stupidedi 1.1.0

data/spec/fixtures/X222-HC837/8-bad.txt

@@ -0,0 +1,64 @@
+Example 8 - Wheelchair 
+
+The patient is the subscriber. Claim is submitted by the provider directly to a Medicare DMERC carrier.
+
+Errors Found in File 5010X222-8
+* 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'
+* H20617:The value '7778889999' does not match the format for a "HIPAA National Provider ID (NPI)"
+* H25377:The 'Billing Provider Postal Zone or ZIP Code' must be the nine digit Zip code.
+* H20204:Code Value 'G2' at element 'REF01' is valid in the X12 standard, but not in this HIPAA implementation
+* H20205:Incomplete loop (2010BB). Missing HIPAA-required N4 (Payer City, State, ZIP Code).
+* B40146:'Durable Medical Equipment Service' (SV5) is generally required for the procedure described in SV1-01.
+* W71117:The Condition Indicator/Durable Medical Equipment is required when DMERC CMN, DMERC DIF or Oxygen Therapy Certification is included on this service line and the information is necessary for adjudication.
+* H24402:The value '1111155555' fails the check digit algorithm for the "HIPAA National Provider ID (NPI)"
+* H46000:The 'Ordering Provider Secondary Identification' is not allowed because the National Provider Identifier has been mandated as the only valid provider identifier for HIPAA transactions
+
+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*112233*005010X222~
+BHT*0019*00*16*20050326*1036*CH~
+NM1*41*2*XYZ WHEELCHAIRS INC*****46*ABC55~
+PER*IC*JANE*TE*2225551111~
+NM1*40*2*DMERC CARRIER*****46*99999~
+HL*1**20*1~
+NM1*85*2*XYZ WHEELCHAIR INC*****XX*7778889999~
+N3*1440 NORTH STREET~
+N4*LAFAYETTE*IN*47904~
+REF*EI*123567989~
+REF*G2*0426960001~
+HL*2*1*22*0~
+SBR*P*18*******MB~
+PAT*******01*155~
+NM1*IL*1*SMITH*JAMES****MI*987654321A~
+N3*12 MAIN ST~
+N4*FRANKFORT*IN*46209~
+DMG*D8*19201023*M~
+NM1*PR*2*DMERC CARRIER*****PI*99999~
+CLM*SMI123*75***12:B:1*Y*A*Y*Y~
+HI*BK:436*BF:3449~
+LX*1~
+SV1*HC:K0001:RR:KH:BR*75*UN*1***1:2~
+PWK*CT*AD~
+CR3*I*MO*99~
+DTP*472*RD8*20050321-20050321~
+DTP*463*D8*20040321~
+DTP*461*D8*20050321~
+MEA*TR*HT*70~
+NM1*DK*1*WILSON*RANDALL****XX*1111155555~
+N3*1226 WEST RAILROAD STREET~
+N4*LAFAYETTE*IN*47905~
+REF*1G*M12345~
+PER*IC*LEE*TE*7659259999~
+LQ*UT*02.03B~
+FRM*1*Y~
+FRM*2*N~
+FRM*3*N~
+FRM*4*N~
+FRM*5**8~
+FRM*8*N~
+FRM*9*Y~
+SE*43*112233~
+GE*1*1~
+IEA*1*000000905~

data/spec/fixtures/X222-HC837/8-good.txt

@@ -0,0 +1,52 @@
+Example 8 - Wheelchair 
+
+The patient is the subscriber. Claim is submitted by the provider directly to a Medicare DMERC carrier.
+
+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*112233*005010X222~
+BHT*0019*00*16*20050326*1036*CH~
+NM1*41*2*XYZ WHEELCHAIRS INC*****46*ABC55~
+PER*IC*JANE*TE*2225551111~
+NM1*40*2*DMERC CARRIER*****46*99999~
+HL*1**20*1~
+NM1*85*2*XYZ WHEELCHAIR INC*****XX*1232343560~
+N3*1440 NORTH STREET~
+N4*LAFAYETTE*IN*479041440~
+REF*EI*123567989~
+HL*2*1*22*0~
+SBR*P*18*******MB~
+PAT*******01*155~
+NM1*IL*1*SMITH*JAMES****MI*987654321A~
+N3*12 MAIN ST~
+N4*FRANKFORT*IN*46209~
+DMG*D8*19201023*M~
+NM1*PR*2*DMERC CARRIER*****PI*99999~
+N4*INDIANAPOLIS*IN*46209~
+CLM*SMI123*75***12:B:1*Y*A*Y*Y~
+HI*BK:436*BF:3449~
+LX*1~
+SV1*HC:K0001:RR:KH:BR*75*UN*1***1:2~
+SV5*HC:K0001*DA*4*200*500*4~
+PWK*CT*AD~
+CR3*I*MO*99~
+CRC*09*Y*38~
+DTP*472*RD8*20050321-20050321~
+DTP*463*D8*20040321~
+DTP*461*D8*20050321~
+MEA*TR*HT*70~
+NM1*DK*1*WILSON*RANDALL****XX*1111155556~
+N3*1226 WEST RAILROAD STREET~
+N4*LAFAYETTE*IN*47905~
+PER*IC*LEE*TE*7659259999~
+LQ*UT*02.03B~
+FRM*1*Y~
+FRM*2*N~
+FRM*3*N~
+FRM*4*N~
+FRM*5**8~
+FRM*8*N~
+FRM*9*Y~
+SE*44*112233~
+GE*1*1~
+IEA*1*000000905~

data/spec/fixtures/X222-HC837/9-bad.txt

@@ -0,0 +1,56 @@
+Example 9 - Anesthesia 
+
+The patient is the subscriber. The payer is Medicare. The claim is billed directly to Medicare.
+
+Errors Found in File 5010X222-9
+* 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 '2366554859' 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.
+* H20205:Incomplete loop (2010BB). Missing HIPAA-required N4 (Payer City, State, ZIP 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.
+* H10602:Assuming Sub-Element Delimiter is > rather than : in HI01
+* H20617:The value '5678912345' does not match the format for a "HIPAA National Provider ID (NPI)"
+* H20204:Code Value 'ZZ' at element 'PRV02' is valid in the X12 standard, but not in this HIPAA implementation
+* 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
+* B20617:Currently the "HIPAA National Provider ID (NPI)" is only being issued with the first digit equal to 1 or 2, with 3 and 4 reserved for future assignment
+* H20617:The value '432198765' does not match the format for a "HIPAA National Provider ID (NPI)"
+* H25377:The 'Laboratory or Facility Postal Zone or ZIP Code' must be the nine digit Zip code.
+* H10602:Assuming Sub-Element Delimiter is > rather than : in SV101
+* B45272:Use of MJ in SV103 indicates Anesthesia Administration, which requires the presence of the Anesthesia Related Surgical Procedure (2300 HI01 = BP).
+
+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*0001*005010X222~
+BHT*0019*00*0123*20050117*1023*CH~
+NM1*41*2*PROVIDER MEDICAL GROUP*****46*N305~
+PER*IC*NINA*TE*6155551212*EX*911~
+NM1*40*2*ABC PAYER*****46*05440~
+HL*1**20*1~
+NM1*85*2*PROVIDER MEDICAL GROUP*****XX*2366554859~
+N3*1234 WEST END AVE~
+N4*NASHVILLE*TN*37232~
+REF*EI*756473826~
+HL*2*1*22*0~
+SBR*P*18*******MB~
+NM1*IL*1*JONES*MARGARET****MI*123456789A~
+N3*123 RAINBOW ROAD~
+N4*NASHVILLE*TN*37232~
+DMG*D8*19740303*F~
+NM1*PR*2*ABC PAYER*****PI*05440~
+CLM*153829140*827***22>B>1*Y*A*Y*Y~
+HI*BK>36616~
+NM1*82*1*TOWNSEND*JACOB*E***XX*5678912345~
+PRV*PE*ZZ*207L00000X~
+REF*1G*A41234~
+NM1*77*2*PROVIDER OP HOSP*****XX*432198765~
+N3*345 MAIN DRIVE~
+N4*NASHVILLE*TN*37232~
+LX*1~
+SV1*HC>00142>QK>QS>P1*827*MJ*61***1~
+DTP*472*D8*20050112~
+SE*29*0001~
+GE*1*1~
+IEA*1*000000905~

data/spec/fixtures/X222-HC837/9-good.txt

@@ -0,0 +1,38 @@
+Example 9 - Anesthesia 
+
+The patient is the subscriber. The payer is Medicare. The claim is billed directly to Medicare.
+
+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*0001*005010X222~
+BHT*0019*00*0123*20050117*1023*CH~
+NM1*41*2*PROVIDER MEDICAL GROUP*****46*N305~
+PER*IC*NINA*TE*6155551212*EX*911~
+NM1*40*2*ABC PAYER*****46*05440~
+HL*1**20*1~
+NM1*85*2*PROVIDER MEDICAL GROUP*****XX*2366554857~
+N3*1234 WEST END AVE~
+N4*NASHVILLE*TN*372321234~
+REF*EI*756473826~
+HL*2*1*22*0~
+SBR*P*18*******MB~
+NM1*IL*1*JONES*MARGARET****MI*123456789A~
+N3*123 RAINBOW ROAD~
+N4*NASHVILLE*TN*37232~
+DMG*D8*19740303*F~
+NM1*PR*2*ABC PAYER*****PI*05440~
+N4*NASHVILLE*TN*37232~
+CLM*153829140*827***22:B:1*Y*A*Y*Y~
+HI*BK:36616~
+HI*BP:94542~
+NM1*82*1*TOWNSEND*JACOB*E***XX*1232343560~
+PRV*PE*PXC*207L00000X~
+NM1*77*2*PROVIDER OP HOSP*****XX*1432198764~
+N3*345 MAIN DRIVE~
+N4*NASHVILLE*TN*372323450~
+LX*1~
+SV1*HC:00142:QK:QS:P1*827*MJ*61***1~
+DTP*472*D8*20050112~
+SE*30*0001~
+GE*1*1~
+IEA*1*000000905~

data/spec/fixtures/X223-HC837/1-bad.txt

@@ -0,0 +1,66 @@
+Business Scenario 1- 837 Institutional Claim 
+
+The patient is the subscriber. The primary payer is Medicare and the secondary payer is State Teachers. The claim has a Type of Bill of 0141.
+
+Errors Found in File 5010X223A1-1
+* 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'
+* H52000:Provider Specialty Code '203BA0200N' not found in Taxonomy Code Table.
+* H20617:The value '9876540809' does not match the format for a "HIPAA National Provider ID (NPI)"
+* H25377:The 'Billing Provider Postal Zone or ZIP Code' must be the nine digit Zip code.
+* H20203:Element CLM06 is present, though marked 'Not Used'
+* H20204:Code Value 'D8' at element 'DTP02' is valid in the X12 standard, but not in this HIPAA implementation
+* H51105:'A2' is not a valid NUBC Value Code.
+* H46000:The 'Attending Provider Secondary Identification' is not allowed because the National Provider Identifier has been mandated as the only valid provider identifier for HIPAA transactions
+* H46216:The Other Insurance Group Name must not be used if the Group Number is submitted.
+* H10023:Unexpected segment (DMG)
+* W24413:Submitters are encouraged to routinely send a Line Item Control Number on all service lines.
+
+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*005010X223A1~
+ST*837*987654*005010X223A1~
+BHT*0019*00*0123*19960918*0932*CH~
+NM1*41*2*JONES HOSPITAL*****46*12345~
+PER*IC*JANE DOE*TE*9005555555~
+NM1*40*2*MEDICARE*****46*00120~
+HL*1**20*1~
+PRV*BI*PXC*203BA0200N~
+NM1*85*2*JONES HOSPITAL*****XX*9876540809~
+N3*225 MAIN STREET BARKLEY BUILDING~
+N4*CENTERVILLE*PA*17111~
+REF*EI*567891234~
+HL*2*1*22*0~
+SBR*P*18*******MB~
+NM1*IL*1*DOE*JOHN*T***MI*030005074A~
+N3*125 CITY AVENUE~
+N4*CENTERVILLE*PA*17111~
+DMG*D8*19261111*M~
+NM1*PR*2*MEDICARE B*****PI*00435~
+REF*G2*330127~
+CLM*756048Q*89.93***14:A:1*Y*A*Y*Y~
+DTP*434*D8*19960911~
+CL1*3**01~
+HI*BK:3669~
+HI*BF:4019*BF:79431~
+HI*BH:A1:D8:19261111*BH:A2:D8:19911101*BH:B1:D8:19261111*BH:B2:D8:19870101~
+HI*BE:A2:::15.31~
+HI*BG:09~
+NM1*71*1*JONES*JOHN*J~
+REF*1G*B99937~
+SBR*S*01*351630*STATE TEACHERS*****CI~
+DMG*D8*19271211*F~
+OI***Y***Y~
+NM1*IL*1*DOE*JANE*S***MI*222004433~
+N3*125 CITY AVENUE~
+N4*CENTERVILLE*PA*17111~
+NM1*PR*2*STATE TEACHERS*****PI*1135~
+LX*1~
+SV2*0305*HC:85025*13.39*UN*1~
+DTP*472*D8*19960911~
+LX*2~
+SV2*0730*HC:93005*76.54*UN*3~
+DTP*472*D8*19960911~
+SE*43*987654~
+GE*1*1~
+IEA*1*000000905~

data/spec/fixtures/X223-HC837/1-good.txt

@@ -0,0 +1,53 @@
+Business Scenario 1- 837 Institutional Claim 
+
+The patient is the subscriber. The primary payer is Medicare and the secondary payer is State Teachers. The claim has a Type of Bill of 0141.
+
+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*005010X223A1~
+ST*837*987654*005010X223A1~
+BHT*0019*00*0123*19960918*0932*CH~
+NM1*41*2*JONES HOSPITAL*****46*12345~
+PER*IC*JANE DOE*TE*9005555555~
+NM1*40*2*MEDICARE*****46*00120~
+HL*1**20*1~
+PRV*BI*PXC*261QM1300X~
+NM1*85*2*JONES HOSPITAL*****XX*1232343560~
+N3*225 MAIN STREET BARKLEY BUILDING~
+N4*CENTERVILLE*PA*171112251~
+REF*EI*567891234~
+HL*2*1*22*0~
+SBR*P*18*******MB~
+NM1*IL*1*DOE*JOHN*T***MI*030005074A~
+N3*125 CITY AVENUE~
+N4*CENTERVILLE*PA*17111~
+DMG*D8*19261111*M~
+NM1*PR*2*MEDICARE B*****PI*00435~
+N4*CENTERVILL*PA*17111~
+REF*G2*330127~
+CLM*756048Q*89.93***14:A:1**A*Y*Y~
+DTP*434*RD8*19960911-19960911~
+CL1*3**01~
+HI*BK:3669~
+HI*BF:4019*BF:79431~
+HI*BH:A1:D8:19261111*BH:A2:D8:19911101*BH:B1:D8:19261111*BH:B2:D8:19870101~
+HI*BE:38:::15.31~
+HI*BG:09~
+NM1*71*1*JONES*JOHN*J***XX*1232343560~
+SBR*S*01*351630******CI~
+OI***Y***Y~
+NM1*IL*1*DOE*JANE*S***MI*222004433~
+N3*125 CITY AVENUE~
+N4*CENTERVILLE*PA*17111~
+NM1*PR*2*STATE TEACHERS*****PI*1135~
+N4*CENTERFIELD*PA*17111~
+LX*1~
+SV2*0305*HC:85025*13.39*UN*1~
+DTP*472*D8*19960911~
+REF*6R*123~
+LX*2~
+SV2*0730*HC:93005*76.54*UN*3~
+DTP*472*D8*19960911~
+REF*6R*124~
+SE*45*987654~
+GE*1*1~
+IEA*1*000000905~

data/spec/fixtures/X223-HC837/2-bad.txt

@@ -0,0 +1,69 @@
+Business Scenario 2- Two Claims for the Same Provider
+
+For both claims, the patient is the subscriber and the transaction is being directly submitted from the provider to the payer.This example contains two claims for the same provider.
+
+Errors Found in File 5010X223A1-2
+* 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)"
+* H25377:The 'Billing Provider Postal Zone or ZIP Code' must be the nine digit Zip code.
+* H20203:Element CLM06 is present, though marked 'Not Used'
+* H25405:The Admission Source Is required for all inpatient and outpatient services.
+* H46000:The 'Attending Provider Secondary Identification' is not allowed because the National Provider Identifier has been mandated as the only valid provider identifier for HIPAA transactions
+* W24413:Submitters are encouraged to routinely send a Line Item Control Number on all service lines.
+* H20617:The value '9999999999' does not match the format for a "HIPAA National Provider ID (NPI)"
+* H52003:Attending Provider Specialty Code '363LP0200N' not found in Taxonomy Code Table
+
+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*005010X223A1~
+ST*837*987654*005010X223A1~
+BHT*0019*00*0123*20050630*0932*CH~
+NM1*41*2*JONES HOSPITAL*****46*12345~
+PER*IC*JANE DOE*TE*1112223333~
+NM1*40*2*TRICARE*****46*99999~
+HL*1**20*1~
+PRV*BI*PXC*282N00000X~
+NM1*85*2*JONES HOSPITAL*****XX*1234567890~
+N3*225 MAIN STREET~
+N4*ANYWHERE*PA*17111~
+REF*EI*123456789~
+HL*2*1*22*0~
+SBR*P*18*******CH~
+NM1*IL*1*DOE*JOHN*T***MI*030005074~
+N3*125 CITY AVENUE~
+N4*ANYWHERE*PA*17111~
+DMG*D8*19681111*M~
+NM1*PR*2*TRICARE*****PI*99999~
+CLM*756048Q*89.95***13:A:1*Y*C*Y*Y~
+DTP*434*RD8*20050315-20050315~
+CL1***01~
+HI*BK:3669~
+HI*BF:4019*BF:79431~
+NM1*71*1*JONES*JOHN*J***XX*1122334455~
+REF*1G*U12345~
+LX*1~
+SV2*0305*HC:85025*13.39*UN*1~
+DTP*472*D8*20050315~
+LX*2~
+SV2*0730*HC:93010*76.56*UN*3~
+DTP*472*D8*20050315~
+HL*3*1*22*0~
+SBR*P*18*******CH~
+NM1*IL*1*SMITH*JOE****MI*123405074~
+N3*5 MAIN STREET~
+N4*ANYWHERE*PA*17111~
+DMG*D8*19621210*M~
+NM1*PR*2*TRICARE*****PI*99999~
+CLM*756049Q*50***13:A:1*Y*C*Y*Y~
+DTP*434*RD8*20050401-20050401~
+CL1***01~
+HI*BK:30000~
+NM1*71*1*JONES*JUDY*J***XX*9999999999~
+PRV*AT*PXC*363LP0200N~
+LX*1~
+SV2*0300*HC:85087*50*UN*1~
+DTP*472*D8*20050401~
+SE*48*987654~
+GE*1*1~
+IEA*1*000000905~

data/spec/fixtures/X223-HC837/2-good.txt

@@ -0,0 +1,60 @@
+Business Scenario 2- Two Claims for the Same Provider
+
+For both claims, the patient is the subscriber and the transaction is being directly submitted from the provider to the payer.This example contains two claims for the same provider.
+
+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*005010X223A1~
+ST*837*987654*005010X223A1~
+BHT*0019*00*0123*20050630*0932*CH~
+NM1*41*2*JONES HOSPITAL*****46*12345~
+PER*IC*JANE DOE*TE*1112223333~
+NM1*40*2*TRICARE*****46*99999~
+HL*1**20*1~
+PRV*BI*PXC*282N00000X~
+NM1*85*2*JONES HOSPITAL*****XX*1232343560~
+N3*225 MAIN STREET~
+N4*ANYWHERE*PA*171112251~
+REF*EI*123456789~
+HL*2*1*22*0~
+SBR*P*18*******CH~
+NM1*IL*1*DOE*JOHN*T***MI*030005074~
+N3*125 CITY AVENUE~
+N4*ANYWHERE*PA*17111~
+DMG*D8*19681111*M~
+NM1*PR*2*TRICARE*****PI*99999~
+N4*ANYWHERE*PA*17111~
+CLM*756048Q*89.95***13:A:1**C*Y*Y~
+DTP*434*RD8*20050315-20050315~
+CL1**7*01~
+HI*BK:3669~
+HI*BF:4019*BF:79431~
+NM1*71*1*JONES*JOHN*J***XX*1122334455~
+LX*1~
+SV2*0305*HC:85025*13.39*UN*1~
+DTP*472*D8*20050315~
+REF*6R*123~
+LX*2~
+SV2*0730*HC:93010*76.56*UN*3~
+DTP*472*D8*20050315~
+REF*6R*124~
+HL*3*1*22*0~
+SBR*P*18*******CH~
+NM1*IL*1*SMITH*JOE****MI*123405074~
+N3*5 MAIN STREET~
+N4*ANYWHERE*PA*17111~
+DMG*D8*19621210*M~
+NM1*PR*2*TRICARE*****PI*99999~
+N4*ANYWHERE*PA*17111~
+CLM*756049Q*50***13:A:1**C*Y*Y~
+DTP*434*RD8*20050401-20050401~
+CL1**7*01~
+HI*BK:30000~
+NM1*71*1*JONES*JUDY*J***XX*1232343560~
+PRV*AT*PXC*204C00000X~
+LX*1~
+SV2*0300*HC:85087*50*UN*1~
+DTP*472*D8*20050401~
+REF*6R*224~
+SE*52*987654~
+GE*1*1~
+IEA*1*000000905~

data/spec/fixtures/X223-HC837/3-bad.txt

@@ -0,0 +1,89 @@
+Business Scenario 3- PPO Repriced Claim
+
+The patient is not the subscriber. Repriced claim is being transmitted from a Regional Preferred Provider Organization to a commercial health insurance company. In this situation, the hospital has sent the claim to a clearinghouse, which then forwarded the claim to the repricer; the claim has been repriced and is now being forwarded to the appropriate payer for payment.
+
+Errors Found in File 837I 5010X223A1-3
+* 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'
+* H25423:The Implementation Convention Reference value must be '005010X223A1'.
+* H24402:The value '1257234346' 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).
+* 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.
+* H20203:Element CLM06 is present, though marked 'Not Used'
+* H24391:Missing HIPAA Required 'CLM07'.
+* H46465:Admission Date (DTP-01=435) was not expected because this claim is not for Inpatient Services.
+* W24411:The Claim Pricing/Repricing Information is to be completed by repricers only.
+* H10602:Assuming Sub-Element Delimiter is > rather than : in HI01
+* H10602:Assuming Sub-Element Delimiter is > rather than : in HI01
+* H20204:Code Value 'BF' at element 'HI0101' is valid in the X12 standard, but not in this HIPAA implementation
+* H61012:Treatment Code Information was not expected because the Claim Facility Type (CLM-05-1) is not between 30 and 39
+* H10602:Assuming Sub-Element Delimiter is > rather than : in HI01
+* H20203:Element HI0103 is present, though marked 'Not Used'
+* H20203:Element HI0104 is present, though marked 'Not Used'
+* H20204:Code Value 'BH' at element 'HI0101' is valid in the X12 standard, but not in this HIPAA implementation
+* H51113:'11' is not a valid Treatment Code.
+* W24411:The Claim Pricing/Repricing Information is to be completed by repricers only.
+* H20617:The value '5544332211' does not match the format for a "HIPAA National Provider ID (NPI)"
+* H10023:Unexpected segment (DMG)
+* H20205:Incomplete loop (2330A). Missing HIPAA-required N4 (Other Subscriber City, State, ZIP Code).
+* H20205:Incomplete loop (2330B). Missing HIPAA-required N4 (Other Payer City, State, ZIP Code).
+* W24413:Submitters are encouraged to routinely send a Line Item Control Number on all service lines.
+* H10602:Assuming Sub-Element Delimiter is > rather than : in SV202
+* W24413:Submitters are encouraged to routinely send a Line Item Control Number on all service lines.
+* H10602:Assuming Sub-Element Delimiter is > rather than : in SV202
+
+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*005010X223A1~
+ST*837*1002*005010X223~
+BHT*0019*00*1002*20050721*09460000*CH~
+NM1*41*2*REGIONAL PPO NETWORK*****46*123456789~
+PER*IC*SUBMITTER CONTACT INFO*TE*8001231234~
+NM1*40*2*LOCAL INSURANCE COMPANY*****46*54334452~
+HL*1**20*1~
+NM1*85*2*GOOD HEALTH HOSPITAL*****XX*1257234346~
+N3*592 NORTH ELM STREET~
+N4*EDGEWOOD*AZ*860015590~
+REF*EI*344232321~
+HL*2*1*22*1~
+SBR*P**46522567AW******CI~
+NM1*IL*1*JONES*JENNY****MI*345U8423H~
+N3*4512 WEST AVENUE~
+N4*EVANSVILLE*AZ*863030000~
+DMG*D8*19690731*F~
+NM1*PR*2*LOCAL INSURANCE COMPANY*****PI*7452723~
+HL*3*2*23*0~
+PAT*19~
+NM1*QC*1*JONES*JOY~
+N3*4512 WEST AVENUE~
+N4*EVANSVILLE*AZ*863030000~
+DMG*D8*19980820*F~
+CLM*456DFH43*237.5***13>A>1*Y**Y*Y~
+DTP*434*RD8*20050706-20050706~
+DTP*435*DT*200507060800~
+CL1**2*01~
+AMT*F3*237.5~
+REF*9A*09459034092~
+REF*D9*04566877634343456~
+HI*BK>38181~
+HI*BF>38900~
+HI*BH>11>D8>20050706~
+HCP*03*182.88*54.62*123456789~
+NM1*71*1*JOHNSON*SIMON****XX*5544332211~
+SBR*S*19**T&T PLUMBING COMPANY*****CI~
+DMG*D8*19700122*M~
+OI***Y***Y~
+NM1*IL*1*JONES*GEORGE****MI*56454566~
+NM1*PR*2*OTHER COVERAGE COMPANY*****PI*534524~
+LX*1~
+SV2*0471*HC>92557*178*UN*1~
+DTP*472*D8*20050706~
+HCP*03*137.06*40.94~
+LX*2~
+SV2*0471*HC>92567*59.5*UN*1~
+DTP*472*D8*20050706~
+HCP*03*45.82*13.68~
+SE*49*1002~
+GE*1*1~
+IEA*1*000000905~

data/spec/fixtures/X223-HC837/3-good.txt

@@ -0,0 +1,61 @@
+Business Scenario 3- PPO Repriced Claim
+
+The patient is not the subscriber. Repriced claim is being transmitted from a Regional Preferred Provider Organization to a commercial health insurance company. In this situation, the hospital has sent the claim to a clearinghouse, which then forwarded the claim to the repricer; the claim has been repriced 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*005010X223A1~
+ST*837*1002*005010X223A1~
+BHT*0019*00*1002*20050721*09460000*CH~
+NM1*41*2*REGIONAL PPO NETWORK*****46*123456789~
+PER*IC*SUBMITTER CONTACT INFO*TE*8001231234~
+NM1*40*2*LOCAL INSURANCE COMPANY*****46*54334452~
+HL*1**20*1~
+NM1*85*2*GOOD HEALTH HOSPITAL*****XX*1232343560~
+N3*592 NORTH ELM STREET~
+N4*EDGEWOOD*AZ*860015590~
+REF*EI*344232321~
+HL*2*1*22*1~
+SBR*P**46522567AW******CI~
+NM1*IL*1*JONES*JENNY****MI*345U8423H~
+N3*4512 WEST AVENUE~
+N4*EVANSVILLE*AZ*863030000~
+DMG*D8*19690731*F~
+NM1*PR*2*LOCAL INSURANCE COMPANY*****PI*7452723~
+N4*EVANSVILL*AZ*86303~
+HL*3*2*23*0~
+PAT*19~
+NM1*QC*1*JONES*JOY~
+N3*4512 WEST AVENUE~
+N4*EVANSVILLE*AZ*863030000~
+DMG*D8*19980820*F~
+CLM*456DFH43*237.5***13:A:1**A*Y*Y~
+DTP*434*RD8*20050706-20050706~
+CL1**2*01~
+AMT*F3*237.5~
+REF*9A*09459034092~
+REF*D9*04566877634343456~
+HI*BK:38181~
+HI*BF:38900~
+HI*BH:11:D8:20050706~
+HCP*03*182.88*54.62*123456789~
+NM1*71*1*JOHNSON*SIMON****XX*1544332210~
+SBR*S*19**T&T PLUMBING COMPANY*****CI~
+OI***Y***Y~
+NM1*IL*1*JONES*GEORGE****MI*56454566~
+N3*845 OAK STREET~
+N4*EVANSVILLE*AZ*863030000~
+NM1*PR*2*OTHER COVERAGE COMPANY*****PI*534524~
+N4*EVANSVILLE*AZ*863030000~
+LX*1~
+SV2*0471*HC:92557*178*UN*1~
+DTP*472*D8*20050706~
+REF*6R*001~
+HCP*03*137.06*40.94~
+LX*2~
+SV2*0471*HC:92567*59.5*UN*1~
+DTP*472*D8*20050706~
+REF*6R*002~
+HCP*03*45.82*13.68~
+SE*53*1002~
+GE*1*1~
+IEA*1*000000905~

data/spec/fixtures/X223-HC837/4-bad.txt

@@ -0,0 +1,60 @@
+Business Scenario 4 - Out of Network Repriced Claim
+
+The patient is the subscriber. The hospital 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 837I 5010X223A1-4
+* 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'
+* H25423:The Implementation Convention Reference value must be '005010X223A1'.
+* H20205:Incomplete loop (2010BB). Missing HIPAA-required N4 (Payer City, State, ZIP 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.
+* H20203:Element CLM06 is present, though marked 'Not Used'
+* H24391:Missing HIPAA Required 'CLM07'.
+* H46465:Admission Date (DTP-01=435) was not expected because this claim is not for Inpatient Services.
+* W24411:The Claim Pricing/Repricing Information is to be completed by repricers only.
+* H61012:Treatment Code Information was not expected because the Claim Facility Type (CLM-05-1) is not between 30 and 39
+* 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
+* H51113:'53081' is not a valid Treatment Code.
+* W24411:The Claim Pricing/Repricing Information is to be completed by repricers only.
+* H24402:The value '2244224455' fails the check digit algorithm for the "HIPAA National Provider ID (NPI)"
+* W24413:Submitters are encouraged to routinely send a Line Item Control Number on all service lines.
+* H10602:Assuming Sub-Element Delimiter is > rather than : in SV202
+
+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*005010X223A1~
+ST*837*1024*005010X223~
+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*LOCAL HOSPITAL*****XX*1122334455~
+N3*3423 SMALL STREET~
+N4*COLUMBUS*OH*432150000~
+REF*EI*111002222~
+HL*2*1*22*0~
+SBR*P*18*34561W******CI~
+NM1*IL*1*SMITH*JAMES*A***MI*34902390F~
+N3*934 NORTH STREET~
+N4*COLUMBUS*OH*432150000~
+DMG*D8*19621015*M~
+NM1*PR*2*CONSERVATIVE INSURANCE*****PI*00123~
+CLM*W392-49141*14.84***13>A>1*Y**Y*Y~
+DTP*434*RD8*20050617-20050617~
+DTP*435*DT*200506170800~
+CL1**1*01~
+AMT*F3*14.84~
+REF*9A*459804390823~
+REF*D9*32423466233~
+HI*BK>53081~
+HCP*00*0**333001234*********T1~
+NM1*71*1*RIVERS*DAWN****XX*2244224455~
+LX*1~
+SV2*0301*HC>82270*14.84*UN*1~
+DTP*472*D8*20050617~
+SE*31*1024~
+GE*1*1~
+IEA*1*000000905~