835 Outbound Sample Profile Overview

When you process numerous claims, batching the data based on various parameters allows you to improve the processing flow. Edifecs XEServer allows you to receive and return data in batches. This sample profile shows you how to batches 835 Healthcare Claim Payment/Advice transactions by "Line of Business" (LOB) based on the Scheduler batching strategy.

Profile Location

Edifecs Library / Best Practices / HIPAA Interactions / 835 Outbound

Requirements

Edifecs Products
  • Edifecs XEngine 9.1 or later
  • Edifecs XEServer 9.1 or later
  • Edifecs Application Manager (EAM) 9.1 or later
  • HIPAA Version V5010A (Standards Release Number 8.8.14 or later)
Other
  • MS SQL or Oracle database

Prerequisites

Set up Batcher

Before you can use the profile, you should set up the Batcher system:

  1. Create a new Batcher configuration named Batcher.
  2. Create a new Batcher Channel named 835Processing.

  3. Define the completion strategy for the 835Processing Channel and declare the following fields:

    Field Value
    Strategy status Enabled
    Strategy type Scheduler
    Strategy name 835Processing
    Criteria 0 /1 0-23 * * ? *

    (a time expression that is triggered every minute)
  4. Select the newly created Batcher configuration to be used by the XEServer Batcher service.

Sample Data

The directory ${XESProfileConfig}/samples has three sample files:

  1. 835-Good_3TRX-1LOB.dat contains 3 Good transactions (TRX) having LOB "CYBIL MENTAL HOSPITAL"

  2. 835-Good_3TRX-Error_1TRX-2LOB.dat contains:

    • 2 Good transactions with the LOB "CYBIL MENTAL HOSPITAL"
    • 1 Invalid transaction with the LOB "CYBIL MENTAL HOSPITAL"
    • 1 Good transaction with the LOB "SAINT JOSEPH MEDICAL CENTER".

  3. 835-Good_4TRX-2LOB.dat contains:

    • 3 Good transactions with the LOB "SAINT JOSEPH MEDICAL CENTER"
    • 1 Good transaction with the LOB "SAINT JOSEPH MEDICAL CENTER".

Test 1

  1. Start the profile. Verify that all the required routes have been started.
  2. Copy the sample 835-Good_3TRX-1LOB.dat file from the directory ${XESProfileConfig}\samples to the directory ${XESWorkspace}test-data\inbound.

Expected Results

  • The directory ${XESWorkspace}\test-data\outbound\Results\CYBIL MENTAL HOSPITAL contains the file CYBIL MENTAL HOSPITAL-3_TRX-at_-.dat with three transactions.
  • The directory ${XESWorkspace}\test-data\outbound\Archive\Reports contains the LDNS and Summary reports.

Test 2

  1. Start the profile. Verify that all the required routes have been started.
  2. Copy the two sample files 835-Good_3TRX-1LOB.dat and 835-Good_3TRX-Error_1TRX-2LOB.dat to ${XESWorkspace}\test-data\inbound.

Expected Results

  • The directory ${XESWorkspace}\test-data\outbound\Results\CYBIL MENTAL HOSPITAL contains the file CYBIL MENTAL HOSPITAL-5_TRX-at_-.dat with five transactions as a result of batching two inbound files.
  • The directory ${XESWorkspace}\test-data\outbound\Results\SAINT JOSEPH MEDICAL CENTER contains the file SAINT JOSEPH MEDICAL CENTER_TRX-at_-.dat with one transaction as a result of batching two inbound files.
  • The directory ${XESWorkspace}\test-data\outbound\Archive\Reports contains the relevant LDNS and Summary reports.
  • The directory ${XESWorkspace}\test-data\outbound\Archive\BadTransactions contains a file with one error transaction.

Test 3

  1. Start the profile. Verify that all the required routes have been started.
  2. Copy the three sample files 835-Good_3TRX-1LOB.dat, 835-Good_3TRX-Error_1TRX-2LOB.dat, and 835-Good_4TRX-2LOB.dat to ${XESWorkspace}\test-data\inbound.

Expected Results

  • The directory ${XESWorkspace}\test-data\outbound\Results\CYBIL MENTAL HOSPITAL contains the file CYBIL MENTAL HOSPITAL-8_TRX-at_-.dat with eight transactions as a result of batching three inbound files.
  • The directory ${XESWorkspace}\test-data\outbound\Results\SAINT JOSEPH MEDICAL CENTER contains the file SAINT JOSEPH MEDICAL CENTER-2_TRX-at_-.dat with two transactions as a result of batching three inbound files.
  • The directory ${XESWorkspace}\test-data\outbound\Archive\Reports contains the relevant LDNS and Summary reports.
  • The directory ${XESWorkspace}\test-data\outbound\Archive\BadTransactions contains the file with one error transaction.