qualifier osegment.set_dataelementvalue(2, 0, sreffld1); // Reference Identification (127) // Issuer Assigned Qualified Health Plan Identifier (REF) string sreffld2 = ""; if (sreffld2!= "") edidatasegment.set(ref osegment, otransactionset.createdatasegment("ref(2)"));

3 osegment.set_dataelementvalue(1, 0, "TV"); // Reference Identification Qualifier 3 osegment.set_dataelementvalue(2, 0, sreffld2); // Reference Identification (127) // Exchange Assigned Employer Group Identifier (REF) string sreffld3 = ""; if (sreffld3!= "") edidatasegment.set(ref osegment, otransactionset.createdatasegment("ref(3)")); osegment.set_dataelementvalue(1, 0, "18"); // Reference Identification Qualifier osegment.set_dataelementvalue(2, 0, sreffld3); // Reference Identification (127) // Issuer Assigned Employer Group Identifier (REF) string sreffld4 = ""; if (sreffld4!= "") edidatasegment.set(ref osegment, otransactionset.createdatasegment("ref(4)")); osegment.set_dataelementvalue(1, 0, "1L"); // Reference Identification Qualifier osegment.set_dataelementvalue(2, 0, sreffld4); // Reference Identification (127) // LOOP 1000A // Payee Name (N1) edidatasegment.set(ref osegment, otransactionset.createdatasegment(@"n1\n1")); // Syntax Rule: If any of 03 or 04 are present, then all are required. osegment.set_dataelementvalue(1, 0, "PE"); // Entity Identifier Code (98) osegment.set_dataelementvalue(2, 0, "BATA INSURANCE CO."); // Name (93) osegment.set_dataelementvalue(3, 0, "FI"); // Identification Code Qualifier (66) osegment.set_dataelementvalue(4, 0, " "); // Identification Code (67) // Unique Health Plan Identifier (REF) string sreffld1a = ""; if (sreffld1a!= "") edidatasegment.set(ref osegment, otransactionset.createdatasegment("ref(4)")); osegment.set_dataelementvalue(1, 0, "ABY"); // Reference Identification Qualifier osegment.set_dataelementvalue(2, 0, sreffld1a); // Reference Identification (127) //LOOP 1000B // Payer's Name (N1) edidatasegment.set(ref osegment, otransactionset.createdatasegment(@"n1\n1")); // Syntax Rule: If any of 03 or 04 are present, then all are required. osegment.set_dataelementvalue(1, 0, "RM"); // Entity Identifier Code (98) osegment.set_dataelementvalue(2, 0, "SOME GOV AGENCY"); // Name (93) osegment.set_dataelementvalue(3, 0, "58"); // Identification Code Qualifier (66) osegment.set_dataelementvalue(4, 0, "123ABC"); // Identification Code (67) // Payer's Administrative Contact Information (PER) string spayercontactname = ""; if (spayercontactname!= "") edidatasegment.set(ref osegment, otransactionset.createdatasegment(@"n1\per")); // Syntax Rule: If any of 03 or 04 are present, then all are required. // Syntax Rule: If any of 05 or 06 are present, then all are required.

4 (364) // Syntax Rule: If any of 07 or 08 are present, then all are required. osegment.set_dataelementvalue(1, 0, "IC"); // Contact Function Code (366) osegment.set_dataelementvalue(2, 0, spayercontactname); // Name (93) osegment.set_dataelementvalue(3, 0, "TE"); // Communication Number Qualifier (365) osegment.set_dataelementvalue(4, 0, " "); // Communication Number (364) osegment.set_dataelementvalue(5, 0, "EM"); // Communication Number Qualifier (365) osegment.set_dataelementvalue(6, 0, // Communication Number osegment.set_dataelementvalue(7, 0, "FX"); // Communication Number Qualifier (365) osegment.set_dataelementvalue(8, 0, " "); // Communication Number (364) 4 (554) (1035) // LOOP 2000 for (int nremittance = 1; nremittance <= 2; nremittance++) // Remittance Information (ENT) edidatasegment.set(ref osegment, otransactionset.createdatasegment(@"ent\ent")); osegment.set_dataelementvalue(1, 0, nremittance.tostring()); // Assigned Number // LOOP 2100 // Individual Name (NM1) edidatasegment.set(ref osegment, otransactionset.createdatasegment(@"ent\nm1\nm1")); // Syntax Rule: If any of 08 or 09 are present, then all are required. osegment.set_dataelementvalue(1, 0, "IL"); // Entity Identifier Code (98) osegment.set_dataelementvalue(2, 0, "1"); // Entity Type Qualifier (1065) osegment.set_dataelementvalue(3, 0, "DOE"); // Name Last or Organization Name osegment.set_dataelementvalue(4, 0, "JOHN"); // Name First (1036) osegment.set_dataelementvalue(5, 0, ""); // Name Middle (1037) osegment.set_dataelementvalue(6, 0, ""); // Name Prefix (1038) osegment.set_dataelementvalue(7, 0, ""); // Name Suffix (1039) osegment.set_dataelementvalue(8, 0, "C1"); // Identification Code Qualifier (66) osegment.set_dataelementvalue(9, 0, "777222"); // Identification Code (67) // Exchange Assigned Qualified Health Plan Identifier (REF) "MASTER POLICY NUMBER" string sentref1 = ""; if (sentref1!= "") edidatasegment.set(ref osegment, otransactionset.createdatasegment(@"ent\nm1\ref")); osegment.set_dataelementvalue(1, 0, "38"); // Reference Identification Qualifier osegment.set_dataelementvalue(2, 0, sentref1); // Reference Identification (127) // Issuer Assigned Qualified Health Plan Identifier (REF) "LINE OF BUSINESS" string sentref2 = ""; if (sentref2!= "") edidatasegment.set(ref osegment, otransactionset.createdatasegment(@"ent\nm1\ref(2)")); osegment.set_dataelementvalue(1, 0, "TV"); // Reference Identification Qualifier osegment.set_dataelementvalue(2, 0, sentref2); // Reference Identification (127) // Exchange Assigned Employer Group Identifier (REF) "PLAN NUMBER" string sentref3 = ""; if (sentref3!= "") edidatasegment.set(ref osegment, otransactionset.createdatasegment(@"ent\nm1\ref(3)")); osegment.set_dataelementvalue(1, 0, "18"); // Reference Identification Qualifier

5 osegment.set_dataelementvalue(2, 0, sentref3); // Reference Identification (127) 5 // Issuer Assigned Employer Group Identifier (REF) "GROUP OR POLICY NUMBER" string sentref4 = ""; if (sentref4!= "") edidatasegment.set(ref osegment, otransactionset.createdatasegment(@"ent\nm1\ref(4)")); osegment.set_dataelementvalue(1, 0, "1L"); // Reference Identification Qualifier osegment.set_dataelementvalue(2, 0, sentref4); // Reference Identification (127) // Exchange Assigned Policy Identifier (REF) "POLICY NUMBER" string sentref5 = "555666"; if (sentref5!= "") edidatasegment.set(ref osegment, otransactionset.createdatasegment(@"ent\nm1\ref(5)")); osegment.set_dataelementvalue(1, 0, "POL"); // Reference Identification Qualifier osegment.set_dataelementvalue(2, 0, sentref5); // Reference Identification (127) // Issuer Assigned Policy Identifier (REF) "HEALTH INSURANCE POLICY NUMBER" string sentref6 = ""; if (sentref6!= "") edidatasegment.set(ref osegment, otransactionset.createdatasegment(@"ent\nm1\ref(6)")); osegment.set_dataelementvalue(1, 0, "AZ"); // Reference Identification Qualifier osegment.set_dataelementvalue(2, 0, sentref6); // Reference Identification (127) // Exchange Assigned APTC Contributor/Tax Payer Identifier (REF) "PERSONAL IDENTIFICATION NUMBER (PIN)" string sentref7 = ""; if (sentref7!= "") edidatasegment.set(ref osegment, otransactionset.createdatasegment(@"ent\nm1\ref(7)")); osegment.set_dataelementvalue(1, 0, "4A"); // Reference Identification Qualifier osegment.set_dataelementvalue(2, 0, sentref7); // Reference Identification (127) // Issuer Assigned APTC Contributor/Tax Payer Identifier (REF) "CLIENT NUMBER" string sentref8 = ""; if (sentref8!= "") edidatasegment.set(ref osegment, otransactionset.createdatasegment(@"ent\nm1\ref(8)")); osegment.set_dataelementvalue(1, 0, "23"); // Reference Identification Qualifier osegment.set_dataelementvalue(2, 0, sentref8); // Reference Identification (127) // Exchange Assigned Dependent Identifier (REF) "CROSS REFERENCE NUMBER" string sentref9 = ""; if (sentref9!= "") edidatasegment.set(ref osegment, otransactionset.createdatasegment(@"ent\nm1\ref(9)")); osegment.set_dataelementvalue(1, 0, "6O"); // Reference Identification Qualifier osegment.set_dataelementvalue(2, 0, sentref9); // Reference Identification (127) // Issuer Assigned Dependent Identifier (REF) "MEMBER IDENTIFICATION NUMBER" string sentref10 = "";

6 ; (127) if (sentref10!= "") edidatasegment.set(ref osegment, osegment.set_dataelementvalue(1, 0, "1W"); osegment.set_dataelementvalue(2, 0, sentref10); // Reference Identification Qualifier // Reference Identification 6 ; (127) // Issuer Assigned Subscriber Identifier (REF) "SUBSCRIBER NUMBER" string sentref11 = ""; if (sentref11!= "") edidatasegment.set(ref osegment, otransactionset.createdatasegment(@"ent\nm1\ref(11)")) osegment.set_dataelementvalue(1, 0, "0F"); osegment.set_dataelementvalue(2, 0, sentref11); // Reference Identification Qualifier // Reference Identification Amount (782) ; Qualifier // LOOP 2300 float nremittanceamnt = 30; while (nremittanceamnt!= 0) // Remittance Detail (RMR) edidatasegment.set(ref osegment, otransactionset.createdatasegment(@"ent\rmr\rmr")); // Syntax Rule: If any of 01 or 02 are present, then all are required. osegment.set_dataelementvalue(1, 0, "ZZ"); // Reference Identification Qualifier osegment.set_dataelementvalue(2, 0, "1"); // Reference Identification (127) osegment.set_dataelementvalue(4, 0, nremittanceamnt.tostring()); // Monetary nremittanceamnt = 0; // Exchange Report Document Control Number (REF) string sremdetref = " "; if (sremdetref!= "") edidatasegment.set(ref osegment, otransactionset.createdatasegment(@"ent\rmr\ref")) osegment.set_dataelementvalue(1, 0, "0N"); // Reference Identification osegment.set_dataelementvalue(2, 0, "1"); // Reference Identification (127) osegment.set_dataelementvalue(3, 0, sremdetref); // Description (352) // Individual Coverage Period (DTM) edidatasegment.set(ref osegment, otransactionset.createdatasegment(@"ent\rmr\dtm")); osegment.set_dataelementvalue(1, 0, "582"); // Date/Time Qualifier (374) osegment.set_dataelementvalue(5, 0, "RD8"); // Date Time Period Format Qualifier (1250) osegment.set_dataelementvalue(6, 0, " "); // Date Time Period (1251) // for // for nremittance // Trailing segments are automatically created when Framework EDI commits // (saves) the instance of "oedidoc" object into an EDI file. oedidoc.save(spath + sedifilename, 0);

7 7 MessageBox.Show(oEdiDoc.GetEdiString()); osegment.dispose(); otransactionset.dispose(); ogroup.dispose(); ointerchange.dispose(); oschema.dispose(); oschemas.dispose(); oedidoc.dispose();

string spath; string sedifile = "277_005010X228.X12"; string sseffile = "277_005010X228.SemRef.EVAL0.SEF";

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