Description

When an EDI 837P Project is created in GenRocket, the entire Transaction Set is enabled. Of course, when you are testing a Transaction Set, not every Segment or Loop will be needed to complete each test or to achieve a specific Business Scenario. 


Test Data Cases can be used to not only perform specific types of testing, but also to create certain Business Case Scenarios, such as a Commercial Health Insurance (shown in this example). This can be accomplished by: 

  1. Creating a Test Data Case
  2. Disabling EDI Segments and Loops within the Test Data Case
  3. Adding any Additionally Needed EDI 837P Segments to the Test Data Case
  4. Altering Loop Counts for Test Data Case Segments
  5. Adding Attributes to Test Data Case Domains for Enabled Segments
  6. Altering Each Added Attribute's Generator Configuration


Prerequisites

  • Create an EDI 837P Project in GenRocket
  • Customize Transaction Set Based on Specific Needs (Review Attributes and Replace Generators as needed)
  • Validate Output File Prior to Configuring Test Data Cases
  • Created Test Data Case Suite and Test Data Category (Integration for this example)

Business Case Scenario 1

This EDI 837P Business Case Scenario will show how to set up Test Data Case for a Commercial Health Insurance claim. 


Important: Please note that this is a sample for tutorial purposes and has been designed to show how Test Data Cases can be used to accomplish your EDI 837P Business Case objectives. The provided EDI Test Data Case samples can be copied and modified to meet your specific testing needs. 


The instructions in this tutorial will show how to configure a Test Data Case to achieve the X12 Syntax displayed below:

 

X12 Syntax for Example


Recommended Action

The example below shows how the provided Business Case Scenario was created and modified to achieve a specified testing goal. 


It is recommended to copy one of the provided Test Data Case Business Case Scenarios and modify it using the same methods below to meet your specific testing needs.



Story

This Story shows how to file a Commercial Health Insurance Claim by configuring an EDI Test Data Case based on the Business Case Scenario Syntax above. 


Step 1: Create a Test Data Case (or Copy an Existing Case to Modify)

  • Access the Test Data Cases (G-Case) Dashboard and select the Test Data Case Suite.
  • Select the Test Data Category within the Dashboard.
  • Click the Create New G-Case button.



  • Enter a Name and Description.

  • Click the Save button.


Note: To copy a Business Scenario Test Data Case, click the Copy icon within the Actions column for the appropriate Test Data Case. 


Step 2: Disable Segments and Loops for the Segment

The EDI Project will be created with all Headers, Segments, and Trailers that make up an EDI 837P Transaction. By default, every Segment and Loop will be enabled for the EDI 837P Project.


Segments and Loops can be disabled or turned "off" directly within the G-Case Dashboard. To do so, complete the following steps: 

  • Click the drop-down menu in the top left corner of the  Dashboard and choose EDI View.


  • Click on the EDI Tree icon on the G-Case Editor tab.



  • Use each checkbox to enable or disable a Segment, Loop, or Element. A checkmark means the item is currently enabled.



  • Expand Segments and Loops within the EDI Tree View to make additional changes. In this example, Loop_2000B has been expanded. 

     
  • Click OK once finished.


Note: When Segments, Loops, and Elements are disabled within the Tree View, specific Segments will be added automatically and enabled or disabled depending on your selections. 


These items have been disabled within the EDI Tree View:

Loop_1000A > PER_SubmitterEDIContactInformation_1000A

  • PER07_ComunicationsNumberQualifier
  • PER08_CommunicationNumber



Loop_2000A

  • CUR_ForeignCurrencyInformation_2000A
  • Loop_2010AC



Loop_2000A > Loop_2010AA

  • REF_BillingProviderUPINLicenseInformation_2010AA
  • PER_BillingProviderContactInformation_2010AA


Loop_2000A > Loop_2000B

  • PAT_PatientInformation_2000B



Loop_2000A > Loop_2000B > SBR_SubscriberInformation_2000B

  • SBR02_IndividualRelationshipCode
  • SBR04_SubscriberGroupName



Loop_2000A > Loop_2000B > Loop_2010BA

  • REF_SubscriberSecondaryIdentification_2010BA
  • REF_PropertyAndCasualtyClaimNumber_2010BA
  • PER_PropertyAndCasualtyContactInformation_2010BA



Loop_2000A > Loop_2000B > Loop_2010BA > NM1_SubscriberName_2010BA

  • NM107_SubscriberNameSuffix



Loop_2000A > Loop_2000B > Loop_2010BB

  • REF_PayerSecondaryIdentification_2010BB



Loop_2000A > Loop>2000B > Loop_2000C > PAT_PatientInformation_2000C

  • PAT05_DateTimePeriodFormatQualifier
  • PAT06_PatientDeathDate
  • PAT07_UnitOrBasisForMeasurementCode
  • PAT08_PatientWeight
  • PAT09_PregnancyIndicator



Loop_2000A > Loop_2000B > Loop_2000C > Loop_2010CA

  • REF_PropertyAndCasualtyClaimNumer_2010CA
  • REF_PropertyAndCasualtyPatientIdentifier_2010CA
  • PER_PropertyAndCasualtyPatientContactInformation_2010CA



Loop_2000A > Loop_2000B > Loop_2000C > Loop_2300V1 

  • DTP_DateOnsetOfCurrentIllnessOrSymptom2300V1
  • DTP_DateInitialTreatmentDate_2300V1
  • DTP_DateLastSeenDate_2300V1
  • DTP_DateAcuteManifestation_2300V1
  • DTP_DateAccident_2300V1
  • DTP_DateLastMenstrualPeriod_2300V1
  • DTP_DateLastXrayDate_2300V1
  • DTP_DateHearingandVisionPrescriptionDate_2300V1
  • DTP_DateDisabilityDates_2300V1
  • DTP_DateLastWorked_2300V1
  • DTP_DateAuthorizedReturnToWork_2300V1
  • DTP_DateAdmission_2300V1
  • DTP_DateDischarge_2300V1
  • DTP_DateAssumedAndRelinquishedCareDates_2300V1
  • DTP_DatePropertyAndCasualtyDateOfFirstContact_2300V1
  • DTP_DateRepricerReceivedDate_2300V1



  • PWK_ClaimSupplementalInformation_2300V1
  • CN1_ContactInformation_2300V1
  • AMT_PatientAmountPaid_2300V1
  • REF_ServiceAuthorizationExceptionCode_2300V1
  • REF_MandatoryMedicareSection4081CrossoverIndicator_2300V1
  • REF_MammographyCertificationNumber_2300V1
  • REF_ReferralNumber_2300V1
  • REF_PriorAuthorization_2300V1
  • REF_PayerClaimControlNumber_2300V1
  • REF_ClinicalLaboratoryImprovementAmendmentCLIANumber_2300V1
  • REF_RepricedClaimNumber_2300V1
  • REF_AdjustedRepricedClaimNumber_2300V1
  • REF_InvestigationalDeviceExemptionNumber_2300V1
  • REF_MedicalRecordNumber_2300V1
  • REF_DemonstrationProjectIdentifier_2300V1
  • REF_CarePlanOversight_2300V1
  • K3_FileInformation_2300V1


 

  • NTE_ClaimNote_2300V1
  • CR1_AmbulanceTransportInformation_2300V1
  • CR2_SpinalManipulationServiceInformation2300V1
  • CRC_AmbulanceCertification_2300V1
  • CRC_PatientConditionInformationVision2300V1
  • CRC_HomeboundIndicator_2300V1
  • CRC_EPSDTReferral_2300V1
  • HI_AnesthesiaRelatedProcedure_2300V1
  • HI_ConditionInformation_2300V1
  • HCP_ClaimPricingRepricingInformation_2300V1
  • Loop_2310AV1
  • Loop_2310BV1
  • Loop_2310CV1
  • Loop_2310DV1
  • Loop_2310EV1
  • Loop_2310FV1
  • Loop_2320V1




Loop_2000A > Loop_2000B > Loop_2000C > Loop_2300V1 > CLM_ClaimInformation_2300V1

  • CLM10_PatientSignatureSourceCode
  • CLM12_SpecialProgramIndicator
  • CLM20_DelayReasonCode




Loop_2000A >Loop_2000B > Loop_2000C > Loop_2300V1 > HI_HealthCareDiagnosisCode_2300V1

  • HI03_V1HealthCareCodeInformation_2300V1
  • HI04_V1HealthCareCodeInformation_2300V1
  • HI05_V1HealthCareCodeInformation_2300V1
  • HI06_V1HealthCareCodeInformation_2300V1
  • HI07_V1HealthCareCodeInformation_2300V1
  • HI08_V1HealthCareCodeInformation_2300V1
  • HI09_V1HealthCareCodeInformation_2300V1
  • HI10_V1HealthCareCodeInformation_2300V1
  • HI11_V1HealthCareCodeInformation_2300V1
  • HI12_V1HealthCareCodeInformation_2300V1



Loop_2000A > Loop_2000B > Loop_2000C > Loop_2300V1 > Loop_2400V1

  • SV5_DurablemedicalEquipmentService_2400V1
  • PWK_LineSupplementalInformation_2400V1
  • PWK_DurableMedicalEquipmentCertificateOfMedicalNecessityIndicator_2400V1
  • CR1_AmbulanceTransportInformation_2400V1
  • CR3_DurableMedicalEquipmentCertificatation_2400V1
  • CRC_AmbulanceCertification_2400V1
  • CRC_HospiceEmployeeIndicator_2400V1
  • CRC_ConditionIndicatorDurableMedicalEquipment_2400V1
  • DTP_DatePrescriptionDate_2400V1
  • DTP_DATECertificationRevisionRecertificationDate_2400V1
  • DTP_DateBeganTherapyDate_2400V1
  • DTP_DateLastCertificationDate_2400V1
  • DTP_DateLastSeenDate_2400V1



  • DTP_DateTestDate_2400V1
  • DTP_DateShippedDate_2400V1
  • DTP_DateLastXrayDate_2400V1
  • DTP_DateInitialTreatmentDate_2400V1
  • QTY_AmbulancePatientCount_2400V1
  • QTY_ObstetricAnesthesiaAdditionalUnits_2400V1
  • MEA_TestResult_2400V1
  • CN1_ContactInformation_2400V1
  • REF_RepricedLineItemReferenceNumber_2400V1
  • REF_AdjustedRepricedLineItemReferenceNumber_2400V1
  • REF_PriorAuthorization_2400V1
  • REF_LineItemCountControlNumber_2400V1
  • REF_MamographyCertificationNumber_2400V1
  • REF_ClinicalLaboratoryImprovementAmendmentCLIANumber_2400V1
  • REF_ReferringClinicalLaboratoryImprovementAmendmentCLIAFacilityIdentification_2400V1
  • REF_ImmunizationBatchNumber_2400V1
  • REF_ReferralNumber_2400V1


  • AMT_SalesTaxAmt_2400V1
  • AMT_PostageClaimedAmount_2400V1
  • K3_FileInformation_24001
  • NTE_LineNote_2400V1
  • NTE_ThirdPartyOrganizationNotes_2400V1
  • PS1_PurchasedServiceInformation_2400V1
  • HCP_LinePricingRepricingInformation_2400V1
  • Loop_2410V1
  • Loop_2420AV1
  • Loop_2420BV1
  • Loop_2420CV1
  • Loop_2420DV1
  • Loop_2420EV1
  • Loop_2420FV1
  • Loop_2420GV1
  • Loop_2420HV1
  • Loop_2430V1
  • Loop_2440V1


Step 3: Add Additional Required Segments to the Test Data Case

Depending on what has been disabled within the Tree View, you may need to add additional Segments or Loops to the Test Data Case. The Tree View is designed to make this process easier; however, sometimes you will need to add one or more Segments or Loops to test a specific Business Case Scenario. 


The basic steps to add each Segment/Loop are shown below: 

  • Use the Filter to locate each needed Segment. For this example "BHT" has been entered to find this Segment: BHT_BeginningOfHiearchicalTransaction.

  • Next, click the Plus (+) icon located to the right of the Segment within the G-Case Editor tab.



  • Once finished, the added Segments will appear in the table located on the right of the G-Case Editor tab. Segments added this way are automatically enabled and will appear at the bottom of the list. 


Note: You can click, drag, and drop a Segment into another location within the list to better organize enabled Segments. 


The following additional Segments will need to be added for this example: 

  • BHT_BeginningOfHierarchicalTransaction
  • HI01_V1HealthCareCodeInformation_2300V1
  • HI02_V1HealthCareCodeInformation_2300V1
  • NM1_SubmitterName_1000A
  • NM1_ReceiverName_1000B
  • PRV_BillingProviderSpecialtyInformation_2000A
  • NM1_BillingProviderName_2010AA
  • REF_BillingProviderTaxIdentification_2010AA
  • NM1_PayerName_2010BB
  • REF_BillingProviderSecondaryIndentification_2010BB
  • CLM05_HealthCareServiceLocationInformation_2300V1
  • REF_ClaimIdentifierForTransmissionIntermediaries_2300V1
  • Loop_2400V1
  • DTP_DateServiceDate_2400V1


Step 4: Change Loop_2400V1 Loop Count to 4

The Loop Count for each Test Data Case Segment/Loop will default to the loopCount Global Variable value. For this example, the Loop Count for Loop_2400V1 will need to be changed to 4 because there will be 4 iterations: 



Complete these steps to change the value: 

  • Click on the Update Loop Count for Domain icon in the Actions column.



  • Enter 4 for the Loop Count and then click the Save button.



  • Loop_2400V1 will now have a 4, as shown below:


Step 5: Add and Configure Attributes for BHT_BeginningOfHierarchicalTransaction 

In some instances, you may need to make changes to the generated data for a specific Test Data Case to match the Business Case Scenario. This can be done by adding a Attribute to the Test Data Case Domain for the Segment and altering the Generator Configuration or assigning a different Generator to an Attribute.


For this example, the BHT_BeginningOfHierarchicalTransaction test data configuration will need to match the following X12 Syntax:



Based on the syntax above, the following Attribute will need to be added and modified to generate this test data: 

  • encounterIdentifier06 = CH


Step 5a: Add the encounterIdentifier06 Attribute to the Test Data Case Domain

Complete the following steps to view the Test Data Case Domain for the Segment and add Attributes with the required test data:

  • Click the Edit Test Data Case Domain icon in the Actions column.


  • Click the Plus (+) button to add one or more Attributes to the Test Data Case Domain.


  • In the dialog window, tick the checkbox for the encounterIdentifier06 Attribute that needs to be added.

  • Click the Save button once finished.


  • The Attribute will be added to the Test Data Case Domain, as shown below:


Step 5b: Modify the encounterIdentifier06 Attribute Generator Configuration

The encounterIdentifier06 Attribute Generator, by default, has 3 identifiers: CH, RP, and 31. For this sample, only CH is needed. You will need to modify the Generator configuration so that only CH is generated. Complete the steps below: 

  • Click on the encounterIdentifier06 Attribute.


  • Click on a value within the list to select it and then click the Remove button. This will need to be done twice to remove each value from the Attribute.


  • The configuration will appear as shown below. Click the Save Generator button.


Completed Test Data for BHT_BeginningOfHierarchicalTransaction Segment


Step 6: Add and Configure Attributes for NM1_SubmitterName_1000A

For this example, the NM1_SubmitterName_1000A Segment test data configuration will need to match the following X12 Syntax: 



Based on the syntax above, the following Attributes will need to be added and modified to generate this test data: 

  • typeQualifier102 = 2
  • organizationName103 = PREMIER BILLING SERVICE 
  • submitterIdentifier109 = TGJ23


Step 6a: Add the Attributes to the Test Data Case Domain

Complete the following steps to view the Test Data Case Domain for the Segment and add Attributes with the required test data:

  • Click the Edit Test Data Case Domain icon in the Actions column.



  • Click the Plus (+) button to add one or more Attributes to the Test Data Case Domain.


  • In the dialog window, tick the checkbox for each Attribute that needs to be added.

  • Click the Save button once finished.


  • The Attributes will be added to the Test Data Case Domain, as shown below:


Step 6b: Modify the typeQualifier102 Attribute Generator Configuration

The typeQualifier102 Attribute Generator, by default, has 2 qualifiers: 1 and 2. For this sample, only 2 is needed. You will need to modify the Generator configuration so that only 2 is generated. Complete the steps below: 

  • Click on the typeQualifier102 Attribute.


  • Click on the 1 within the list to select it and then click the Remove button. 


  • Click the Save Generator button.


Step 6c: Modify the organizationName103 Attribute Generator Configuration

To change the name to match the X12 Syntax, the organizationName103 Attribute Generator will need to be replaced with the ConstantGen. 

  • Click on the organizationName103 Attribute.


  • Select the ConstantGen Generator in the Quick Generator Replacement Menu.

  • Once selected, click the Replace button to replace the current Generator.


  • Click Yes to replace the Generator.



  • Enter PREMIER BILLING SERVICE as the value and click the Save Generator button.


Step 6d: Modify the submitterIdentifier109 Attribute Generator Configuration

To change the name to match the X12 Syntax, the submitterIdentifier109 Attribute Generator will need to be replaced with the ConstantGen. 

  • Click on the submitterIdentifier109 Attribute.


  • Select the ConstantGen Generator in the Quick Generator Replacement Menu.

  • Once selected, click the Replace button to replace the current Generator.


     
  • Click Yes to replace the Generator.



  • Enter TGJ23 as the value and click the Save Generator button.


Completed Test Data for NM1_SubmitterName_1000A Segment


Step 7: Add and Configure Attributes for PER_SubmitterEDIContactInformation_1000A

For this example, the PER_SubmitterEDIContactInformation_1000A Segment test data configuration will need to match the following X12 Syntax: 



Based on the syntax above, the following Attributes will need to be added and modified to generate this test data: 

  • numberQualifier03 = TE
  • numberQualifier05 = EX

Step 7a: Add the Attributes to the Test Data Case Domain

Complete the following steps to view the Test Data Case Domain for the Segment and add Attributes with the required test data:

  • Click the Edit Test Data Case Domain icon in the Actions column.


  • Click the Plus (+) button to add one or more Attributes to the Test Data Case Domain.


  • In the dialog window, tick the checkbox for each Attribute that needs to be added.

  • Click the Save button once finished.


  • The Attributes will be added to the Test Data Case Domain, as shown below:


Step 7b: Modify the numberQualifier03 Attribute Generator Configuration

The numberQualifier03 Attribute Generator, by default, has 3 qualifiers: EM, FX, and TE. For this sample, only TE is needed. You will need to modify the Generator configuration so that only TE is generated. Complete the steps below: 

  • Click on the numberQualifier03 Attribute.


  • Click on a value within the list to select it and then click the Remove button. This step will need to be completed twice.


  • Then click the Save Generator button.


Step 7c: Modify the numberQualifier05 Attribute Generator Configuration

The numberQualifier05 Attribute Generator, by default, has 4 qualifiers: EM, EX, FX, and TE. For this sample, only EX is needed. You will need to modify the Generator configuration so that only EX is generated. Complete the steps below: 

  • Click on the numberQualifier05 Attribute.


  • Click on a value within the list to select it and then click the Remove button. This step will need to be completed 3 times.
     

  • Then click the Save Generator button.


Completed Test Data for PER_SubmitterEDIContactInformation_1000A Segment


Step 8: Add and Configure Attributes for NM1_ReceiverName_1000B

For this example, the NM1_ReceiverName_1000B Segment test data configuration will need to match the following X12 Syntax: 



Based on the syntax above, the following Attributes will need to be added and modified to generate this test data: 

  • receiverName103 = KEY INSURANCE COMPANY
  • primaryIdentifier109 = 66783JJT


Step 8a: Add the Attributes to the Test Data Case Domain

Complete the following steps to view the Test Data Case Domain for the Segment and add Attributes with the required test data:

  • Click the Edit Test Data Case Domain icon in the Actions column.


  • Click the Plus (+) button to add one or more Attributes to the Test Data Case Domain.


  • In the dialog window, tick the checkbox for each Attribute that needs to be added.

  • Click the Save button once finished.


  • The Attributes will be added to the Test Data Case Domain, as shown below:


Step 8b: Modify the receiverName103 Attribute Generator Configuration

To change the name to match the X12 Syntax, the receiverName103 Attribute Generator will need to be replaced with the ConstantGen. 

  • Click on the receiverName103 Attribute.


  • Select the ConstantGen Generator in the Quick Generator Replacement Menu.

  • Once selected, click the Replace button to replace the current Generator.



  • Click Yes to replace the Generator.



  • Enter KEY INSURANCE COMPANY as the value and click the Save Generator button.


Step 8c: Modify the primaryIdentifier109 Attribute Generator Configuration

To change the name to match the X12 Syntax, the primaryIdentifier109 Attribute Generator will need to be replaced with the ConstantGen. 

  • Click on the primaryIdentifier109 Attribute.


  • Select the ConstantGen Generator in the Quick Generator Replacement Menu.

  • Once selected, click the Replace button to replace the current Generator.


  • Click Yes to replace the Generator.



  • Enter 66783JJT as the value and click the Save Generator button.


Completed Test Data for NM1_ReceiverName_1000B Segment


Step 9: Add and Configure Attributes for PRV_BillingProviderSpecialityInformation_2000A

For this example, the PRV_BillingProviderSpecialtyInformation_2000A Segment test data configuration will need to match the following X12 Syntax: 



Based on the syntax above, the following Attributes will need to be added and modified to generate this test data: 

  • taxonomyCode03 = 203BF0100Y


Step 9a: Add the Attributes to the Test Data Case Domain

Complete the following steps to view the Test Data Case Domain for the Segment and add Attributes with the required test data:

  • Click the Edit Test Data Case Domain icon in the Actions column.


  • Click the Plus (+) button to add one or more Attributes to the Test Data Case Domain.


  • In the dialog window, tick the checkbox for each Attribute that needs to be added.

  • Click the Save button once finished.


  • The Attribute will be added to the Test Data Case Domain, as shown below:


Step 9b: Modify the taxonomyCode03 Attribute Generator Configuration

To change the name to match the X12 Syntax, the taxonomyCode03 Attribute Generator will need to be replaced with the ConstantGen. 

  • Click on the taxonomyCode03 Attribute.


  • Enter 203BF0100Y as the value and click the Save Generator button.


Completed Test Data forPRV_BillingProviderSpecialtyInformation_2000A Segment


Step 10: Add and Configure Attributes for NM1_BillingProviderName_2010AA

For this example, the NM1_BillingProviderName_2010AA Segment test data configuration will need to match the following X12 Syntax: 



Based on the syntax above, the following Attributes will need to be added and modified to generate this test data: 

  • typeQualifier102 = 2
  • organizationalName103 = BEN KILDARE SERVICE
  • providerIdentifier109 = 9876543210


Step 10a: Add the Attributes to the Test Data Case Domain

Complete the following steps to view the Test Data Case Domain for the Segment and add Attributes with the required test data:

  • Click the Edit Test Data Case Domain icon in the Actions column.


  • Click the Plus (+) button to add one or more Attributes to the Test Data Case Domain.


  • In the dialog window, tick the checkbox for each Attribute that needs to be added.

  • Click the Save button once finished.


  • The Attributes will be added to the Test Data Case Domain, as shown below:


Step 10b: Modify the typeQualifier102 Attribute Generator Configuration

The typeQualifier102 Attribute Generator, by default, has 2 qualifiers: 1 and 2. For this sample, only 2 is needed. You will need to modify the Generator configuration so that only 2 is generated. Complete the steps below: 

  • Click on the typeQualifier102 Attribute.


  • Click on the 1 within the list to select it and then click the Remove button. 


  • Then click the Save Generator button.


Step 10c: Modify the organizationName103 Attribute Generator Configuration

To change the name to match the X12 Syntax, the organizationName103 Attribute Generator will need to be replaced with the ConstantGen. 

  • Click on the organizationName103 Attribute.

  • Select the ConstantGen Generator in the Quick Generator Replacement Menu.

  • Once selected, click the Replace button to replace the current Generator.


  • Click Yes to replace the Generator.



  • Enter BEN KILDARE SERVICE as the value and click the Save Generator button.


Step 10d: Modify the providerIdentifier109 Attribute Generator Configuration

To change the name to match the X12 Syntax, providerIdentifier109 Attribute Generator will need to be replaced with the ConstantGen. 

  • Click on the providerIdentifier109 Attribute.


  • Select the ConstantGen Generator in the Quick Generator Replacement Menu.

  • Once selected, click the Replace button to replace the current Generator.


  • Enter 987654321 as the value and click the Save Generator button.


Completed Test Data for NM1_BillingProviderName_2010AA Segment


Step 11: N3_BillingProviderAddress_2010AA & N4_BillingProviderLocation (Optional)

For this example, no changes have been made to these Segments. This is because the assigned Generators automatically create synthetic data to match the required information. However, you can modify this information to be a specified street address, city, state, etc.


The X12 Syntax for this example appears as shown below for these 2 segments: 



Step 12: Add and Configure Attributes for REF_BillingProviderTaxIdentification_2010AA

For this example, the REF_BillingProviderTaxIdentification_2010AA Segment test data configuration will need to match the following X12 Syntax: 



Based on the syntax above, the following Attributes will need to be added and modified to generate this test data: 

  • identificationQualifier01 = El
  • identificationNumber02 = 587654321


Step 12a: Add the Attributes to the Test Data Case Domain

Complete the following steps to view the Test Data Case Domain for the Segment and add Attributes with the required test data:

  • Click the Edit Test Data Case Domain icon in the Actions column.


  • Click the Plus (+) button to add one or more Attributes to the Test Data Case Domain.


  • In the dialog window, tick the checkbox for each Attribute that needs to be added.

  • Click the Save button once finished.



  • The Attribute will be added to the Test Data Case Domain, as shown below:


Step 12b: Modify the identificationQualifier01 Attribute Generator Configuration

The identificationQualifier01 Attribute Generator, by default, has 2 qualifiers: EI and SY. For this sample, only EI is needed. You will need to modify the Generator configuration so that only EI is generated. Complete the steps below: 

  • Click on the identificationQualifier01 Attribute.


  • Click on the SY value within the list to select it and then click the Remove button.
     
  • Then click the Save Generator button.


Step 12c: Modify the identificationNumber02 Attribute Generator Configuration

To change the name to match the X12 Syntax, identificationNumber02 Attribute Generator will need to be replaced with the ConstantGen. 

  • Click on the identificationNumber02 Attribute.


  • Select the ConstantGen Generator in the Quick Generator Replacement Menu.

  • Once selected, click the Replace button to replace the current Generator.


  • Enter 587654321 as the value and click the Save Generator button.



Completed Test Data for REF_BillingProviderTaxIdentification_2010AA Segment


Step 13: NM1_PayToAddressName_2010AB, N3_PayToAddressADDRESS_2010AB, and N4_PayToAddressCityStateZIPCode_2010AB (Optional)

For this example, no changes have been made these Segment Attribute Generator configurations. This is because the assigned Generators automatically generate synthetic test data. They can be altered if desired following the same methods used in this tutorial. 


The current configuration for these Segments matches the following X12 Syntax: 


Step 14: Add and Configure Attributes for SBR_SubscriberInformation_2000B

For this example, the SBR_SubscriberInformation_2000B Segment test data configuration will need to match the following X12 Syntax: 



Based on the syntax above, the following Attributes will need to be added and modified to generate this test data: 

  • numberCode01 = P
  • policyNumber03 = 2222-SJ
  • indicatorCode09 = Cl


Step 14a: Add the Attributes to the Test Data Case Domain

Complete the following steps to view the Test Data Case Domain for the Segment and add Attributes with the required test data:

  • Click the Edit Test Data Case Domain icon in the Actions column.


  • Click the Plus (+) button to add one or more Attributes to the Test Data Case Domain.



  • In the dialog window, tick the checkbox for each Attribute that needs to be added.

  • Click the Save button once finished.



  • The Attributes will be added to the Test Data Case Domain, as shown below:


Step 14b: Modify the numberCode01 Attribute Generator Configuration

The numberCode01 Attribute Generator, by default, has several codes: A, B, C, D, E, F, G, H, P, S, T, and U. For this sample, only P is needed. You will need to modify the Generator configuration so that only P is generated. Complete the steps below: 

  • Click on the numberCode01 Attribute.


  • Click on a value within the list to select it and then click the Remove button. This step will need to be completed several times.
     

  • Then click the Save Generator button.


Step 14c: Modify the policyNumber03 Attribute Generator Configuration

The value for the policyNumber03 Attribute Generator will need to be changed to: 2222-SJ. Complete the steps below: 

  • Click on the policyNumber03 Attribute.


  • Enter 2222-SJ as the value and then click the Save Generator button.


Step 14d: Modify the indicatorCode09 Attribute Generator Configuration

The indicatorCode09 Attribute Generator, by default, has several codes: 11, 12, 13, 14, 15, 16, 17, etc.. For this sample, only CI is needed. You will need to modify the Generator configuration so that only CI is generated. Complete the steps below: 

  • Click on indicatorCode09 Attribute.

     

  • Click on a value within the list to select it and then click the Remove button. This step will need to be performed several times. 
     
    Note: In an instance such as above, you could also replace the current Generator with the ConstantGen Generator and enter the CI as the value. 

  • Click the Save Generator button.


Completed Test Data for SBR_SubscriberInformation_2000B Segment



Step 15: Add and Configure Attributes for NM1_SubscriberName_2010BA

For this example, the NM1_SubscriberName_2010BA Segment test data configuration will need to match the following X12 Syntax: 


Based on the syntax above, the following Attributes will need to be added and modified to generate this test data: 

  • typeQualifier102 = 1
  • codeQualifier108 = MI


Step 15a: Add the Attributes to the Test Data Case Domain

Complete the following steps to view the Test Data Case Domain for the Segment and add Attributes with the required test data:

  • Click the Edit Test Data Case Domain icon in the Actions column.


  • Click the Plus (+) button to add one or more Attributes to the Test Data Case Domain.



  • In the dialog window, tick the checkbox for each Attribute that needs to be added.

  • Click the Save button once finished.



  • The Attribute will be added to the Test Data Case Domain, as shown below:


Step 15b: Modify the typeQualifier102 Attribute Generator Configuration

The typeQualifier102 Attribute Generator, by default, has 2 qualifiers: 1 and 2. For this sample, only 1 is needed. You will need to modify the Generator configuration so that only 1 is generated. Complete the steps below: 

  • Click on typeQualfier102 Attribute.

     

  • Click on the 2 within the list to select it and then click the Remove button.
     
  • Then click the Save Generator button.


Step 15c: Modify the codeQualifier108 Attribute Generator Configuration

The codeQualifier108 Attribute Generator, by default, has 2 qualifiers: II and MI. For this sample, only MI is needed. You will need to modify the Generator configuration so that only MI is generated. Complete the steps below: 

  • Click on codeQualifier108 Attribute.

     

  • Click on the II within the list to select it and then click the Remove button.
     
  • Then click the Save Generator button.


Completed Test Data for NM1_SubscriberName_2010BA Segment


Step 16: DMG_SubscriberDemographicInformation_2010BA (Optional)

For this example, no changes have been made to this Segment. This is because the assigned Generators automatically create synthetic data to match the required information. However, you can modify this information if needed.


The X12 Syntax for this example appears as shown below for this Segment: 



Step 17: Add and Configure Attributes for NM1_PayerName_2010BB

For this example, the NM1_PayerName_2010BB Segment test data configuration will need to match the following X12 Syntax: 


Based on the syntax above, the following Attributes will need to be added and modified to generate this test data: 

  • payerName103 = KEY INSURANCE COMPANY
  • codeQualifier108 = PI
  • payerIdentifier109 = 999996666


Step 17a: Add the Attributes to the Test Data Case Domain

Complete the following steps to view the Test Data Case Domain for the Segment and add Attributes with the required test data:

  • Click the Edit Test Data Case Domain icon in the Actions column.


  • Click the Plus (+) button to add one or more Attributes to the Test Data Case Domain.



  • In the dialog window, tick the checkbox for each Attribute that needs to be added.

  • Click the Save button once finished.



  • The Attributes will be added to the Test Data Case Domain, as shown below:


Step 17b: Modify the payerName103 Attribute Generator Configuration

To change the name to match the X12 Syntax, payerName103 Attribute Generator will need to be replaced with the ConstantGen. 

  • Click on payerName103 Attribute.

     
  • Select the ConstantGen Generator in the Quick Generator Replacement Menu.

  • Once selected, click the Replace button to replace the current Generator.


  • Click Yes to replace the Generator.


  • Enter KEY INSURANCE COMPANY as the value and click the Save Generator button.


Step 17c: Modify the codeQualifier108 Attribute Generator Configuration

The codeQualifer108 Attribute Generator, by default, has 2 qualifiers: PI and XV. For this sample, only PI is needed. You will need to modify the Generator configuration so that only PI is generated. Complete the steps below: 

  • Click on codeQualifier108 Attribute.

     

  • Click on the XV within the list to select it and then click the Remove button.


     
  • Then click the Save Generator button.


Step 17d: Modify the payerIdentifier109 Attribute Generator Configuration

To change the name to match the X12 Syntax, payerIdentifier109 Attribute Generator will need to be replaced with the ConstantGen. 

  • Click on payerIdentifier109 Attribute.

     
  • Select the ConstantGen Generator in the Quick Generator Replacement Menu.

  • Once selected, click the Replace button to replace the current Generator.


  • Click Yes to replace the Generator.


  • Enter 999996666 as the value and click the Save Generator button.


Completed Test Data for NM1_PayerName_2010BB Segment


Step 18: Add and Configure Attributes for REF_BillingProviderSecondaryIdentification_2010BB

For this example, the REF_BillingProviderSecondaryIdentification_2010BB Segment test data configuration will need to match the following X12 Syntax: 


Based on the syntax above, the following Attributes will need to be added and modified to generate this test data: 

  • identificationQualifier01 = G2
  • secondaryIdentifier02 = KA6663


Step 18a: Add the Attributes to the Test Data Case Domain

Complete the following steps to view the Test Data Case Domain for the Segment and add Attributes with the required test data:

  • Click the Edit Test Data Case Domain icon in the Actions column.



  • Click the Plus (+) button to add one or more Attributes to the Test Data Case Domain.



  • In the dialog window, tick the checkbox for each Attribute that needs to be added.

  • Click the Save button once finished.



  • The Attributes will be added to the Test Data Case Domain, as shown below:


Step 18b: Modify the identificationQualifier01 Attribute Generator Configuration

The identificationQualifier01 Attribute Generator, by default, has 2 qualifiers: G2 and LU. For this sample, only G2I is needed. You will need to modify the Generator configuration so that only G2 is generated. Complete the steps below: 

  • Click on identificationQualifier01 Attribute.

     

  • Click on the LU within the list to select it and then click the Remove button.


     
  • Then click the Save Generator button.


Step 18c: Modify the secondaryIdentifier02 Attribute Generator Configuration

To change the name to match the X12 Syntax, secondaryIdentifier02 Attribute Generator will need to be replaced with the ConstantGen. 

  • Click on secondaryIdentifier02 Attribute.


      
  • Select the ConstantGen Generator in the Quick Generator Replacement Menu.

  • Once selected, click the Replace button to replace the current Generator.


  • Click Yes to replace the Generator.


  • Enter KA6663 as the value and click the Save Generator button.


Completed Test Data for REF_BillingProviderSecondaryIdentification_2010BB Segment


Step 19: Add and Configure Attributes for PAT_PatientInformation_2000C

For this example, the PAT_PatientInformation_2000C Segment test data configuration will need to match the following X12 Syntax: 


Based on the syntax above, the following Attributes will need to be added and modified to generate this test data: 

  • relationshipCode01 = 19


Step 19a: Add the Attributes to the Test Data Case Domain

Complete the following steps to view the Test Data Case Domain for the Segment and add Attributes with the required test data:

  • Click the Edit Test Data Case Domain icon in the Actions column.


  • Click the Plus (+) button to add one or more Attributes to the Test Data Case Domain.


  • In the dialog window, tick the checkbox for each Attribute that needs to be added.

  • Click the Save button once finished.



  • The Attribute will be added to the Test Data Case Domain, as shown below:


Step 19b: Modify the relationshipCode01 Attribute Generator Configuration

The relationshipCode01 Attribute Generator, by default, has several codes. For this sample, only 19 is needed. You will need to modify the Generator configuration so that only 19 is generated. Complete the steps below: 

  • Click on relationshipCode01 Attribute.

     

  • Click on a value within the list to select it and then click the Remove button. This step will need to be completed several times.

     
  • Then click the Save Generator button.


Completed Test Data for PAT_PatientInformation_2000C Segment


Step 20: NM1_PatientName_2010CA, N3_PatientAddress_2010CA, N4_PatientCityStateZIPCode_2010CA, and DMG_PatientDemographicInformation_2010CA (Optional)

For this example, no changes have been made to these Segments. This is because the assigned Generators automatically create synthetic data to match the required information. However, you can modify this information if needed.


The X12 Syntax for this example appears as shown below for these Segments: 


 

Step 21: Add and Configure Attributes for CLM_ClaimInformation_2300V1

For this example, the CLM_ClaimInformation_2300V1 Segment test data configuration will need to match the following X12 Syntax: 


Based on the syntax above, the following Attributes will need to be added and modified to generate this test data: 

  • signatureIndicator06 = Y
  • participationCode07 = A
  • certificationIndicator08 = Y


Step 21a: Add the Attributes to the Test Data Case Domain

Complete the following steps to view the Test Data Case Domain for the Segment and add Attributes with the required test data:

  • Click the Edit Test Data Case Domain icon in the Actions column.



  • Click the Plus (+) button to add one or more Attributes to the Test Data Case Domain.


  • In the dialog window, tick the checkbox for each Attribute that needs to be added.

  • Click the Save button once finished.



  • The Attributes will be added to the Test Data Case Domain, as shown below:


Step 21b: Modify the signatureIndicator06 Attribute Generator Configuration

ThesignatureIndicator06 Attribute Generator, by default, has 2 indicators: N and Y. For this sample, only Y is needed. You will need to modify the Generator configuration so that only Y is generated. Complete the steps below: 

  • Click on signatureIndicator06 Attribute.

     

  • Click on the N within the list to select it and then click the Remove button. 

     
  • Then click the Save Generator button.


Step 21c: Modify the participationCode07 Attribute Generator Configuration

The participationCode07 Attribute Generator, by default, has 3 codes: A, B, and C. For this sample, only A is needed. You will need to modify the Generator configuration so that only A is generated. Complete the steps below: 

  • Click on participationCode07 Attribute.

     

  • Click on a value within the list to select it and then click the Remove button. This step will need to be completed twice.

     
  • Then click the Save Generator button.


Step 21d: Modify the certificationIndicator08 Attribute Generator Configuration

The certificationIndicator08 Attribute Generator, by default, has 3 indicators: N, W, and Y. For this sample, only Y is needed. You will need to modify the Generator configuration so that only Y is generated. Complete the steps below: 

  • Click on certificationIndicator08 Attribute.


  • Click on a value within the list to select it and then click the Remove button. This step will need to be performed twice.
     
  • Then click the Save Generator button.



Completed Test Data for CLM_ClaimInformation_2300V1 Segment


Step 22: REF_ClaimIdentifierForTransmissionIntermediaries_2300V1, HI_HealthCareDiagnosisCode_2300V1, LX_ServiceLineNumber_2400V1, SV1_ProfessionalService_2400V1 (Optional)

For this example, no changes have been made to these Segments. This is because the assigned Generators automatically create synthetic data to match the required information. However, you can modify this information if needed.


The X12 Syntax for this example appears as shown below for these Segments: 



Step 23: Add and Configure Attributes for DTP_DateServiceDate_2400V1

For this example, the DTP_DateServiceDate_2r00V1 Segment test data configuration will need to match the following X12 Syntax: 


Based on the syntax above, the following Attributes will need to be added and modified to generate this test data: 

  • formatQualifier02 - D8


Step 23a: Add the Attributes to the Test Data Case Domain

Complete the following steps to view the Test Data Case Domain for the Segment and add Attributes with the required test data:

  • Click the Edit Test Data Case Domain icon in the Actions column.



  • Click the Plus (+) button to add one or more Attributes to the Test Data Case Domain.


  • In the dialog window, tick the checkbox for each Attribute that needs to be added.

  • Click the Save button once finished.



  • The Attribute will be added to the Test Data Case Domain, as shown below:


Step 23b: Modify the formatQualifier02 Attribute Generator Configuration

The formatQualifier02 Attribute Generator, by default, has 2 qualifiers: RD8 and D8. For this sample, only D8 is needed. You will need to modify the Generator configuration so that only D8 is generated. Complete the steps below: 

  • Click on formatQualifier02 Attribute.

     

  • Click on RD8 within the list to select it and then click the Remove button.
     
     
  • Then click the Save Generator button.


Completed Test Data for DTP_DateServiceDate_2400V1 Segment