This blog post describes the conversion of HIPAA transactions to CSV files and vice versa.

HIPAA has defined 12 transactions, ranging from healthcare claim, payment and remittance advice, healthcare enrollment, and eligibility, etc. Because of the complexity of the HIPAA transactions in both syntax and semantics, healthcare professionals found it is difficult to integrate the HIPAA transactions to their existing applications. Some of the difficulties are:

• Healthcare claim (837) is using the HL (hierarchical level) segment to represent different loop level of the claim data.
• Some of the related claim data are split into multiple segments, e.g., single billing provider is split into seven segments.
• Use the code qualifier extensively.
• Use four different separators to formulate the data.

Because of the above, users came to us and asked if it was possible to have a simple format that can represent HIPAA data. We have then since created an RMap (Redix Maps for HIPAA) module. This module defines the HIPAA transaction in a CSV (comma separated value) format and yet carries 100% of the HIPAA compliance. This format encapsulate HIPAA data into a more concise and readable format. It is easier to understand and program because of the fewer number of records and fields. As a result, the RMap module is being used by many healthcare entities as their repository for storing their healthcare data.

Redix RMap Module

The following table compares the Redix RMap format with the HIPAA format.

Click here to find out more about the RMaps. You can use this link to review the RMap definitions.

Pre-Defined Maps

The Redix RMap module contains pre-defined maps for all of 12 HIPAA transactions.

The maps are divided into two categories: HIPAA to RMAP for users that receive HIPAA files, and RMAP to HIPAA for users that submit HIPAA files.

HIPAA to RMAP (Inbound Process):

RMAP to HIPAA (Outbound Process):

Example

You can test the conversion using this link. Below is an example of the RMap 837 Professional and its corresponding 837 file.

RMap 837 Professional (use “*” as a separator):

RMP*RMap_5_837P*20120925*0629*HIPAA_5010_837_Prof_to_RMap_5.map
IGM*00**00**ZZ*123456789012345*ZZ*123456789012345*030101*1253**00501*987654321*1*T*:*HC*123456789012345*123456789012345*19991231*0802*123456789*837*2021*1*987654321*1*123456789*52*2021**^*005010X222A1*005010X222A1
TR1*PREMIER BILLING SERVICE**************TGJ23*XYZ REPRICER*66783JJT*00*0123*20051015*1023*CH*JERRY*TE*3055552222*************2
PR0****KILDARE*BEN****1234567893*1234 SEAWAY ST**MIAMI*FL*33111***EI*123456789*****************************************2345 OCEAN BLVD**MIAMI*FL*33111************CONNIE*TE*3055551234*************2**************1
SB0*P******CI*19430501****SMITH*JANE***MI*111223333*******F**********KEY INSURANCE COMPANY*PI*999996666*3333OCEAN ST**SOUTH MIAMI*FL*33000***************PBS3334**1
PT0*19****SMITH*TED***236 N MAIN ST**MIAMI*FL*33413**19730501*M
CL0*26407789*79.04*11*1*Y*A*Y*I*P*********4779*2724*2780*53081****************************************************BK*BF*BF*BF
PR3*******************KILDARE*BEN****1234567893*204C00000X*G2*KA6663**************************************1
PR4**KILDARE ASSOCIATES***1234567893*2345 OCEAN BLVD**MIAMI*FL*33111
OS0*S*01****CI**Y*P*Y*SMITH*JACK***MI*T55TY666*236 N MAIN ST**MIAMI*FL*33111*********KEY INSURANCE COMPANY*PI*999996666*************************************1
LX0*HC*99213*****43*UN*1**1*2*3*4*************************20051003
LX1****************************************
LX0*HC*90782*****15*UN*1**1*2***************************20051003
LX1****************************************
LX0*HC*J3301*****21.04*UN*1**1*2***************************20051003
LX1****************************************
EOF

HIPAA 837 Professional:

ISA*00*          *00*          *ZZ*123456789012345*ZZ*123456789012345*030101*1253*?*00501*987654321*1*T*
GS*HC*123456789012345*123456789012345*19991231*0802*123456789*X*005010X222A1
ST*837*2021*005010X222A1
BHT*0019*00*0123*20051015*1023*CH
NM1*41*2*PREMIER BILLING SERVICE*****46*TGJ23
PER*IC*JERRY*TE*3055552222
NM1*40*2*XYZ REPRICER*****46*66783JJT
HL*1**20*1
NM1*85*1*KILDARE*BEN****XX*1234567893
N3*1234 SEAWAY ST
N4*MIAMI*FL*33111
REF*EI*123456789
PER*IC*CONNIE*TE*3055551234
NM1*87*2
N3*2345 OCEAN BLVD
N4*MIAMI*FL*33111
HL*2*1*22*1
SBR*P********CI
NM1*IL*1*SMITH*JANE****MI*111223333
DMG*D8*19430501*F
NM1*PR*2*KEY INSURANCE COMPANY*****PI*999996666
N3*3333OCEAN ST
N4*SOUTH MIAMI*FL*33000
REF*G2*PBS3334
HL*3*2*23*0
PAT*19
NM1*QC*1*SMITH*TED
N3*236 N MAIN ST
N4*MIAMI*FL*33413
DMG*D8*19730501*M
CLM*26407789*79.04***11:B:1*Y*A*Y*I*P
HI*BK:4779*BF:2724*BF:2780*BF:53081
NM1*82*1*KILDARE*BEN****XX*1234567893
PRV*PE*PXC*204C00000X
REF*G2*KA6663
NM1*77*2*KILDARE ASSOCIATES*****XX*1234567893
N3*2345 OCEAN BLVD
N4*MIAMI*FL*33111
SBR*S*01*******CI
OI***Y*P**Y
NM1*IL*1*SMITH*JACK****MI*T55TY666
N3*236 N MAIN ST
N4*MIAMI*FL*33111
NM1*PR*2*KEY INSURANCE COMPANY*****PI*999996666
LX*1
SV1*HC:99213*43*UN*1***1:2:3:4
DTP*472*D8*20051003
LX*2
SV1*HC:90782*15*UN*1***1:2
DTP*472*D8*20051003
LX*3
SV1*HC:J3301*21.04*UN*1***1:2
DTP*472*D8*20051003
SE*52*2021
GE*1*123456789
IEA*1*987654321

About Us

Redix International, Inc. is an enterprise software company. Redix develops software and provides services to help organizations convert their proprietary or organization-specific data to standardized data. Among the standardized formats supported are X12, EDIFACT, XML, NSF, UB92, HIPAA, HL7, CDA, Blue-Ribbon, FHIR, NCPDP, and PDF.

Redix International, Inc. recently published a new website https://www.redixhipaa.com. This blog post describes the purpose and features of this new site.

Redix has been providing software to support HIPAA compliances and conversions for almost two decades. More than 200+ pre-defined HIPAA maps have been developed. These pre-defined maps allow users to easily integrate the HIPAA compliance and conversions into the users’ applications.

This new site provides a web-based interface to help users test the pre-defined maps. The interfaces are categorized into four sections:

• HIPAA Compliance
  • HIPAA validation and compliance reporting for WEDI SNIP Types 1 through 5.
    • Type 1 EDI Standard Integrity Testing
    • Type 2 HIPAA Implementation Guide Requirement Testing
    • Type 3 HIPAA Balance Testing
    • Type 4 HIPAA Inter-Segment Situation Testing
    • Type 5 HIPAA External Code Set Testing
  • Supports compliance to 11 HIPAA transactions: 270, 271, 276, 277, 278 request, 278 response, 834, 835, 837 professional, 837 institutional, and 837 dental.
• HIPAA Conversions
  • HIPAA conversions to PDF
    • 837 professional to CMS 1500
    • 837 institutional to CMS UB04
    • 837 dental to ADA J400
    • 835 to Medicare National Standard Intermediary Remittance Advice
  • HIPAA conversions to CSV
    • Convert HIPAA transaction to CSV
    • Supports 11 HIPAA transactions
    • Definition of the CSV (or Redix RMap) can be found here: https://www.redixhipaa.com/supplements/rmap5/HTML/index.html
  • CSV conversions to HIPAA
    • Convert CSV to HIPAA transaction
    • Supports 11 HIPAA transactions
    • Definition of the CSV (or Redix RMap) can be found here: https://www.redixhipaa.com/supplements/rmap5/HTML/index.html
  • HIPAA conversions to XML
    • Convert HIPAA transaction to XML
    • Supports 11 HIPAA transactions
  • XML conversions to HIPAA
    • Convert XML to HIPAA transaction
    • Supports 11 HIPAA transactions
  • NCPDP Conversions
    • NCPDP conversions to CSV
      • Convert NCPDP D.0 transaction to CSV
      • Supports all D.0 transactions defined in NCPDP
      • Definition of the CSV (or Redix RMap) can be found here: https://www.redixhipaa.com/supplements/ncpdp_d0/HTML/index.html
    • CSV conversions to HIPAA
      • Convert CSV to NCPDP D.0 transaction
      • Supports all D.0 transactions defined in NCPDP
      • Definition of the CSV (or Redix RMap) can be found here: https://www.redixhipaa.com/supplements/ncpdp_d0/HTML/index.html
    • HL7 Conversions
      • HL7 2.x conversions to FHIR
        • Convert HL7 2.x conversions to FHIR STU3
        • Following HL7 2.x messages are supported: ADT, ORU, MFN, PPP, SIU, and VXU.
      • C-CDA conversions to FHIR
        • Convert C-CDA to FHIR STU3

How to Test

The user can simply follow these steps:

1. Go to the Redix HIPAA Compliance &Conversion Demo site: https://www.redixhipaa.com.
2. Select a conversion type using the drop-down menus.
3. Choose a file from your system. The file will be automatically uploaded, and then validated and converted. The outputs will be sent back to you.
4. The output could be a single file or a zip file that contains multiple outputs.
5. If the validation fails during the conversion process, an error message will be returned.

Since this is a demo site, you should follow these guidelines when submitting your file:

• The file size must be less than 10 KB.
• Do not use the real data.
• The uploaded file will be automatically deleted 15 minutes after the file is submitted.

Redix HIPAA Products

Redix provides a suite of solutions to help enterprises exchange healthcare transactions electronically. These products include:

• AnyToAny Format Converter Engine
• HL7 Module
• NCPDP Module
• RMap Module
• PDF Module

All of the pre-defined maps are built using the Redix AnyToAny Format Converter Engine and some of the modules.

Consultation Services

If our pre-defined maps do not meet your needs, you can contact us and we can help you to build customized maps.

Privacy Policy

Please refer to the Redix privacy policy before you use the site: https://www.redixhipaa.com/privacy

About Us

Redix International, Inc. is an enterprise software company. Redix develops software and provides services to help organizations convert their proprietary or organization-specific data to standardized data. Among the standardized formats supported are X12, EDIFACT, XML, NSF, UB92, HIPAA, HL7, CDA, Blue-Ribbon, FHIR, NCPDP, and PDF.