stupidedi 1.1.0

data/spec/fixtures/X222-HC837/11-bad.txt

@@ -0,0 +1,69 @@
+Example 11 - PPO Repriced Claim
+
+Repriced claim being transmitted from a regional PPO to a commercial health insurance company. The patient is the subscriber. In this situation, the provider has sent the claim to a clearinghouse, which then forwarded the claim to the repricer. The claim has been repriced and is forwarded to the appropriate payer for payment.
+
+Errors Found in File 837P 5010X222-11
+* W10009:Padding, spaces or control characters detected after segment terminator.
+* H10203:Functional Group ID 'XX' mismatch - Transaction Set is type 'HC'
+* H11204:Code Value 'XX' not used for element 'GS01'
+* H24402:The value '1234567890' fails the check digit algorithm for the "HIPAA National Provider ID (NPI)"
+* H20205:Incomplete loop (2010BB). Missing HIPAA-required N4 (Payer City, State, ZIP Code).
+* H20205:Incomplete loop (2300). Missing HIPAA-required HI (Health Care Diagnosis Code).
+* H10602:Assuming Sub-Element Delimiter is > rather than : in CLM05
+* W22004:Your data contains character(s) from the extended character set which may only be used by agreement between communicating parties.
+* W24411:The Claim Pricing/Repricing Information is to be completed by repricers only.
+* H10602:Assuming Sub-Element Delimiter is > rather than : in HI01
+* H20204:Code Value 'BK' at element 'HI0101' is valid in the X12 standard, but not in this HIPAA implementation
+* H10602:Assuming Sub-Element Delimiter is > rather than : in HI02
+* H20204:Code Value 'BF' at element 'HI0201' is valid in the X12 standard, but not in this HIPAA implementation
+* W24411:The Claim Pricing/Repricing Information is to be completed by repricers only.
+* W40362:The 'Referring Provider Name' without 'Prior Authorization or Referral Number' is allowed, but should notbe used unless necessary.
+* H20617:The value '9988776655' does not match the format for a "HIPAA National Provider ID (NPI)"
+* B40146:'Durable Medical Equipment Service' (SV5) is generally required for the procedure described in SV1-01.
+* H10602:Assuming Sub-Element Delimiter is > rather than : in SV101
+* H10602:Assuming Sub-Element Delimiter is > rather than : in SV107
+* W24411:The Claim Pricing/Repricing Information is to be completed by repricers only.
+* H10602:Assuming Sub-Element Delimiter is > rather than : in SV101
+* W24411:The Claim Pricing/Repricing Information is to be completed by repricers only.
+
+ISA*00*..........*01*SECRET....*ZZ*SUBMITTERS.ID..*ZZ*RECEIVERS.ID...*030101*1253*^*00501*000000905*1*T*:~
+GS*XX*SENDER CODE*RECEIVER CODE*19991231*0802*1*X*005010X222~
+ST*837*1002*005010X222~
+BHT*0019*00*1002*20050620*09460000*CH~
+NM1*41*2*REGIONAL PPO NETWORK*****46*123456789~
+PER*IC*SUBMITTER CONTACT INFO*TE*8001231234~
+NM1*40*2*EXTRA HEALTHY INSURANCE*****46*112244~
+HL*1**20*1~
+NM1*85*2*HAPPY DOCTORS GROUP PRACTICE*****XX*1234567890~
+N3*P O BOX 123~
+N4*FORT WAYNE*IN*462540000~
+REF*EI*555512345~
+PER*IC*SUE BILLINGSWORTH*TE*8881231234~
+HL*2*1*22*0~
+SBR*P*18*123XYZ******CI~
+NM1*IL*1*RING*DIAMOND*D***MI*00124A089~
+N3*123 EXAMPLE DRIVE~
+N4*INDIANAPOLIS*IN*462290000~
+DMG*D8*19401229*F~
+NM1*PR*2*EXTRA HEALTHY INSURANCE*****PI*12345~
+CLM*ABC123-RI*28.75***11>B>1*Y*A*Y*Y*P~
+REF*9A*0902352342~
+REF*D9*061505501749388~
+HI*BK>496*BF>25000~
+HCP*03*26.75*2*908231234~
+NM1*DN*1*DOE*JOHN****XX*9988776655~
+NM1*82*1*ANTHONY*SUSAN*B***XX*1122334455~
+NM1*77*2*HAPPY DOCTORS GROUP~
+N3*123 FEEL GOOD ROAD~
+N4*WASHINGTON*IN*475010000~
+LX*1~
+SV1*HC>E0570>RR*25*UN*1***1>2~
+DTP*472*D8*20050514~
+HCP*03*23.75*1.25*908231234~
+LX*2~
+SV1*HC>A7003>NU*3.75*UN*1***1~
+DTP*472*D8*20050514~
+HCP*03*3*.75*908231234~
+SE*37*1002~
+GE*1*1~
+IEA*1*000000905~

data/spec/fixtures/X222-HC837/11-good.txt

@@ -0,0 +1,45 @@
+Example 11 - PPO Repriced Claim
+
+Repriced claim being transmitted from a regional PPO to a commercial health insurance company. The patient is the subscriber. In this situation, the provider has sent the claim to a clearinghouse, which then forwarded the claim to the repricer. The claim has been repriced and is forwarded to the appropriate payer for payment.
+
+ISA*00*..........*01*SECRET....*ZZ*SUBMITTERS.ID..*ZZ*RECEIVERS.ID...*030101*1253*^*00501*000000905*1*T*:~
+GS*HC*SENDER CODE*RECEIVER CODE*19991231*0802*1*X*005010X222~
+ST*837*1002*005010X222~
+BHT*0019*00*1002*20050620*09460000*CH~
+NM1*41*2*REGIONAL PPO NETWORK*****46*123456789~
+PER*IC*SUBMITTER CONTACT INFO*TE*8001231234~
+NM1*40*2*EXTRA HEALTHY INSURANCE*****46*112244~
+HL*1**20*1~
+NM1*85*2*HAPPY DOCTORS GROUP PRACTICE*****XX*1232343560~
+N3*P O BOX 123~
+N4*FORT WAYNE*IN*462540000~
+REF*EI*555512345~
+PER*IC*SUE BILLINGSWORTH*TE*8881231234~
+HL*2*1*22*0~
+SBR*P*18*123XYZ******CI~
+NM1*IL*1*RING*DIAMOND*D***MI*00124A089~
+N3*123 EXAMPLE DRIVE~
+N4*INDIANAPOLIS*IN*462290000~
+DMG*D8*19401229*F~
+NM1*PR*2*EXTRA HEALTHY INSURANCE*****PI*12345~
+N4*BOSTON*MA*02108~
+CLM*ABC123-RI*28.75***11:B:1*Y*A*Y*Y*P~
+REF*9A*0902352342~
+REF*D9*061505501749388~
+REF*9F*123AA7~
+HI*BK:496*BF:25000~
+HCP*03*26.75*2*908231234~
+NM1*DN*1*DOE*JOHN****XX*1988776658~
+NM1*82*1*ANTHONY*SUSAN*B***XX*1122334455~
+LX*1~
+SV1*HC:E0570:RR*25*UN*1***1:2~
+SV5*HC:E0570*DA*2*85*160*4~
+DTP*472*D8*20050514~
+HCP*03*23.75*1.25*908231234~
+LX*2~
+SV1*HC:A7003:NU*3.75*UN*1***1~
+DTP*472*D8*20050514~
+HCP*03*3*.75*908231234~
+SE*37*1002~
+GE*1*1~
+IEA*1*000000905~

data/spec/fixtures/X222-HC837/12-bad.txt

@@ -0,0 +1,73 @@
+Example 12 - Out of Network Repriced Claim 
+
+The patient is a not the subscriber. The provider has sent the claim to a clearinghouse, which then forwarded the claim to the repricer; the claim has been determined to be out of network and is now being forwarded to the appropriate payer for payment.
+
+Errors Found in File 5010X222-12
+* W10009:Padding, spaces or control characters detected after segment terminator.
+* H10203:Functional Group ID 'XX' mismatch - Transaction Set is type 'HC'
+* H11204:Code Value 'XX' not used for element 'GS01'
+* B51124:This Zip Code is not valid for this State.
+* H50010:Invalid ZIP Code ('919910000'), not in USPS tables.
+* B51124:This Zip Code is not valid for this State.
+* H50010:Invalid ZIP Code ('919910000'), not in USPS tables.
+* H20205:Incomplete loop (2010BB). Missing HIPAA-required N4 (Payer City, State, ZIP Code).
+* B51124:This Zip Code is not valid for this State.
+* H50010:Invalid ZIP Code ('919910000'), not in USPS tables.
+* H20205:Incomplete loop (2300). Missing HIPAA-required HI (Health Care Diagnosis Code).
+* H10602:Assuming Sub-Element Delimiter is > rather than : in CLM05
+* W22004:Your data contains character(s) from the extended character set which may only be used by agreement between communicating parties.
+* W24411:The Claim Pricing/Repricing Information is to be completed by repricers only.
+* H10602:Assuming Sub-Element Delimiter is > rather than : in HI01
+* H20204:Code Value 'BK' at element 'HI0101' is valid in the X12 standard, but not in this HIPAA implementation
+* W24411:The Claim Pricing/Repricing Information is to be completed by repricers only.
+* H24402:The value '1112223336' fails the check digit algorithm for the "HIPAA National Provider ID (NPI)"
+* H10023:Unexpected segment (DMG)
+* B51124:This Zip Code is not valid for this State.
+* H50010:Invalid ZIP Code ('919910000'), not in USPS tables.
+* H20205:Incomplete loop (2330B). Missing HIPAA-required N4 (Other Payer City, State, ZIP Code).
+* H10602:Assuming Sub-Element Delimiter is > rather than : in SV101
+
+ISA*00*..........*01*SECRET....*ZZ*SUBMITTERS.ID..*ZZ*RECEIVERS.ID...*030101*1253*^*00501*000000905*1*T*:~
+GS*XX*SENDER CODE*RECEIVER CODE*19991231*0802*1*X*005010X222~
+ST*837*1024*005010X222~
+BHT*0019*00*1024*20050711*1335*CH~
+NM1*41*2*REGIONAL PPO NETWORK*****46*123456789~
+PER*IC*SUBMITTER CONTACT INFO*TE*8001231234~
+NM1*40*2*CONSERVATIVE INSURANCE*****46*000110002~
+HL*1**20*1~
+NM1*85*2*EMERGENCY PHYSICIANS GROUP*****XX*1122334455~
+N3*7423 SUPER STREET~
+N4*BILLINGS*MO*919910000~
+REF*EI*111002222~
+HL*2*1*22*1~
+SBR*P**232AA******CI~
+NM1*IL*1*SMITH*MATTHEW*R***MI*57976235C~
+N3*5698 SOUTH STREET~
+N4*BILLINGS*MO*919910000~
+DMG*D8*19561015*M~
+NM1*PR*2*CONSERVATIVE INSURANCE*****PI*00123~
+HL*3*2*23*0~
+PAT*19~
+NM1*QC*1*SMITH*TOM*E~
+N3*5698 SOUTH STREET~
+N4*BILLINGS*MO*919910000~
+DMG*D8*19960807*M~
+CLM*TS234H3*252.71***23>B>1*Y*A*Y*Y*P~
+REF*9A*0902345406~
+REF*D9*687534234346~
+HI*BK>9951~
+HCP*00*0**333001234*********T1~
+NM1*82*1*BLUE*JACKIE*D***XX*1112223336~
+SBR*S*18*56567******CI~
+DMG*D8*19960807*M~
+OI***Y***Y~
+NM1*IL*1*SMITH*TOM*E***MI*23424570~
+N3*5698 SOUTH STREET~
+N4*BILLINGS*MO*919910000~
+NM1*PR*2*SECONDARY INSURANCE COMPANY*****PI*95645~
+LX*1~
+SV1*HC>99284*252.71*UN*1***1~
+DTP*472*D8*20050506~
+SE*40*1024~
+GE*1*1~
+IEA*1*000000905~

data/spec/fixtures/X222-HC837/12-good.txt

@@ -0,0 +1,51 @@
+Example 12 - Out of Network Repriced Claim 
+
+The patient is a not the subscriber. The provider has sent the claim to a clearinghouse, which then forwarded the claim to the repricer; the claim has been determined to be out of network and is now being forwarded to the appropriate payer for payment.
+
+ISA*00*..........*01*SECRET....*ZZ*SUBMITTERS.ID..*ZZ*RECEIVERS.ID...*030101*1253*^*00501*000000905*1*T*:~
+GS*HC*SENDER CODE*RECEIVER CODE*19991231*0802*1*X*005010X222~
+ST*837*1024*005010X222~
+BHT*0019*00*1024*20050711*1335*CH~
+NM1*41*2*REGIONAL PPO NETWORK*****46*123456789~
+PER*IC*SUBMITTER CONTACT INFO*TE*8001231234~
+NM1*40*2*CONSERVATIVE INSURANCE*****46*000110002~
+HL*1**20*1~
+NM1*85*2*EMERGENCY PHYSICIANS GROUP*****XX*1122334455~
+N3*7423 SUPER STREET~
+N4*BILLINGS*MT*591017423~
+REF*EI*111002222~
+HL*2*1*22*1~
+SBR*P**232AA******CI~
+NM1*IL*1*SMITH*MATTHEW*R***MI*57976235C~
+N3*5698 SOUTH STREET~
+N4*BILLINGS*MT*59102~
+DMG*D8*19561015*M~
+NM1*PR*2*CONSERVATIVE INSURANCE*****PI*00123~
+N3*257 OAK STREET~
+N4*BOSTON*MA*02108~
+HL*3*2*23*0~
+PAT*19~
+NM1*QC*1*SMITH*TOM*E~
+N3*5698 SOUTH STREET~
+N4*BILLINGS*MT*59102~
+DMG*D8*19960807*M~
+CLM*TS234H3*252.71***23:B:1*Y*A*Y*Y*P~
+REF*9A*0902345406~
+REF*D9*687534234346~
+HI*BK:9951~
+HCP*00*0**333001234*********T1~
+NM1*82*1*BLUE*JACKIE*D***XX*1232343560~
+SBR*S*18*56567******CI~
+OI***Y***Y~
+NM1*IL*1*SMITH*TOM*E***MI*23424570~
+N3*5698 SOUTH STREET~
+N4*BILLINGS*MT*59101~
+NM1*PR*2*SECONDARY INSURANCE COMPANY*****PI*95645~
+N3*PO BOX 853~
+N4*BOISE*ID*83702~
+LX*1~
+SV1*HC:99284*252.71*UN*1***1~
+DTP*472*D8*20050506~
+SE*43*1024~
+GE*1*1~
+IEA*1*000000905~

data/spec/fixtures/X222-HC837/13-bad.txt

@@ -0,0 +1,64 @@
+Property and Casualty: Automobile Accident
+
+The patient is not the subscriber.The bill is sent directly from the provider to the payer. � The date of accident/occurrence/onset of symptoms (Date of Loss) is a critical piece of information and is used to determine the eligibility of coverage. Without a date of loss on the bill, the bill will be incomplete and may be rejected. In this case-the property and casualty claim number is known and sent in the patient loop.
+
+Errors Found in File 837P 5010X222-13
+* W10009:Padding, spaces or control characters detected after segment terminator.
+* H10203:Functional Group ID 'XX' mismatch - Transaction Set is type 'HC'
+* H11204:Code Value 'XX' not used for element 'GS01'
+* H24402:The value '1253695747' fails the check digit algorithm for the "HIPAA National Provider ID (NPI)"
+* B51124:This Zip Code is not valid for this State.
+* H25377:The 'Billing Provider Postal Zone or ZIP Code' must be the nine digit Zip code.
+* H50010:Invalid ZIP Code ('99997'), not in USPS tables.
+* H20205:Incomplete loop (2010BA). Missing HIPAA-required N4 (Subscriber City, State, ZIP Code).
+* H20205:Incomplete loop (2010BB). Missing HIPAA-required N4 (Payer City, State, ZIP Code).
+* B51124:This Zip Code is not valid for this State.
+* H51086:ICD9 Code '8540' is not valid, must be coded to the highest number of digits possible (4th or 5th digit).
+* H24402:The value '2366552595' fails the check digit algorithm for the "HIPAA National Provider ID (NPI)"
+* H24402:The value '1235767887' fails the check digit algorithm for the "HIPAA National Provider ID (NPI)"
+* B51124:This Zip Code is not valid for this State.
+* H25377:The 'Laboratory or Facility Postal Zone or ZIP Code' must be the nine digit Zip code.
+
+ISA*00*..........*01*SECRET....*ZZ*SUBMITTERS.ID..*ZZ*RECEIVERS.ID...*030101*1253*^*00501*000000905*1*T*:~
+GS*XX*SENDER CODE*RECEIVER CODE*19991231*0802*1*X*005010X222~
+ST*837*0021*005010X222~
+BHT*0019*00*0125*20051111*1524*CH~
+NM1*41*2*ASSOCIATED MEDICAL GROUP*****46*1253695747~
+PER*IC*JANICE HENDRIX*TE*2125557987~
+NM1*40*2*HEISMAN INSURANCE COMPANY*****46*999888777~
+HL*1**20*1~
+NM1*85*2*ASSOCIATED MEDICAL GROUP*****XX*1253695747~
+N3*10 1/2 SHOEMAKER STREET~
+N4*COBBLER*CA*99997~
+REF*EI*579999999~
+HL*2*1*22*1~
+SBR*P********AM~
+NM1*IL*1*HOWLING*HAL****MI*B99977791G~
+NM1*PR*2*HEISMAN INSURANCE COMPANY*****PI*999888777~
+HL*3*2*23*0~
+PAT*21~
+NM1*QC*1*DIMPSON*DJ~
+N3*32 BUFFALO RUN~
+N4*ROCKING HORSE*CA*99666~
+DMG*D8*19480601*M~
+REF*Y4*32323232~
+PER*IC*DJ DIMPSON*TE*8157665902~
+CLM*900000032*185***11:B:1*Y*A*Y*Y**AA:::CA~
+DTP*439*D8*20051031~
+DTP*444*D8*20051031~
+HI*BK:8540~
+NM1*82*1*MOGLIE*BRUNO****XX*2366552595~
+PRV*PE*PXC*208D00000X~
+NM1*77*2*ASSOCIATED MEDICAL GROUP*****XX*1235767887~
+N3*101 EAST PRYOR STREET~
+N4*LOMA LINDA*CA*99622~
+PER*IC*KAREN SPARKLE*TE*3425557987~
+LX*1~
+SV1*HC:99201*150*UN*1***1**Y~
+DTP*472*D8*20051031~
+LX*2~
+SV1*HC:26010*35*UN*1***1**Y~
+DTP*472*D8*20051031~
+SE*39*0021~
+GE*1*1~
+IEA*1*000000905~

data/spec/fixtures/X222-HC837/13-good.txt

@@ -0,0 +1,46 @@
+Property and Casualty: Automobile Accident
+
+The patient is not the subscriber.The bill is sent directly from the provider to the payer. � The date of accident/occurrence/onset of symptoms (Date of Loss) is a critical piece of information and is used to determine the eligibility of coverage. Without a date of loss on the bill, the bill will be incomplete and may be rejected. In this case-the property and casualty claim number is known and sent in the patient loop.
+
+ISA*00*..........*01*SECRET....*ZZ*SUBMITTERS.ID..*ZZ*RECEIVERS.ID...*030101*1253*^*00501*000000905*1*T*:~
+GS*HC*SENDER CODE*RECEIVER CODE*19991231*0802*1*X*005010X222~
+ST*837*0021*005010X222~
+BHT*0019*00*0125*20051111*1524*CH~
+NM1*41*2*ASSOCIATED MEDICAL GROUP*****46*1232343560~
+PER*IC*JANICE HENDRIX*TE*2125557987~
+NM1*40*2*HEISMAN INSURANCE COMPANY*****46*999888777~
+HL*1**20*1~
+NM1*85*2*ASSOCIATED MEDICAL GROUP*****XX*1253695740~
+N3*10 1/2 SHOEMAKER STREET~
+N4*SACRAMENTO*CA*958201234~
+REF*EI*579999999~
+HL*2*1*22*1~
+SBR*P********AM~
+NM1*IL*1*HOWLING*HAL****MI*B99977791G~
+N3*847 C AVENUE~
+N4*SACRAMENTO*CA*95820~
+NM1*PR*2*HEISMAN INSURANCE COMPANY*****PI*999888777~
+N4*GREEN BAY*WI*54229~
+HL*3*2*23*0~
+PAT*21~
+NM1*QC*1*DIMPSON*DJ~
+N3*32 BUFFALO RUN~
+N4*SACRAMENTO*CA*95820~
+DMG*D8*19480601*M~
+REF*Y4*32323232~
+PER*IC*DJ DIMPSON*TE*8157665902~
+CLM*900000032*185***11:B:1*Y*A*Y*Y**AA:::CA~
+DTP*439*D8*20051031~
+DTP*444*D8*20051031~
+HI*BK:85400~
+NM1*82*1*MOGLIE*BRUNO****XX*1366552598~
+PRV*PE*PXC*208D00000X~
+LX*1~
+SV1*HC:99201*150*UN*1***1**Y~
+DTP*472*D8*20051031~
+LX*2~
+SV1*HC:26010*35*UN*1***1**Y~
+DTP*472*D8*20051031~
+SE*38*0021~
+GE*1*1~
+IEA*1*000000905~

data/spec/fixtures/X222-HC837/3a-bad.txt

@@ -0,0 +1,83 @@
+Example 3A - Coordination of Benefits (COB) 
+
+The patient is not the subscriber. A billing service transmits the claim to Payer A who adjudicates the claim. Both payers are commercial health insurance companies. The claim submitted to primary insurer with information pertaining to the secondary payer.
+
+Errors Found in File 5010X222-3a
+* W10009:Padding, spaces or control characters detected after segment terminator.
+* H10203:Functional Group ID 'XX' mismatch - Transaction Set is type 'HC'
+* H11204:Code Value 'XX' not used for element 'GS01'
+* H24402:The value '1999996666' fails the check digit algorithm for the "HIPAA National Provider ID (NPI)"
+* H25377:The 'Billing Provider Postal Zone or ZIP Code' must be the nine digit Zip code.
+* H20203:Element SBR08 is present, though marked 'Not Used'
+* H24236:'Claim Filing Indicator Code' was not found, but was expected because PlanID has not yet been mandated.
+* H20205:Incomplete loop (2010BA). Missing HIPAA-required N4 (Subscriber City, State, ZIP Code).
+* H40170:The 'Claim Filing Indicator Code' in SBR-09 is missing. Required until the HIPAA Plan ID is mandated.
+* H50010:Invalid ZIP Code ('33000'), not in USPS tables.
+* W40387:The 'Service Facility' generally not needed for Office services, unless it is different from Billing Provider address.
+* H51086:ICD9 Code '2780' is not valid, must be coded to the highest number of digits possible (4th or 5th digit).
+* H24402:The value '1999996666' fails the check digit algorithm for the "HIPAA National Provider ID (NPI)"
+* H46214:The Rendering Provider information must different than the Billing Provider.
+* H46000:The 'Rendering Provider Secondary Identification' is not allowed because the National Provider Identifier has been mandated as the only valid provider identifier for HIPAA transactions
+* H24402:The value '1581234567' fails the check digit algorithm for the "HIPAA National Provider ID (NPI)"
+* H25377:The 'Laboratory or Facility Postal Zone or ZIP Code' must be the nine digit Zip code.
+* H10023:Unexpected segment (DMG)
+* H46248:The Release of Information Code (OI06) must match the value sent in CLM09.
+* H20205:Incomplete loop (2330B). Missing HIPAA-required N4 (Other Payer City, State, ZIP Code).
+
+ISA*00*..........*01*SECRET....*ZZ*SUBMITTERS.ID..*ZZ*RECEIVERS.ID...*030101*1253*^*00501*000000905*1*T*:~
+GS*XX*SENDER CODE*RECEIVER CODE*19991231*0802*1*X*005010X222~
+ST*837*0021*005010X222~
+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*1999996666~
+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*1999996666~
+PRV*PE*PXC*204C00000X~
+REF*G2*KA6663~
+NM1*77*2*KILDARE ASSOCIATES*****XX*1581234567~
+N3*2345 OCEAN BLVD~
+N4*MIAMI*FL*33111~
+SBR*S*01*******CI~
+DMG*D8*19430501*F~
+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*53*0021~
+GE*1*1~
+IEA*1*000000905~

data/spec/fixtures/X222-HC837/3a-good.txt

@@ -0,0 +1,59 @@
+Example 3A - Coordination of Benefits (COB) 
+
+The patient is not the subscriber. A billing service transmits the claim to Payer A who adjudicates the claim. Both payers are commercial health insurance companies. The claim submitted to primary insurer with information pertaining to the secondary payer.
+
+ISA*00*..........*01*SECRET....*ZZ*SUBMITTERS.ID..*ZZ*RECEIVERS.ID...*030101*1253*^*00501*000000905*1*T*:~
+GS*HC*SENDER CODE*RECEIVER CODE*19991231*0802*1*X*005010X222~
+ST*837*0021*005010X222~
+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*1232343560~
+N3*1234 SEAWAY ST~
+N4*MIAMI*FL*331111234~
+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~
+N3*1234 ELM STREET~
+N4*MIAMI*FL*33111~
+DMG*D8*19430501*F~
+NM1*PR*2*KEY INSURANCE COMPANY*****PI*999996666~
+N3*3333 OCEAN ST~
+N4*SOUTH MIAMI*FL*33111~
+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:27801*BF:53081~
+NM1*82*1*SMITH*FRED****XX*1234567893~
+PRV*PE*PXC*204C00000X~
+SBR*S*01*******CI~
+OI***Y*P**I~
+NM1*IL*1*SMITH*JACK****MI*T55TY666~
+N3*236 N MAIN ST~
+N4*MIAMI*FL*33111~
+NM1*PR*2*KEY INSURANCE COMPANY*****PI*999996666~
+N4*MIAMI*FL*33111~
+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*51*0021~
+GE*1*1~
+IEA*1*000000905~

data/spec/fixtures/X222-HC837/3b-bad.txt

@@ -0,0 +1,97 @@
+Example 3B - Coordination of Benefits (COB)
+
+The patient is not the subscriber. Both payers are commercial health insurance companies. Patient and subscriber have same primary ID number. Payer A transmits an 835 to the billing provider.The billing provider then submits a second claim to Payer B
+
+Errors Found in File 837P 5010X222-3b
+* W10009:Padding, spaces or control characters detected after segment terminator.
+* H10203:Functional Group ID 'XX' mismatch - Transaction Set is type 'HC'
+* H11204:Code Value 'XX' not used for element 'GS01'
+* H24402:The value '1999996666' fails the check digit algorithm for the "HIPAA National Provider ID (NPI)"
+* H25377:The 'Billing Provider Postal Zone or ZIP Code' must be the nine digit Zip code.
+* H20751:Invalid ZIP Code ('3111')
+* H10023:Unexpected segment (REF)
+* H20205:Incomplete loop (2010BA). Missing HIPAA-required N4 (Subscriber City, State, ZIP Code).
+* B51124:This Zip Code is not valid for this State.
+* H51086:ICD9 Code '2780' is not valid, must be coded to the highest number of digits possible (4th or 5th digit).
+* H24402:The value '1999996666' fails the check digit algorithm for the "HIPAA National Provider ID (NPI)"
+* H46214:The Rendering Provider information must different than the Billing Provider.
+* H46000:The 'Rendering Provider Secondary Identification' is not allowed because the National Provider Identifierhas been mandated as the only valid provider identifier for HIPAA transactions
+* H24402:The value '1581234567' fails the check digit algorithm for the "HIPAA National Provider ID (NPI)"
+* H25377:The 'Laboratory or Facility Postal Zone or ZIP Code' must be the nine digit Zip code.
+* H10023:Unexpected segment (DMG)
+* H46248:The Release of Information Code (OI06) must match the value sent in CLM09.
+* H20205:Incomplete loop (2330B). Missing HIPAA-required N4 (Other Payer City, State, ZIP Code).
+* H20205:Incomplete loop (2430). Missing HIPAA-required DTP (Line Check or Remittance Date).
+* H51108:'42' is not a valid 'Line Level Adjustment Reason Code'
+* H10023:Unexpected segment (DPT)
+* H20205:Incomplete loop (2430). Missing HIPAA-required DTP (Line Check or Remittance Date).
+* H10023:Unexpected segment (DPT)
+* H10904:Number of Included Segments '63' does not match actual segment count '64'.
+
+ISA*00*..........*01*SECRET....*ZZ*SUBMITTERS.ID..*ZZ*RECEIVERS.ID...*030101*1253*^*00501*000000905*1*T*:~
+GS*XX*SENDER CODE*RECEIVER CODE*19991231*0802*1*X*005010X222~
+ST*837*1234*005010X222~
+BHT*0019*00*0123*20051015*1023*CH~
+NM1*41*2*PREMIER BILLING SERVICE*****46*12EEER 000TY~
+PER*IC*JERRY*TE*3055552222~
+NM1*40*2*GREAT PRAIRIES HEALTH*****46*567890~
+HL*1**20*1~
+NM1*85*1*KILDARE*BEN****XX*1999996666~
+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*3111~
+REF*G2*EX7777~
+HL*2*1*22*1~
+SBR*S********CI~
+NM1*IL*1*SMITH*JACK****MI*222334444~
+DMG*D8*19431022*M~
+NM1*PR*2*GREAT PRAIRIES HEALTH*****PI*567890~
+N3*4456 SOUTH SHORE BLVD~
+N4*CHICAGO*IL*44444~
+REF*G2*567890~
+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~
+HI*BK:4779*BF:2724*BF:2780*BF:53081~
+NM1*82*1*KILDARE*BEN****XX*1999996666~
+PRV*PE*PXC*204C00000X~
+REF*G2*88877~
+NM1*77*2*KILDARE ASSOCIATES*****XX*1581234567~
+N3*2345 OCEAN BLVD~
+N4*MIAMI*FL*33111~
+SBR*P*01*******CI~
+CAS*PR*1*21.89**2*15~
+AMT*D*39.15~
+AMT*EAF*36.89~
+DMG*D8*19430501*F~
+OI***Y*P**Y~
+NM1*IL*1*SMITH*JANE****MI*JS00111223333~
+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~
+SVD*999996666*40*HC:99213**1~
+CAS*CO*42*3~
+DPT*573*D8*20051015~
+LX*2~
+SV1*HC:90782*15*UN*1***1:2~
+DTP*472*D8*20051003~
+SVD*999996666*15*HC:90782**1~
+DTP*573*D8*20051015~
+LX*3~
+SV1*HC:J3301*21.04*UN*1***1:2~
+DTP*472*D8*20051003~
+SVD*999996666*21.04*HC:J3301**1~
+DPT*573*D8*20051015~
+SE*63*1234~
+GE*1*1~
+IEA*1*000000905~

data/spec/fixtures/X222-HC837/3b-good.txt

@@ -0,0 +1,70 @@
+Example 3B - Coordination of Benefits (COB)
+
+The patient is not the subscriber. Both payers are commercial health insurance companies. Patient and subscriber have same primary ID number. Payer A transmits an 835 to the billing provider.The billing provider then submits a second claim to Payer B
+
+ISA*00*..........*01*SECRET....*ZZ*SUBMITTERS.ID..*ZZ*RECEIVERS.ID...*030101*1253*^*00501*000000905*1*T*:~
+GS*HC*SENDER CODE*RECEIVER CODE*19991231*0802*1*X*005010X222~
+ST*837*1234*005010X222~
+BHT*0019*00*0123*20051015*1023*CH~
+NM1*41*2*PREMIER BILLING SERVICE*****46*12EEER 000TY~
+PER*IC*JERRY*TE*3055552222~
+NM1*40*2*GREAT PRAIRIES HEALTH*****46*567890~
+HL*1**20*1~
+NM1*85*1*KILDARE*BEN****XX*1232343560~
+N3*1234 SEAWAY ST~
+N4*MIAMI*FL*331111234~
+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*S********CI~
+NM1*IL*1*SMITH*JACK****MI*222334444~
+N4*MIAMI*FL*33111~
+DMG*D8*19431022*M~
+NM1*PR*2*GREAT PRAIRIES HEALTH*****PI*567890~
+N3*4456 SOUTH SHORE BLVD~
+N4*CHICAGO*IL*60601~
+REF*G2*567890~
+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~
+HI*BK:4779*BF:2724*BF:27802*BF:53081~
+NM1*82*1*KILDARE*BEN****XX*1234567893~
+PRV*PE*PXC*204C00000X~
+NM1*77*2*KILDARE ASSOCIATES*****XX*1581234568~
+N3*2345 OCEAN BLVD~
+N4*MIAMI*FL*331112345~
+SBR*P*01*******CI~
+CAS*PR*1*21.89**2*15~
+AMT*D*39.15~
+AMT*EAF*36.89~
+OI***Y*P**I~
+NM1*IL*1*SMITH*JANE****MI*JS00111223333~
+N3*236 N MAIN ST~
+N4*MIAMI*FL*33111~
+NM1*PR*2*KEY INSURANCE COMPANY*****PI*999996666~
+N4*BOSTON*MA*02115~
+LX*1~
+SV1*HC:99213*43*UN*1***1:2:3:4~
+DTP*472*D8*20051003~
+SVD*999996666*40*HC:99213**1~
+CAS*CO*45*3~
+DTP*573*D8*20051015~
+LX*2~
+SV1*HC:90782*15*UN*1***1:2~
+DTP*472*D8*20051003~
+SVD*999996666*15*HC:90782**1~
+DTP*573*D8*20051015~
+LX*3~
+SV1*HC:J3301*21.04*UN*1***1:2~
+DTP*472*D8*20051003~
+SVD*999996666*21.04*HC:J3301**1~
+DTP*573*D8*20051015~
+SE*63*1234~
+GE*1*1~
+IEA*1*000000905~