HIPAA EDI 837 Transaction Terminology
Segments are what make up an EDI document, incl. HIPAA EDI 837 transaction. Segments consist of data elements that are logically related. The following is an example of the Claim segment:
CLM*ABC7001*145.5***11:B:1*Y*A*Y*Y
Segment Terminator: These are the special characters appearing at the end of a segment to indicate the termination of the segment (e.g., N/L). Sometimes, you cannot see them in HIPAA EDI 837 transaction, for example, like the carriage-return-line-feed in the example above is not visible to the human eye, but it does exist. Sometimes they are visible and may look like this:
HL*1**20*1~PRV*BI*PXC*207Q00000X
The HL and PRV segments are separated by the tilde character ~.
Data Element and Element Delimiters
The data element is the smallest item in the EDI data. It is similar to a field in a database. The elements contain the actual data. They consist of qualifiers and values.
HL*1**20*1~PRV*BI*PXC*207Q00000X
To illustrate this, the segments above are bold and the data elements are italic.
Element Delimiter: The data element delimiter is a special character that separates the data elements.
HL*1**20*1~PRV*BI*PXC*207Q00000X
In this case the element delimiter is an asterisk character.
Suggested Values For Delimiters
| Suggested Values For Delimiters | ||
| Data Element Separator | * | Asterisk |
| Sub-Element Separator | : | Colon |
| Segment Terminator | ~ | Tilde |
| Repetition Separator | ^ | Caret |
Qualifier
A qualifier is sometimes used to indicate what the values in the data elements are. In the following example DTP-01 = 472 means “Service Date” and the DTP-02 element is the Date Time Period Format Qualifier ‘D8’ means “Date Expressed in Format CCYYMMDD”.
DTP*472*D8*20081121~
In the following example DTP-02 = RD8 which means “Range of Dates Expressed in Format CCYYMMDD-CCYYMMDD”.
DTP*472*RD8*20081121-20091122~
There are more than 100 qualifiers available in the EDI standards just for the date and time segments. Using qualifiers eliminates the need to have dedicated fields. For example, CLM-02 is the Claim Charge Amount. CLM-02 does not need a qualifier. In the case of date types, with more than 100 possibilities, it would be inefficient and cumbersome to allot a dedicated field to each one.
Composite Data Elements
Are a set of sub-elements that represent a single named item. Thinking of them as a set of child elements of a regular data element can be helpful. For example the SVC segment has seven regular elements and two composite (sub-elements) elements. In the example the composite elements are highlighted in bold and the simple elements are highlighted in italic.
SVC01 C003 Composite Medical Procedure Identifier
SVC01 – 1 – Sub Element
SVC01 – 2 – Sub Element
SVC01 – 3 – Sub Element
SVC01 – 4 – Sub Element
SVC01 – 5 – Sub Element
SVC01 – 6 – Sub Element
SVC01 – 7 – Sub Element
SVC02 Monetary Amount
SVC03 Monetary Amount
SVC04 Product/Service
SVC05 Quantity
SVC06 C003 Composite Medical Procedure
SVC06 – 1 – Sub Element
SVC06 – 2 – Sub Element
SVC06 – 3 – Sub Element
SVC06 – 4 – Sub Element
SVC06 – 5 – Sub Element
SVC06 – 6 – Sub Element
SVC06– 7 – Sub Element
SVC07 Quantity
The regular element separator separates SVC01, SVC02, SVC03, SVC04, SVC05, SVC06, SVC07 and the sub-element separator separates the sub-elements in SVC01 and SVC06. In the example below the element separator is an asterisk * the sub-element separator is a colon : (defined in ISA-16 element), and segment the Terminator is “~”, the SVC segment can look like this (only using SVC01-01 and SVC01-02 in the example):
SVC*HC:99214*600*340 ~
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