275 transactions at Foresight - TIBCO Product Documentation

TIBCO Foresight Products Creating and Using 275 Transactions June 2013

Two-second advantage®

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Contents Introduction................................................................................................................... 2 Intended Audience ................................................................................................. 2 System Requirements and other Requirements .................................................... 2 How TIBCO Foresight Programs work with 275s .................................................. 2 Using Transaction Insight to prepare 275 Input Files .................................................. 3 System Setup for 275 Attachments Page .............................................................. 3 Customizing the 275 Configuration File ................................................................. 6 Transaction Insight Permissions for 275 Attachments Page ................................. 6 Using the 275 Attachments Page .......................................................................... 9 Generating 275s in Foresight Studio .........................................................................12 Generating 275s from the Command Line .................................................................15 Input and Output ..................................................................................................15 Gen275 Command Line .......................................................................................16 Appendix A: DDE File Details ....................................................................................18 Appendix B: Attachment Details.................................................................................19 Appendix C: 275 Details .............................................................................................21 Appendix D: 275 Attachments Portal Page Data Map ...............................................23

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Introduction Intended Audience This document is intended for TIBCO Foresight® EDISIM®, TIBCO Foresight® HIPAA Validator® Desktop, TIBCO Foresight® Instream®, TIBCO Foresight® Studio, and TIBCO Foresight®Transaction Insight® users and administrators who are working with 275 (Additional Information to Support a Health Care Claim or Encounter) transactions.

System Requirements and other Requirements Please see Gen275 in SystemRequirements.pdf.

How TIBCO Foresight Programs work with 275s Program

Capabilities

HIPAA Validator® Desktop

Validate

EDISIM®

Analyzer

Skips BIN02 when validating

Library Skips BIN02 when validating

Comparator Document Builder Standards Editor Test Data Generator Validator Instream®

Foresight™ Studio

Transaction Insight®

Skips BIN02 when validating

Validate

Skips BIN02 when validating

Response Generator

Responses to 275 include 997, 999, 824 (no 277 or custom reports)

Docsplitter

Any kind of splitting (at ST or 2000A)

Dataswapper

Any swapping that does not include the BIN02

Demo

V_DS_275_5010_Binary in Instream’s Scripts directory

Component

Generate275 component to create 275s from DDE file and ATTACH file

Workflow

Gen275 workflow

Demo

Workflow to generate 275s

Upload attachment and create corresponding DDE file (used as input to Instream’s Gen275 program) Import 275 statistics (not the EDI or attachments) See statistics for 275 in portal; No 275 form, raw EDI view, extended fields, or tasks Create DDE file and upload attachment to serve as input to Gen275 program that creates 275s (add-on feature – please consult with your TIBCO Foresight account executive)

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Using Transaction Insight to Prepare 275 Input Files Capabilities from within the Transaction Insight Portal: Import 275s

See statistics regarding imported 275s. You will not see the attachment, form views, or raw EDI data.

All Transaction Insight implementations

Create input file necessary for 275 creation

275 Attachments page lets you upload an attachment and create a corresponding DDE file.

Add-on function

Instream’s Gen275 Java program can then use them to create a 275 with attachment.

System Setup for 275 Attachments Page 1. See your account executive about a Transaction Insight license file for the 275 Attachments page. Although all Transaction Insight users can import 275 DTL files, you need a special license to also display the 275 Attachments page. 2. Copy the new license file to your Transaction Insight environment’s Bin directory.

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3. Edit the environment’s Web.config file and specify which directory is to receive the DDE files and the uploaded attachments:

275AttachmentFileMaximumSize

Default is 64MB, the X12N limit per BIN segment. Recommendation: do not exceed this limit.

275AttachmentFilesDirectory

This is a directory where Transaction Insight will place: 

The attachment – uploaded when a user clicks Upload Attachment from Transaction Insight’s 275 Attachments page.



The corresponding DDE file – created when a user clicks Save Attachment from Transaction Insight’s 275 Attachments page.

Set this to a directory that has ASP.NET read/write permission (see below). Example:

4. Create the directory for the 275 DDE file and attachments:

5. Check the directory’s ASP.NET permission: a.

Right-click on the directory and choose Sharing and Security (or equivalent on your system):

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b.

Under Security, look for ASP.NET and be sure that it has read/write/execute permissions.

c.

If ASP.NET is not in the list of names, add it. Type s er v ern a m e \ASPNET and click Check Names. If it becomes underlined, it is correct and you can add it and then select the necessary permissions:

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Customizing the 275 Configuration File 275settings.xml in the Transaction Insight environment’s TIWeb directory contains values that are always used when creating a DDE file. These values eventually end up in the 275s that you will be creating. The information on the 275 Attachments page plus the information in 275settings.xml are used together to create the DDE file. To customize: 1. Edit 275settings.xml with an XML tool or a text editor. 2. Change values to the ones you want to use in the 275s you will be creating. Do not include trailing spaces. Values will automatically be padded to meet minimum lengths. Only change tags that already have values. For example, the FileName tag is empty, so leave it empty. It will be filled automatically Keep proper XML structure with starting and ending tags, etc. 3. Save.

Transaction Insight Permissions for 275 Attachments Page 1. Log on to the Transaction Insight Portal as an administrator. 2. Under Roles, edit the Administrators role. 3. Be sure that 275 Attachments is selected.

4. If non-administrators will be creating 275s, either add that permission to their existing roles or create a new role especially for those who create 275s

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5. Under the Roles | Users tab, assign that role to users who will create 275s. Here are some permissions that affect the ability to upload and view 275s in Transaction Insight: Permission

Access Granted

Additional Abilities

Admin

All pages under the Admin label on the left menu

Control ability to restrict/permit 275 upload page access

Statistics

User can view all pages under the Statistics label on the main menu

Users having access to All Partners can view 275 summary data

Files

275 Upload Page – Upload attachment file and save attachment details to create 275 documents

Upload 275 documents

Search

The Documents page under the Search label on the main menu

Search for 275 documents

Example 1 – users who only upload 275s Permissions

Upload 275 Attachments

Partner Group

None

User gets this menu

When users click 275 Attachments, they are taken to the screen described on page 9.

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Example 2 – general purpose user with 275 upload Permissions

Partner Group

Statistics

Read

Tasks

Read

Files

Upload View 275 Attachment

Hillsdale

User gets this menu (can see only data for Hillsdale partner)

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Using the 275 Attachments Page Big steps in creating a 275 1. Use Transaction Insight Portal’s 275 Attachments page to upload an existing attachment to the web server machine. 2. Use the 275 Attachments page to create a corresponding DDE file. 3. Feed the attachment and DDE file into Use Instream’s Gen275 to create the 275. Using the 275 Attachments page 1. Log in to the portal with a username that has 275 permission (see page 6). 2. Choose 275 Attachments on the left menu.

3. At the top, click Browse and choose the attachment file.

4. Click Upload Attachment.

Look for the “Successfully uploaded file” message.

(A Remove This File link appears in case you upload the wrong file.)

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The upload copied the attachment to a temporary name and placed it in a directory on the server:

This directory was specified by 275AttachmentFilesDirectory in Web.config. 5.

Under 275 Attachment Details, type or select the information that describes this attachment. This will go into the DDE file and the 275 transaction that will be generated later (see Appendix D: 275 Attachments Portal Page Data Map on page 23). Some fields have drop-down lists so that you can make a selection:

For date fields, click the calendar icon and select the date:

For each user, the last values entered here are saved for that user’s future use. Example completed 275 page:

6. Click Save Attachment to create the DDE file in the same directory as the attachment. Look for the success message at the top:

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The 275 directory now has the two files needed to create 275s. The filenames match, except for file types. The attachment file now has a file type of Attach, although its contents are the same as the original file before it was uploaded.

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Generating 275s in Foresight Studio This section assumes familiarity with Foresight Studio. The easiest way to create 275s from your DDE files and Attach files is with Foresight Studio. Foresight Studio 7.6 and later has a Generate275 component under the Validator tab:

It has a Gen275 workflow under InStreamDemoSystem:

Setup Be sure that the necessary workflow global variable is set: 1. Open Studio and choose File | Edit Globals. 2. Check for FS_OSD_GEN275BAT. 3. If missing, add it, like this:

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Running the workflow 1. Copy the DDE file and Attach file from Foresight Studio’s DemoFiles directory into InStreamDemoSystem’s In directory.

2. From Studio, open the Gen275 workflow.

3. Click the Log toolbar button until it turns green.

4. Start the workflow.

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5. When all components have executed, look for the 275 here:

This workflow uses Gen275.bat in Instream’s Bin directory to execute the Java program Gen275 in Instream’s Java directory.

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Generating 275s from the Command Line Gen275 is a Java application that will generate a HIPAA-compliant X12-5010 275.

Input and Output Gen275 creates a 275 based on: 

An XML configuration file called the DDE file



A file containing the attachment for the BIN02 Attachment Uploaded with TI 275 Attachments page

Gen275 program

DDE file Created with TI 275 Attachments page

5010 275 EDI with BIN02

Attachment

A file containing the attachment to go into the BIN02 – for example, an Xray or other binary data. Typically, this was uploaded and renamed from Transaction Insight’s 275 Attachments page. See page 9.

DDE file

An XML, IT 275 Data Entry session file. This configuration file contains data for the 275 elements. This was created from user input on Transaction Insight’s 275 Attachments page. See page 9.

Gen275

A java program distributed with Instream:

See page 16. 275

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File containing one ISA with one embedded X12 5010 275 attachment. See page 21.

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Gen275 Command Line To run Gen275 from the command line, you must have Java 1.6 or newer installed on your machine. The format is: java -jar "path \Gen275.jar" -a"attachFile " -d"DDEfile " -e"OutputEDI " Where:

path

Path to Gen275.jar:

attachF ile

Path and filename to a file containing the attachment that is to go into the 275’s BIN02 segment. This file was typically uploaded to Transaction Insight from the 275 Attachments page (see Using Transaction Insight to Prepare 275 on page 3). If you upload this file with Transaction Insight’s 275 Attachments page, this file will have a unique name and file type Attach. It has the same contents as the original file. For an example, see Instream’s DemoData\Gen275 directory. For more information about attachment files, see page 19.

DDEfile

Path and filename to an XML DDE file containing the data that is to go into the other elements in the 275. Gen275 uses these values to populate the 275. This information comes from: 

User-entered on Transaction Insight Portal’s 275 Attachment page (see Using Transaction Insight to Prepare 275 on page 3)



Hard-coded entries in 275Settings.xml, in the Transaction Insight environment’s TIWeb directory.

If you create the DDE file from Transaction Insight’s 275 Attachments page, this file will have the same name as the attachments file after uploading, and will have file type is DDE. The Foresight Studio component relies on the filenames being the same, with Attach and DDE as the file types. For an example, see Instream’s DemoData\Gen275 directory. For more information about DDE files, see page 18. 275 Transactions at Foresight

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OutputEDI

Path and filename for the output 275 that is to be created by Gen275. In a Foresight Studio workflow, this will have the same filename as the input EDI and Attach files and will have file type EDI. For a command line example, run the Generate275 script in Instream’s scripts directory and then look in Instream’s Output directory.

Example This example takes an attachment file and DDE file created from Transaction Insight and creates a 275 called 275_file1.edi. java -jar "C:\Foresight\InStream\java\Gen275.jar" -a"C:\Foresight\InStream\ DemoData\Gen275\file1.Attach" -d"C:\Foresight\InStream\ DemoData\Gen275\ file1.DDE" -e"C:\ Foresight\InStream\Output\275_file1.edi"

The filenames have been simplified in this example. In reality, Transaction Insightcreated ATTACH and DDE files have much longer names: 59e3faed-7fa7-4776-af47bba0f40a4d52.ATTACH, for example.

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Appendix A: DDE File Details These files supply the values for the elements in the 275 that is created by Gen275: 

A user-created DDE file (usually created with TI’s 275 Attachments page)



A TIBCO Foresight-supplied file called 275Settings.xml, in the environment’s TIWeb directory.

Note the comments that show which element will get the value: KAVER866004791

A couple of non-EDI values are included in the BIN element: Element

Contents

Example

FileName

Name of the attachment file (after uploading if using Transaction Insight to create the DDE file)

46c174d1-8e7f-49fc-b294faf9c3a1f858. Attach

OriginalFileName

Original name of the attachment file (before uploading if using Transaction Insight to create the DDE file)

XRAY20090628WILSONR.jpg

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Appendix B: Attachment Details Considerations concerning the attachment file: 

The attachment file contains binary information that goes in the 275’s BIN02 element. It will be wrapped in other information as described in Appendix C: 275 Details on page 21.



If you are running Gen275 from the command line, you can use any filenames and types.



If you upload it from the Transaction Insight 275 Attachments page, it will be assigned a unique filename and type Attach.



If you are using the Gen275 component in Foresight Studio, the attachment filename must match that of the DDE file and the type must be Attach. The component’s trigger requires this.



The original filename, before uploading from the Transaction Insight 275 Attachments page, is shown in the BIN02. In this example: 

name shows the name once it is uploaded.



Content_ID shows the name before it was uploaded. Notice that you can determine the original file type here. This could be useful in interpreting the binary information.

------=_Part_0_19621457.1247074089561 Content-Type: application/octet-stream; name=59e3faed-7fa7-4776-af47-bba0f40a4d52.Attach Content-Transfer-Encoding: base64 Content-Disposition: attachment; filename=59e3faed-7fa7-4776-af47-bba0f40a4d52.Attach Content-ID: back.gif

(filename is not currently used. It is a placeholder for future use.) Example Look at the Attach file in Instream’s DemoData\Gen275 directory. Viewed as a graphic, it looks like this:

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It is actually binary information that will go into a BIN02 element:

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Appendix C: 275 Details This appendix describes the X12 5010 275 created by Instream’s Gen275 program. Gen275 uses an attachment file and a DDE file to create a file containing one 275 transaction that has one attachment in the BIN02. The DDE file is most easily created with a Transaction Insight add-on that provides a 275 Attachments page. The 275 contains the EDI X12 segments with the attachment in the BIN02: 

The EDI portion of the 275 conforms to TIBCO Foresight’s PDSX5010275X210 guideline.



The BIN02 element consists of a MIME-multipart message. This MIME-multipart message contains an XML header that conforms to the “HL7 Additional Information Specification Implementation Guide July 2007 post-ballot draft” and the "Additional Information Specification 0009: Patient Information – Unspecified Content Attachment, Release 1.0, and March 2008.” Because of the MIME encoding, the BIN02 will not be human-readable and Instream will be unable to validate it.

Example 275 ISA*00* *00* *ZZ*_TI_ *ZZ*HORIZONE GS*PI*_TI_*HORIZONE*20090508*142742*0*X*005010X210~ ST*275*0000*005010X210~ BGN*00**20090508*142742~ Length of BIN02 in bytes. During validation, Instream skips this number of byes and then resumes validating

…

. . .

etc. . . .

EFI*05~ BIN*34556*Message-ID: MIME-Version: 1.0 Content-Type: multipart/related; boundary="----=_Part_0_23163273.1241807262092"

------=_Part_0_23163273.1241807262092 Content-Type: text/xml; charset=iso-8859-1 Start of CDA document that Content-Transfer-Encoding: 7bit describes the attachment

Patient Information Unspecified Content

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End of CDA document

_TI_ _TI_ ------=_Part_0_23163273.1241807262092 Content-Type: image/jpeg; name=XRAY.jpg Content-Transfer-Encoding: base64 Content-Disposition: attachment; filename=XRAY.jpg Content-ID: XRAY.jpg 0lGOlhFAAPAPcAAAAAAAAAMwAAZgAAmQAAzAAA/wAzAAAzMwAzZgAzmQAzzAAz/wBmAABmMwB mbvZgBmmQBmzABm/wCZAACZMwCZZgCZmQCZzACZ/wDMAADMMwDMZgDMmQDMzADM/wD/AAD/Mw

Attachment

End of BIN02

... data removed for clarity's sake... AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAACH5BAEAANgALAAAAAAUA AAhFALEJHEiwoMGDAA4qHAgg4UKEIxw+JAhgRMSJFC1GbMiRo8GKGkOGlCgQpMiTJEueRAnRY CkGmxFhxJk2bNDHqNBgQADs= ------=_Part_0_23163273.1241807262092-~ SE*20*0000~ GE*1*0~ IEA*1*000000666

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Appendix D: 275 Attachments Portal Page Data Map Field on 275 attachments page

275 EDI file produced by 275Gen

Attachment Information Format Code

2100B CAT02

Claim Service Period End Date

Does not directly map to an EDI element, used to determine the values in 1000D DTP02

Claim Service Period Start Date

1000D DTP03

Medical Record Identification Number

1000D REF02 (REF01=EA)

Patient Control Number

1000D REF02 (REF01=EJ)

Patient First Name

1000D NM104

Patient Last Name

1000D NM103

Patient Primary Identifier

1000D NM109

Payer Claim Control Number or

TRN02

Provider Attachment Control Number Provider Address

1100C N301

Provider City

1000C N401

Provider First Name

1000C NM104

Provider Identifier Type

It does not directly map to an EDI element, it is used to determine the values in the 1000C NM108, NM109, REF01, and REF02

Provider Identifier/Provider Secondary Identifier 1000C NM109/1000C REF02 Provider Last or Organization Name

1000C NM103

Provider State

1100C N402

Submitter Last or Organization Name

1000B NM103

Transaction Set Purpose Code

BGN01

Zip Code

1000C N403

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