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This chapter briefly introduces the X12 standard and Ensemble support for X12. It contains the following sections:

Introduction to X12

The American National Standards Institute (ANSI) founded the Accredited Standards Committee (ASC) X12 as a cross-industry forum to build and support electronic data exchange standards, related documents and products intended for worldwide use. Thus, X12 is the ANSI standard for Electronic Data Interchange (EDI). There are more than 300 document types defined. No X12 document type is excluded from Ensemble support, but most of the focus at InterSystems has been on the documents related to the Health Insurance Portability and Accountability Act (HIPAA).

X12 and HIPAA

Title II of HIPAA, the Administrative Simplification (AS) provisions, requires the establishment of national standards for electronic healthcare transactions and national identifiers for providers, health insurance plans, and employers. The AS provisions also address the security and privacy of health data. The standards are meant to improve the efficiency and effectiveness of the healthcare system in the United States by encouraging the widespread use of electronic data interchange in the US healthcare system.

Among the X12 documents that specifically support HIPAA are:

  • 270_X092: Eligibility, Coverage or Benefit Inquiry

  • 271_X092: Eligibility, Coverage or Benefit Information

  • 276_X093: Healthcare Claim Status Request

  • 277_X093: Healthcare Claim Status Notification

  • 278_X094Request: Healthcare Service Review (Request)

  • 278_X094Response: Healthcare Service Review (Response)

  • 820_X061: Payment Order/Remittance Advice

  • 834_X095: Benefit Enrollment and Maintenance

  • 835_X091: Healthcare Claim Payment/Advice

  • 837_X096: Healthcare Claim: Institutional

  • 837_X097: Healthcare Claim: Dental

  • 837_X098: Healthcare Claim: Professional

Ensemble comes prepackaged with HIPAA 4010 and HIPAA 5010 Schemas installed. HIPAA 5010 provides additional documents for health insurance exchange including 277CA, 820hix, 837apD, 837apI, 837apP, and 999.

Standard Exchange Format (SEF) Files

The X12 Standards describe in detail the syntax and semantics of documents. These descriptions are available as PDF files from the official publisher, Washington Publishing Company:

http://www.wpc-edi.comOpens in a new tab

While informative, the documents are not intended to be machine readable. That is where SEF files come in. The SEF file encodes the syntax and much of the semantics of an EDI document. For example, not only does it specify the size and types of fields and any code values which may be applicable, but it also defines dependencies between fields and dependencies between segments within documents. The SEF standard was developed by Foresight Corporation to encode any EDI specification (not just X12) and put into the public domain. You can download a printable version of the standard from: in a new tab

This information is worth examining, as it will give you an idea of the scope and complexity of EDI. Many organizations have encoded various EDI standards and made them available to the public. In addition, the United States Department of Defense has published many SEF files for their acquisition systems.

Ensemble Support for X12 Documents

Ensemble stores X12 documents as type of Caché object called a virtual document to enable faster processing. Specifically, an X12 document is stored as an EnsLib.EDI.X12.Document where each segment of the X12 document is stored as an EnsLib.EDI.X12.Segment. X12 Interchanges are also stored as an EnsLib.EDI.X12.Document with pointers to the other X12 documents contained within. Segments and Elements of a Transaction Set are reached by using a virtual property path. For example, the identifier code of a given Transaction Set would be accessed by virtual property path “ST:TransactionSetIdentifierCode”. See Parsing the Document for more information.

Ensemble provides tools so that you can access values in virtual documents for use in data transformations, business rules, and searching and filtering messages. For background information, see Ensemble Virtual Documents.

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