You may need to enable Pop-Ups through your browser preferences/options.
Do Not Use Live, Real, or Private data.
Presently this is a free service. This may change in the near future.
Initially, you will be able to make 10 requests. After the 10th request you will be prompted to send an email requesting more transactions.
We will update your request count once we receive the email.
If your document contains carriage return or new line characters then be sure your segment delimiters are removed.
Most of the rules have been validated BUT there MAY be some errors in the definitions.
For all documents - the GS08 "480" must contain the HIPAA Version/Release/Industry Identifier Code
At this time the addenda definitions are built as defined below, as of Aug, 2002
If you don't use the correct GS08 format the application will fall back to the standard X12-4010
addenda versions apply.
270 - 005010X279
271 - 005010X279
276 - 005010X212
277 - 005010X212
278 - 005010X217
820 - 005010X218
834 - 005010X220
835 - 005010X221
Institutional - 005010X223
Dental - 005010X224
Professional - 004010X098 and 005010X222
For example:GS*HN*SENDER CODE*RECEIVER CODE*19940331*0802*1*X*005010X222
For 278 Documents - either the ISA06 \"I06\" must contain the 278 (response/request) type:
example for request
ISA*00* *01* SECRET *ZZ*request *ZZ*RECEIVERS ID *930602*1253*U*00501*000000905*1*T*:
example for response
ISA*00* *01* SECRET *ZZ*response *ZZ*RECEIVERS ID *930602*1253*U*00501*000000905*1*T*:
Note the use of lower case characters.
Several IDDE code fields are not validated such as ICDs, DRG, etc.
Presently there is no support for 277-004010X104
We reserve the right to limit the number of test transactions you use.