How do EDI to JSON Translations work?
First, here's a quick look at an EDI claim status report:
https://apigw.changehealthcare.com/medicalnetwork/reports/v1/X3000000.XX
{
"report_content": "ISA~00~ ~00~ ~ZZ~CLAIMSCH ~ZZ~010414 ~180511~1112~|~00501~100321569~0~P~^_TA1~020120501~131121~1506~A~000_GS~FA~ECGCLAIMS~K10353~20180511~1112~000000001~X~005010X231A1_ST~999~0001~005010X231A1_AK1~HC~1~005010X223A1_AK2~837~00704~005010X223A1_IK5~A_AK9~A~000001~000001~000001_SE~0000000006~0001_GE~000001~000000001_IEA~00001~100321569_"
}
You append the /277 suffix to the same path, and the API renders the translation:
https://apigw.changehealthcare.com/medicalnetwork/reports/v1/X3000000.XX/277
{
"claims": [
{
"claimStatus": {
"effectiveDate": "20200107",
"entity": "Mutually Defined",
"entityCode": "ZZ",
"statusCategoryCode": "E1",
"statusCategoryCodeValue": "Response not possible - System Status",
"statusCode": "689",
"statusCodeValue": "Entity was unable to respond within the expected time frame. Usage: This code requires use of an Entity Code.",
"trackingNumber": "ABCD"
}
}
...
Here's an example of a 1:1 translation from EDI to JSON, starting with getting a display of an EDI-formatted Remittance file:
GET
https://apigw.changehealthcare.com/medicalnetwork/reports/v1/R5000000.XX
{
"report_content": "ISA~00~ ~00~ ~ZZ~CHC ~ZZ~658675C9801437 ~200422~2313~|~00501~156233287~0~P~^_GS~HP~CHC~658675C9801437~20200422~23135600~1~X~005010X221A1_ST~835~000000001_BPR~I~2563.13~C~ACH~CCP~01~042000013~DA~152302017834~1351840597~~01~071921891~DA~4638544662~20200423_TRN~1~895322770~1351840597_REF~EV~99992_DTM~405~20200422_N1~PR~NATIONAL GOVERNMENT SERVICES, INC._N3~PO BOX 6475_N4~INDIANAPOLIS~IN~462066475_REF~2U~06102_PER~CX~NATIONAL GOVERNMENT SERVICES, INC.~TE~8779089499_PER~BL~NATIONAL GOVERNMENT SERVICES, INC.~TE~8772734334~UR~WWW.NGSMEDICARE.COM_N1~PE~ADVANED DENTAL AND IMPLANT C~XX~1578001830_N3~2310 HUNTINGTON DR N_N4~ALGONQUIN~IL~601024420_REF~TJ~270424820_LX~1_CLP~00309~19~9006~2563.13~711.4~MB~0220087697150~11~1_NM1~QC~1~DOE~JANE~~~~MI~7SL5RA7XR19_NM1~82~1~~~~~~XX~1234567893_NM1~TT~2~HUMANA, INC.~~~~~PI~00268_MOA~~~MA01~MA15~MA18_DTM~050~20200327_SVC~HC^21210^79~3600~1455.51~~1~HC^21210^79^51_DTM~472~20200101_CAS~CO~45~1685.95~~253~29.7_CAS~PR~1~57.54~~2~371.3_REF~LU~11_AMT~B6~1914.05_SVC~HC^21026^79^51~1890~217.29~~1_DTM~472~20200101_CAS~CO~45~1335.71~~253~4.43~~59~277.14_CAS~PR~2~55.43_REF~LU~11_AMT~B6~277.15_SVC~HC^21208^79^51~1836~648.83~~1_DTM~472~20200101_CAS~CO~45~180.82~~253~13.24~~59~827.59_CAS~PR~2~165.52_REF~LU~11_AMT~B6~827.59_SVC~HC^30580^79^51~1680~241.5~~1_DTM~472~20200101_CAS~CO~45~1063.93~~253~4.93~~59~308.03_CAS~PR~2~61.61_REF~LU~11_AMT~B6~308.04_SE~47~000000001_GE~1~1_IEA~1~156233287_"
}
This is quite a substantial body of EDI information.
Then, you append the /835 suffix to get the JSON translation of the same Remittance file. It consists of a complete breakdown of payment information for all service identifications, payments, payment adjustments, financial information, and Payer and Payee information:
GET
https://apigw.changehealthcare.com/medicalnetwork/reports/v1/R5000000.XX/835
{
"detailInfo": [
{
"assignedNumber": "1",
"paymentInfo": [
{
"claimPaymentInfo": {
"claimFilingIndicatorCode": "MB",
"claimFrequencyCode": "1",
"claimPaymentAmount": "2563.13",
"claimStatusCode": "19",
"facilityTypeCode": "11",
"patientControlNumber": "00309",
"patientResponsibilityAmount": "711.4",
"payerClaimControlNumber": "0220087697150",
"totalClaimChargeAmount": "9006"
},
"claimReceivedDate": {
"date": "20200327",
"dateTimeQualifier": "050"
},
"crossoverCarrier": {
"entityIdentifierCode": "TT",
"entityTypeQualifier": "2",
"identificationCode": "00268",
"identificationCodeQualifier": "PI",
"name": "HUMANA, INC."
},
"outpatientAdjudication": {
"claimPaymentRemarkCode1": "MA01",
"claimPaymentRemarkCode2": "MA15",
"claimPaymentRemarkCode3": "MA18"
},
"patientName": {
"entityIdentifierCode": "QC",
"entityTypeQualifier": "1",
"firstName": "JANE",
"identificationCode": "7SL5RA7XR19",
"identificationCodeQualifier": "MI",
"name": "DOE"
},
"renderingProvider": {
"entityIdentifierCode": "82",
"entityTypeQualifier": "1",
"identificationCode": "1234567893",
"identificationCodeQualifier": "XX"
...
Updated 9 months ago
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