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

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Ernest Antony Manning
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1 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_gen277x228 public partial class Form1 : Form public Form1() InitializeComponent(); private void button1_click(object sender, EventArgs e) edidocument oedidoc = null; edischema oschema = null; edischemas oschemas = null; ediinterchange ointerchange = null; edigroup ogroup = null; editransactionset otransactionset = null; edidatasegment osegment = null; int nhlcounter; int nhlinfosourcecounter; int nhlinforeceivercounter; int nhlserviceprovidercounter; int nhlpatientcounter; int nservicelinecounter; int nhlinfosources; int nhlinforeceivers; int nhlserviceproviders; int nhlpatients; int nservicelines; int nhlinforeceiverparent; int nhlserviceproviderparent; int nhlpatientparent; string spath; string sedifile = "277_005010X228.X12"; string sseffile = "277_005010X228.SemRef.EVAL0.SEF"; //evaluation SEF files spath = AppDomain.CurrentDomain.BaseDirectory; //CREATES OEDIDOC OBJECT edidocument.set(ref 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. edischemas.set(ref oschemas, (edischemas)oedidoc.getschemas()); oschemas.enablestandardreference = false; //ENABLES FORWARD WRITE, AND INCREASES BUFFER I/O TO IMPROVE PERFORMANCE oedidoc.cursortype = DocumentCursorTypeConstants.Cursor_ForwardWrite; oedidoc.set_property(documentpropertyidconstants.property_documentbufferio, 2000); //SET TERMINATORS oedidoc.segmentterminator = "~13:10"; oedidoc.elementterminator = "*";

2 oedidoc.compositeterminator = ":"; 2 //LOADS THE SEF FILE edischema.set(ref oschema, (edischema)oedidoc.loadschema(spath + sseffile, 0)); //CREATES THE ISA SEGMENT ediinterchange.set(ref ointerchange, (ediinterchange)oedidoc.createinterchange("x", "005010")); edidatasegment.set(ref osegment, (edidatasegment)ointerchange.getdatasegmentheader()); osegment.set_dataelementvalue(1, 0, "00"); //Authorization Information osegment.set_dataelementvalue(2, 0, " "); //Authorization Information osegment.set_dataelementvalue(3, 0, "00"); //Security Information osegment.set_dataelementvalue(4, 0, " "); //Security Information osegment.set_dataelementvalue(5, 0, "ZZ"); //Interchange ID osegment.set_dataelementvalue(6, 0, "SENDER ID "); //Interchange Sender ID osegment.set_dataelementvalue(7, 0, "ZZ"); //Interchange ID osegment.set_dataelementvalue(8, 0, "RECEIVER ID "); //Interchange Receiver ID osegment.set_dataelementvalue(9, 0, "010101"); //Interchange Date osegment.set_dataelementvalue(10, 0, "0101"); //Interchange Time osegment.set_dataelementvalue(11, 0, "^"); //Repetition Separator osegment.set_dataelementvalue(12, 0, "00501"); //Interchange Control Version Number osegment.set_dataelementvalue(13, 0, " "); //Interchange Control Number osegment.set_dataelementvalue(14, 0, "0"); //Acknowledgment Requested osegment.set_dataelementvalue(15, 0, "T"); //Usage Indicator osegment.set_dataelementvalue(16, 0, ":"); //Component Element Separator //CREATES THE GS SEGMENT edigroup.set(ref ogroup, (edigroup)ointerchange.creategroup("005010x228")); edidatasegment.set(ref osegment, (edidatasegment)ogroup.getdatasegmentheader()); osegment.set_dataelementvalue(1, 0, "HN"); //Functional Identifier Code osegment.set_dataelementvalue(2, 0, "APP SENDER"); //Application Sender's Code osegment.set_dataelementvalue(3, 0, "APP RECEIVER"); //Application Receiver's Code osegment.set_dataelementvalue(4, 0, " "); //Date osegment.set_dataelementvalue(5, 0, " "); //Time osegment.set_dataelementvalue(6, 0, "1"); //Group Control Number osegment.set_dataelementvalue(7, 0, "X"); //Responsible Agency Code osegment.set_dataelementvalue(8, 0, "005010X228"); //Version / Release / Industry Identifier Code )); //CREATES THE ST SEGMENT editransactionset.set(ref otransactionset, (editransactionset)ogroup.createtransactionset("277" edidatasegment.set(ref osegment, (edidatasegment)otransactionset.getdatasegmentheader()); osegment.set_dataelementvalue(1, 0, "277"); //Transaction Set Identifier Code osegment.set_dataelementvalue(2, 0, "0001"); //Transaction Set Control Number osegment.set_dataelementvalue(3, 0, "005010X228"); //Implementation Convention Reference //BHT BEGINNING OF HIERARCHICAL TRANSACTION edidatasegment.set(ref osegment, (edidatasegment)otransactionset.createdatasegment("bht")); osegment.set_dataelementvalue(1, 0, "0085"); //Hierarchical Structure Code osegment.set_dataelementvalue(2, 0, "08"); //Transaction Set Purpose Code osegment.set_dataelementvalue(3, 0, "277PEND123"); osegment.set_dataelementvalue(4, 0, " "); //Date osegment.set_dataelementvalue(5, 0, "1635"); //Time osegment.set_dataelementvalue(6, 0, "NO"); //Transaction Type Code nhlcounter = 0; nhlinfosourcecounter = 1; nhlinforeceivercounter = 1; nhlserviceprovidercounter = 1; nhlpatientcounter = 1; nservicelinecounter = 1; //This example has one of the following: nhlinfosources = 1; nhlinforeceivers = 1;

3 nhlserviceproviders = 1; nhlpatients = 1; nservicelines = 1; 3 //2000A INFORMATION SOURCE LEVEL while (nhlinfosourcecounter <= nhlinfosources) nhlcounter = nhlcounter + 1; //increment HL loop nhlinforeceiverparent = nhlcounter; //The value of this HL counter is the HL parent for the HL subscriber loop osegment.set_dataelementvalue(1, nhlcounter.tostring()); //Hierarchical ID Number osegment.set_dataelementvalue(3, "20"); //Hierarchical Level Code osegment.set_dataelementvalue(4, "1"); //Hierarchical Child Code \\NM1")); //2100A PAYER NAME //NM1 Payer Name edidatasegment.set(ref osegment, (edidatasegment)otransactionset.createdatasegment("hl\\nm1 osegment.set_dataelementvalue(1, 0, "PR"); //Entity Identifier Code osegment.set_dataelementvalue(2, 0, "2"); //Entity Type osegment.set_dataelementvalue(3, 0, "ABC INSURANCE"); //Name Last or Organization Name osegment.set_dataelementvalue(8, 0, "PI"); //Identification Code osegment.set_dataelementvalue(9, 0, "12345"); //Identification Code //2000B INFORMATION RECEIVER LEVEL while (nhlinforeceivercounter <= nhlinforeceivers) nhlcounter = nhlcounter + 1; nhlserviceproviderparent = nhlcounter; osegment.set_dataelementvalue(1, nhlcounter.tostring()); //Hierarchical ID Number osegment.set_dataelementvalue(2, nhlinforeceiverparent.tostring()); //Hierarchical Parent ID Number osegment.set_dataelementvalue(3, "21"); //Hierarchical Level Code osegment.set_dataelementvalue(4, "1"); //Hierarchical Child Code \NM1\\NM1")); Name //2100B INFORMATION RECEIVER NAME //NM1 Information Receiver Name edidatasegment.set(ref osegment, (edidatasegment)otransactionset.createdatasegment("hl\ osegment.set_dataelementvalue(1, 0, "41"); //Entity Identifier Code osegment.set_dataelementvalue(2, 0, "2"); //Entity Type osegment.set_dataelementvalue(3, 0, "XYZ SERVICE"); //Name Last or Organization osegment.set_dataelementvalue(8, 0, "46"); osegment.set_dataelementvalue(9, 0, "X67E"); //Identification Code //Identification Code //2000C SERVICE PROVIDER DETAIL LEVEL while (nhlserviceprovidercounter <= nhlserviceproviders) nhlcounter = nhlcounter + 1; nhlpatientparent = nhlcounter; osegment.set_dataelementvalue(1, nhlcounter.tostring()); //Hierarchical ID Number osegment.set_dataelementvalue(2, nhlserviceproviderparent.tostring()); // Hierarchical Parent ID Number osegment.set_dataelementvalue(3, "19"); //Hierarchical Level Code

4 osegment.set_dataelementvalue(4, "1"); //Hierarchical Child Code 4 ("HL\\NM1\\NM1")); Organization Name //2100C SERVICE PROVIDER NAME //NM1 Provider Name edidatasegment.set(ref osegment, (edidatasegment)otransactionset.createdatasegment osegment.set_dataelementvalue(1, 0, "1P"); //Entity Identifier Code osegment.set_dataelementvalue(2, 0, "2"); //Entity Type osegment.set_dataelementvalue(3, 0, "HOME HOSPITAL"); //Name Last or osegment.set_dataelementvalue(8, 0, "XX"); //Identification Code osegment.set_dataelementvalue(9, 0, " "); //Identification Code //2000D PATIENT DETAIL LEVEL while (nhlpatientcounter <= nhlpatients) nhlcounter = nhlcounter + 1; osegment.set_dataelementvalue(1, "4"); //Hierarchical ID Number osegment.set_dataelementvalue(2, "3"); //Hierarchical Parent ID Number osegment.set_dataelementvalue(3, "PT"); //Hierarchical Level Code NM1")); Name TRN")); Identification STC")); REF")); REF(2)")); //2100D PATIENT NAME //NM1 Patient Name edidatasegment.set(ref osegment, otransactionset.createdatasegment("hl\\nm1\\ osegment.set_dataelementvalue(1, 0, "QC"); osegment.set_dataelementvalue(2, 0, "1"); osegment.set_dataelementvalue(3, 0, "SMITH"); //Entity Identifier Code //Entity Type //Name Last or Organization osegment.set_dataelementvalue(4, 0, "FRED"); //Name First osegment.set_dataelementvalue(8, 0, "MI"); //Identification Code osegment.set_dataelementvalue(9, 0, " A"); //Identification Code //2200D PAYER CLAIM CONTROL NUMBER //TRN Payer Claim Control Number osegment.set_dataelementvalue(1, 0, "1"); //Trace Type Code osegment.set_dataelementvalue(2, 0, " "); //Reference //CLAIM LEVEL STATUS INFORMATION //STC STATUS INFORMATION osegment.set_dataelementvalue(1, 1, "P3"); //Health Care Claim Status osegment.set_dataelementvalue(1, 2, "317"); //Date osegment.set_dataelementvalue(2, 0, " "); //Date osegment.set_dataelementvalue(4, 0, " "); //Monetary Amount //PATIENT CONTROL NUMBER //REF REFERNCE IDENTIFICATION osegment.set_dataelementvalue(1, 0, "EJ"); osegment.set_dataelementvalue(2, 0, "SM123456"); //INSTITUTIONAL BILL TYPE IDENTIFIER //REF REFERNCE IDENTIFICATION osegment.set_dataelementvalue(1, "BLT");

5 osegment.set_dataelementvalue(2, "111"); 5 REF(3)")); REF(4)")); ////PHARMACY PRESCRIPTION NUMBER ////REF REFERNCE IDENTIFICATION // //osegment.set_dataelementvalue(1, "XZ"); //osegment.set_dataelementvalue(2, "222"); ////CLAIM ID NUMBER FOR CLEARINGHOUSE AND OTHER TRANSMISSION INTERMEDIARIES ////REF REFERNCE IDENTIFICATION // //osegment.set_dataelementvalue(1, "D9"); // //osegment.set_dataelementvalue(2, " "); // DTP")); Period //CLAIM LEVEL SERVICE DATE //DTP DATE OR TIME OR PERIOD osegment.set_dataelementvalue(1, 0, "472"); osegment.set_dataelementvalue(2, 0, "RD8"); osegment.set_dataelementvalue(3, 0, " "); //Date/Time //Date Time Period Format //Date Time //CLAIM RECEIVED DATE //DTP DATE OR TIME OR PERIOD edidatasegment.set(ref osegment, (edidatasegment)otransactionset. CreateDataSegment("HL\\TRN\\DTP(2)")); osegment.set_dataelementvalue(1, 0, "050"); //Date/Time osegment.set_dataelementvalue(2, 0, "D8"); //Date Time Period Format osegment.set_dataelementvalue(3, 0, " "); //Date Time Period (235) (234) \\SVC\\STC")); (98) //2220D SERVICE LINE INFORMATION while (nservicelinecounter <= nservicelines) //SVC Service Information osegment = otransactionset.createdatasegment("hl\\trn\\svc\\svc"); osegment.set_dataelementvalue(1, 1, "HC"); // Product/Service ID osegment.set_dataelementvalue(1, 2, "22305"); // Product/Service ID osegment.set_dataelementvalue(1, 3, ""); // Procedure Modifier (1339) osegment.set_dataelementvalue(1, 4, ""); // Procedure Modifier (1339) osegment.set_dataelementvalue(1, 5, ""); // Procedure Modifier (1339) osegment.set_dataelementvalue(1, 6, ""); // Procedure Modifier (1339) osegment.set_dataelementvalue(2, "350"); // Monetary Amount (782) osegment.set_dataelementvalue(4, ""); // Product/Service ID (234) osegment.set_dataelementvalue(7, "1"); // Quantity (380) //SERVICE LINE LEVEL STATUS INFO //STC Status Information edidatasegment.set(ref osegment, otransactionset.createdatasegment("hl\\trn osegment.set_dataelementvalue(1, 1, "A3"); // Industry Code (1271) osegment.set_dataelementvalue(1, 2, "122"); // Industry Code (1271) osegment.set_dataelementvalue(1, 3, "03"); // Entity Identifier Code osegment.set_dataelementvalue(1, 4, ""); // Entity Identifier Code (98) osegment.set_dataelementvalue(2, 0, " "); //Date

6 osegment.set_dataelementvalue(10, 1, "A3"); // Industry Code (1271) 6 (1271) Code (98) Code (98) (98) Code (98) \\SVC\\REF")); (128) (127) osegment.set_dataelementvalue(10, 2, "153"); osegment.set_dataelementvalue(10, 3, "82"); //osegment.set_dataelementvalue(10, 4, "RX"); // Industry Code // Entity Identifier // Entity Identifier osegment.set_dataelementvalue(11, 1, ""); // Industry Code (1271) osegment.set_dataelementvalue(11, 2, ""); // Industry Code (1271) osegment.set_dataelementvalue(11, 3, ""); // Entity Identifier Code //osegment.set_dataelementvalue(11, 4, "RX"); // Entity Identifier //SERVICE LINE ITEM ID //REF Reference Identification edidatasegment.set(ref osegment, otransactionset.createdatasegment("hl\\trn osegment.set_dataelementvalue(1, "FJ"); osegment.set_dataelementvalue(2, "11"); // Reference Identification // Reference Identification ////PHARMACY PRESCRIPTION NUMBER ////REF Reference Identification //edidatasegment.set(ref osegment, otransactionset.createdatasegment("hl\\ TRN\\SVC\\REF(2)")); //osegment.set_dataelementvalue(1, "XZ"); // Reference Identification (128) //osegment.set_dataelementvalue(2, "A1B2C3D4E5"); // Reference Identification (127) \\SVC\\DTP")); (374) (1250) (1251) //SERVICE LINE DATE //DTP Date or Time or Period edidatasegment.set(ref osegment, otransactionset.createdatasegment("hl\\trn osegment.set_dataelementvalue(1, "472"); osegment.set_dataelementvalue(2, "D8"); osegment.set_dataelementvalue(3, " "); // Date/Time // Date Time Period Format // Date Time Period nservicelinecounter = nservicelinecounter + 1; //nservicelinecounter = nservicelines nhlpatientcounter = nhlpatientcounter + 1; //nhlpatientcounter <= nhlpatients nhlserviceprovidercounter = nhlserviceprovidercounter + 1; //nhlserviceprovidercounter <= nhlserviceproviders nhlinforeceivercounter = nhlinforeceivercounter + 1; //nhlinforeceivercounter <= nhlinforeceivers nhlinfosourcecounter = nhlinfosourcecounter + 1; //nhlinfosourcecounter <= nhlinfosources //TRAILING SEGMENTS ARE AUTOMATICALLY CREATED WHEN FREDI COMMITS (SAVES) //THE EDIDOC OBJECT INTO AN EDI FILE. oedidoc.save(spath + sedifile); MessageBox.Show(oEdiDoc.GetEdiString(), "EDI X228");

7 //DESTROYS OBJECTS osegment.dispose(); otransactionset.dispose(); ogroup.dispose(); ointerchange.dispose(); oschema.dispose(); oschemas.dispose(); oedidoc.dispose(); 7

namespace csharp_gen277x214 { public partial class Form1 : Form { public Form1() { InitializeComponent(); }

$namespace csharp_gen277x214 { public partial class Form1 : Form { public Form1() { InitializeComponent(); }$ 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