Description

When an EDI 837I 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 an 837 Institutional Claim (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 837I EDI 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 X12 EDI 837I Project
  • 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 837I Business Case Scenario will show how to set up Test Data Cases 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 837I 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:



Recommended Action

The example below shows how the provided Business Case Scenario was created and modified to achieve a specific 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 an 837 Institutional 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 837I Transaction. By default, every Segment and Loop will be enabled for the 837I EDI Project.


Segments and Loops can be disabled or turned "off" directly within the Test Data Cases (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_2000A 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

  • PER05_CommunicationNumberQualifier
  • PER06_CommunicationNumber
  • PER07_CommunicationNumberQualifier
  • PER08_CommunicationNumber


Loop_2000A

  • CUR_ForeignCurrencyInformation_2000A
  • Loop_2010AB
  • Loop_2010AC


Loop_2000A > Loop_2010AA

  • PER_BillingProviderContactInformation_2010AA


Loop_2000A > Loop_2010AA > N4_BillingProviderCityStateZIPCode_2010AA

  • N404_CountryCode
  • N407_CountrySubdivisionCode


Loop_2000A > Loop_2000B >Loop_2010BA

  • REF_SubscriberSecondaryIdentification_2010BA
  • REF_PropertyAndCasualtyClaimNumber_2010BA



Loop_2000A > Loop_2000B >Loop_2010BA >N4_SubscriberCityStateZIPCode_2010BA

  • N404_CountryCode
  • N407_CountrySubdivisionCode



Loop_2000A > Loop_2000B >Loop_2010BB

  • N3_PayerAddress_21010BB
  • N4_PayerCityStateZIPCode_2010BB
  • REF_PayerSecondaryIdentification_21010BB



Loop_2000A > Loop_2000B > Loop_2000C

  • HL_PatientHierarchicalLevel_2000C
  • PAT_PatientInformation_2000C
  • Loop_2010CA



Loop_2000A > Loop_2000B > Loop_2000C > Loop_2300V1 

  • DTP_DischargeHour_2300V1
  • DTP_AdmissionDateHour_2300V1
  • DTP_DateRepricerReceiverDate_2300V1
  • PWK_ClaimSuppplementalInformation_2300V1
  • CN1_ContactInformation_2300V1
  • AMT_PatientEstimatedAmountDue_2300V1
  • REF_ServiceAuthorizationExceptionCode_2300V1
  • REF_ReferralNumber_2300V1
  • REF_PriorAuthorization_2300V1
  • REF_PayerClaimControlNumber_2300V1
  • REF_RepricedClaimNumber_2300V1
  • REF_AdjustedRepricedClaimNumber_2300V1
  • REF_InvestigationalDeviceExemptionNumber_2300V1



  • REF_ClaimIdentifierForTransmissionIntermediaries_2300V1
  • REF_AutoAccidentState_2300V1
  • REF_MedicalRecordNumber_2300V1
  • REF_DemonstrationProjectIdentifier_2300V1
  • REF_PeerReviewOrganizationPROApprovalNumber_2300V1
  • K3_FileInformation_2300V1
  • NTE_ClaimNote_2300V1
  • NTE_BillingNote_2300V1
  • CRC_EPSDTReferral_2300V1
  • HI_AdmittingDiagnosis_2300V1
  • HI_PatientsReasonForVisit_2300V1
  • HI_ExternalCauseOfInjury_2300V1
  • HI_DiagnosisRelatedGroupDRGInformation_2300V1
  • HI_PrincipleProcedureInformation_2300V1
  • HI_OtherProcedureInformation_2300V1
  • HI_OccurrenceSpanInformation_2300V1


  • HI_TreatmentCodeInformation_2300V1
  • HCP_ClaimPricingRepricingInformation_2300V1
  • Loop_2310CV1
  • Loop_2310DV1
  • Loop_2310EV1
  • Loop_2310FV1


Loop_2000A > Loop_2000B > Loop_2000C > Loop_2300V1 > CLM_ClaimInformation_2300V1

  • CLM06
  • CLM20_DelayReasonCode




Loop_2000A > Loop_2000B > Loop_2000C > Loop_2300V1 > CL1_InstitutionalClaimCode_2300V1

  • CLI02_AdmissionSourceCode



Loop_2000A > Loop_2000B > Loop_2000C > Loop_2300V1 > HI_OtherDiagnosisInformation_2300V1

  • HI03_V3HealthCareCodeInformation_2300V1
  • HI04_V2HealthCareCodeInformation_2300V1
  • HI05_V2HealthCareCodeInformation_2300V1
  • HI06_V2HealthCareCodeInformation_2300V1
  • HI07_V2HealthCareCodeInformation_2300V1
  • HI08_V2HealthCareCodeInformation_2300V1
  • HI09_V2HealthCareCodeInformation_2300V1
  • HI10_V2HealthCareCodeInformation_2300V1
  • HI11_V2HealthCareCodeInformation_2300V1
  • HI12_V2HealthCareCodeInformation_2300V1



Loop_2000A > Loop_2000B > Loop_2000C > Loop_2300V1 > HI_OccuranceInformation_2300V1

  • HI05_V5HealthCareCodeInformation_2300V1
  • HI06_V5HealthCareCodeInformation_2300V1
  • HI07_V5HealthCareCodeInformation_2300V1
  • HI08_V5HealthCareCodeInformation_2300V1
  • HI09_V5HealthCareCodeInformation_2300V1
  • HI10_V5HealthCareCodeInformation_2300V1
  • HI11_V5HealthCareCodeInformation_2300V1
  • HI12_V5HealthCareCodeInformation_2300V1



Loop_2000A > Loop_2000B > Loop_2000C > Loop_2300V1 > HI_ValueInformation_2300V1

  • HI02_V7HealthCareCodeInformation_2300V1
  • HI03_V7HealthCareCodeInformation_2300V1
  • HI04_V6HealthCareCodeInformation_2300V1
  • HI05_V6HealthCareCodeInformation_2300V1
  • HI06_V6HealthCareCodeInformation_2300V1
  • HI07_V6HealthCareCodeInformation_2300V1
  • HI08_V6HealthCareCodeInformation_2300V1
  • HI09_V6HealthCareCodeInformation_2300V1
  • HI10_V6HealthCareCodeInformation_2300V1
  • HI11_V6HealthCareCodeInformation_2300V1
  • HI12_V6HealthCareCodeInformation_2300V1



Loop_2000A > Loop_2000B > Loop_2000C > Loop_2300V1 > HI__ConditionInformation_2300V1

  • HI02_V8HealthCareCodeInformation_2300V1
  • HI03_V8HealthCareCodeInformation_2300V1
  • HI04_V7HealthCareCodeInformation_2300V1
  • HI05_V7HealthCareCodeInformation_2300V1
  • HI06_V7HealthCareCodeInformation_2300V1
  • HI07_V7HealthCareCodeInformation_2300V1
  • HI08_V7HealthCareCodeInformation_2300V1
  • HI09_V7HealthCareCodeInformation_2300V1
  • HI10_V7HealthCareCodeInformation_2300V1
  • HI11_V7HealthCareCodeInformation_2300V1
  • HI12_V7HealthCareCodeInformation_2300V1



Loop_2000A > Loop_2000B > Loop_2000C > Loop_2300V1 > Loop_2310AV1

  • PRV_AttendingProviderSpecialtyInformation_2300AV1



Loop_2000A > Loop_2000B > Loop_2000C > Loop_2300V1 > Loop_2320V1

  • CAS_ClaimLevelAdjustments_2320V1
  • AMT_CoordinationOfBenefitsCOBPayerPaidAmount_2320V1
  • AMT_RemainigPatientLiability_2320V1
  • AMT_CoordinationOfBenefitsCOBTotalNonCoveredAmount_2320V1
  • MIA_InpatientAdjudicationInformation_2320V1
  • MOA_OutpatientAdjudicationInformation_2320V1
  • Loop_2330CV1
  • Loop_2330DV1
  • Loop_2330EV1
  • Loop_2330FV1
  • Loop_2330GV1
  • Loop_2330HV1
  • Loop_2330IV1



Loop_2000A > Loop_2000B > Loop_2000C > Loop_2300V1 > Loop_2320V1 > Loop_2330AV1

  • REF_OtherSubscriberSecondaryIdentification_2330AV1



Loop_2000A > Loop_2000B > Loop_2000C > Loop_2300V1 > Loop_2320V1 > Loop_2330AV1 > N4_OtherSubscriberCityStateZIPCode

  • N404_CountryCode
  • N407_CountrySubdivisionCode



Loop_2000A > Loop_2000B > Loop_2000C > Loop_2300V1 > Loop_2320V1 > Loop_2330BV1

  • N3_OtherPayerAddress_2330BV1
  • N4_OtherPayerCityStateZIPCode_2330BV1
  • DTP_ClaimCheckOrRemittanceDate_2330BV1
  • REF_OtherPayerSecondaryIdentifier_2330BV1
  • REF_OtherPayerPriorAuthorizationNumber_2330BV1
  • REF_OtherPayerReferralNumber_2330BV1
  • REF_OtherPayerClaimAdjustmentIndicator_2330BV1
  • REF_OtherPayerClaimControlNumber_2330BV1



Loop_2000A > Loop_2000B > Loop_2000C > Loop_2300V1 > Loop_2400V1

  • PWK_LineSupplementalInformation_2400V1
  • REF_LineItemControlNumber_2400V1
  • REF_RepricedLineItemReferenceNumber_2400V1
  • REF_AdjustedRepricedLineItemReferenceNumber_2400V1
  • AMT_ServiceTaxAmount_2400V1
  • AMT_FacilityTaxAmount_2400V1
  • NTE_ThirdPartyOrganizationNotes_2400V1
  • HCP_LinePricingRepricingInformation_2400V1
  • Loop_2410V1
  • Loop_2420AV1
  • Loop_2420BV1
  • Loop_2420CV1
  • Loop_2420DV1
  • Loop_2430V1



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 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 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 or use the Filter input field to locate a specific Segment or Loop.


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

  • BHT_BeginningOFHiearchicalTransaction
  • NM1_SubmitterName_1000A
  • NM1_BillingProviderName_2010AA
  • SBR_SubscriberInformation_2000B
  • NM1_SubcriberName_2010BA
  • NM1_PayerName_2010BB
  • REF_BillingProviderSecondaryIdentification_2010BB
  • CLM05_HealthCareServiceLocationInformation_2300V1
  • HI01_V1HealthCareCodeInformation_2300V1
  • HI01_V6HealthCareCodeInformation_2300V1
  • HI01_V10HealthCareCodeInformation_2300V1
  • HI01_V11HealthCareCodeInformation_2300V1
  • HI01_V12HealthCareCodeInformation_2300V1
  • NM1_AttendingProviderName_2310AV1
  • REF_AttendingProviderSecondaryIdentification_2310AV1
  • SBR_OtherSubscriberInformation_2320V1
  • OI_OtherInsuranceCoverageInformation_2320V1
  • NM1_OtherSubscriberName_2330AV1
  • NM1_OtherPayerName_2330BV1
  • SV2_InstitutionServiceLine_2400V1
  • SV202_CompositeMedicalProcedureIdentifier_2400V1
  • DTP_DateServiceDate_2400V1
  • NM1_ReceiverName_1000B
  • HL_BillingProviderHierarchicalLevel_2000A
  • PRV_BillingProviderSpecialtyInformation_2000A
  • REF_BillingProviderTaxIdentification_2010AA
  • DMG_SubscriberDemographicInformation_2010BA
  • HI_PrincipalDiagnosis_2300V1
  • HI02_V3HealthCareCodeInformation_2300V1
  • HI02_V6HealthCareCodeInformation_2300V1
  • HI03_V6HealthCareCodeInformation_2300V1
  • HI04_V5HealthCareCodeInformation_2300V1
  • Loop_2400V1


Step 4: Change Loop_2400V1 Loop Count to 2

The Loop Count for each Test Data Case Segment/Loop will default to the loopCount Global Variable value. 


The Loop Count for Loop_2400V1 will need to be changed to 2 because there will be 2 iterations: 



Complete these steps to change the value: 

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



  • Enter 2 for the Loop Count and then click the Save button.


  • Loop_2400V1 will now have a 2, 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.


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: 

  • purposeCode02 = 00
  • claimIdentifier06 = CH


Step 5a: Add 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 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 5b: Modify the purposeCode02 Attribute Generator Configuration

The purposeCode02 Attribute Generator, by default, has 2 codes: 00 and 18. For this sample, only 00 is needed. You will need to modify the Generator configuration so that only 00 is generated. Complete the steps below: 

  • Click on the purposeCode02 Attribute.



  • Click on 18 within the list to select it and then click the Remove button. 


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


Step 5c: Modify the claimIdentifier06 Attribute Generator Configuration

The claimIdentifier06 Attribute Generator, by default, has 3 codes: 31, CH, and RP. 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 claimIdentifier06 Attribute.

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


  • 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 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: 

  • typeQualifier102 = 2


Step 6a: Add the typeQualifier102 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 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 6b: Modify the typeQualifier102 Attribute Generator Configuration

The typeQualifier102 Attribute Generator, by default, has 2 codes: 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 1 within the list to select it and then click the Remove button. 

  • Click the Save Generator button.



Completed Test Data for NM1_SubmitterName_1000A Segment


Step 7: PER_SubmitterEDIContactInformation_1000A (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 by following the same methods shown throughout this tutorial.


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





Step 8: NM1_ReceiverName_1000B1 (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 by following the same methods shown throughout this tutorial.


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



Step 9: Add and Configure Attributes for HL_BillingProviderHierarchicalLevel_2000A Segment

For this example, the HL_BillingProviderHiearchicalLevel_2000A  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: 

  • hL02 = "empty"


Step 9a: Add 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.


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


Step 9b: Modify the hL02 Attribute Generator Configuration

To change the name to match the X12 Syntax, the hL02 Attribute Generator will need to be replaced with the ConstantGen and set to "Empty". 

  • Click on the hL02 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 current Generator.



  • Type #{EMPTY} for the value Parameter and click the Save Generator button.


Completed Test Data for the HL_BillingProviderHierarchicalLevel_2000A Segment


Step 10: Add and Configure Attributes for PRV_BillingProviderSpecialtyInformation_2000A

For this example, the PRV_BillingProviderSpecialtyInformation_2000A 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: 

  • pRV04 = "empty"
  • pRV05 = "empty"
  • pRV04 = "empty"


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.


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


Note: No additional steps are needed because the added Attributes are already set to "Empty".


Step 11: Add and Configure Attributes for NM1_BillingProviderName_2010AA

For this example, the NM1_BillingProviderName_2010AA 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: 

  • organizationName103 = JONES HOSPITAL


Step 11a: Add the organizationName103 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 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 11b: 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 current Generator.



  • Type JONES HOSPITAL for the value Parameter and click the Save Generator button.



Completed Test Data for NM1_BillingProviderName_2010AA Segment


Step 12: NM1_BillingProviderAddress_2010AA and N4_BillingProviderCityStateZIPCode_2010AA (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 by following the same methods shown throughout this tutorial.


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




Step 13: Add and Configure Attributes for REF_BillingProviderTaxIdentificationNumber_2010AA

For this example, the REF_BillingProviderTaxIdentificationNumber_2010AA 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: 

  • rEF03 = "empty"
  • rEF04 = "empty"

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:

Note: No additional steps are needed because the added Attributes are already set to "Empty".


Step 14: HL_SubscriberHiearchicalLevel_2000B,  SBR_SubscriberInformation_2000B, NM1_SubscriberName_2010BA, N3_SubscriberAddress_2010BA, and N4_SubscriberCityStateZIPCode_2010BA (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 by following the same methods shown throughout this tutorial.


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


 

Step 15: 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 by following the same methods shown throughout this tutorial.


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




Step 16: Add and Configure Attributes for NM1_PayerName_2010BB

For this example, the NM1_PayerName_2010BB 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: 

  • payerName103 = MEDICARE B
  • codeQualifier108 = PI
  • nM104 = "empty"
  • nM105 = "empty"
  • nM106 = "empty"
  • nM107 = "empty"
  • nM110 = "empty"
  • nM111 = "empty"
  • nM112 = "empty"


Step 16a: Add 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 16b: Modify the payerName103 Attribute Generator Configuration

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

  • Click on the 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 current Generator.



  • Type MEDICARE B for the value Parameter and click the Save Generator button.


Step 16c: Modify the codeQualifier108 Attribute Generator Configuration

The codeQualifier108 Attribute Generator, by default, has 2 qualifier codes: 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 the codeQualifier108 Attribute.



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



  • Click the Save Generator button.


Completed Test Data for NM1_PayerName_2010BB Segment



Step 17: Add and Configure Attributes for REF_BillingProviderSecondaryIdentification_2010BB

For this example, the REF_BillingProviderSecondaryIdenification_2010AA 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: 

  • identificationQualifier01 = G2
  • secondaryIdentifier02 = 330127


Step 17a: Add 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 17b: Modify the indentificationQualifier01 Attribute Generator Configuration

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

  • Click on the identificationQualifier01 Attribute.



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



  • Click the Save Generator button.


Step 17c: Modify the secondaryIdentifier02 Attribute Generator Configuration

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

  • Click on the 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 current Generator.



  • Type 330127 for the value Parameter and click the Save Generator button.


Completed Test Data for REF_BillingProviderSecondaryIdentification_2010BB Segment



Step 18: Add and Configure Attributes for CLM_ClaimInformation_2300V1

For this example, the CLM_ClaimInformation_2300V1 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: 

  • cLM03 = "empty"
  • cLM04 = "empty"
  • cLM06 = "empty"
  • cLM10 = "empty"
  • cLM11 = "empty"
  • cLM12 = "empty"
  • cLM13 = "empty"
  • cLM14 = "empty"
  • cLM15 = "empty"

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:


Note: These Attributes have already been set to "empty" and no other steps are necessary.




Step 19: DTP_StatementDates (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 by following the same methods shown throughout this tutorial.


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



Step 20: Add and Configure Attributes for CL1__InstitutionalClaimCode_2300V1

For this example, the CL1_InstitutionalClaimCode_2300V1 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: 

  • sourceCode102 = "empty"
  • cL104 = "empty"

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:


Note: These Attributes have already been set to "empty" and no other steps are necessary.



Step 21: HI__PrincipalDiagnosisCodes_2300V1 (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 by following the same methods shown throughout this tutorial.


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




Step 22: HI_OtherDiagnosisInformation_2300V1, HI_OccurrenceInformation_2300V1, HI_ValueInformation_2300V1, and HI_ConditionInformation_2300V1(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 by following the same methods shown throughout this tutorial.


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



Step 23: NM1__AttendingProviderName_2310AV1 (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 by following the same methods shown throughout this tutorial.


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





Step 24: REF_AttendingProviderSecondaryIdentification_2310A (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 by following the same methods shown throughout this tutorial.


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




Step 25: Add and Configure Attributes for SBR_OtherSubscriberInformation_2320V1

For this example, the SBR_OtherSubscriberInformation_2320V1 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: 

  • numberCode01 = S
  • relationshipCode02 = 01
  • policyNumber03 = 351630
  • groupName04 = STATE TEACHERS
  • sBR05 = "empty"
  • sBR06 = "empty"
  • sBR07 = "empty"
  • sBR08 = "empty"
  • indicatorCode09 = CI


Step 25a: Add 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 25b: Modify the numberCode01 Attribute Generator Configuration

The numberCode01 Attribute Generator, by default, has 12 codes. For this sample, only S is needed. You will need to modify the Generator configuration so that only S is generated. The easiest way to do this when several codes are available is to replace the current Generator with the ConstantGen and enter S as a constant value. Complete the steps below: 

  • Click on the numberCode01 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 current Generator.



  • Type S for the value Parameter and click the Save Generator button.



Step 25c: Modify the relationshipCode02 Generator Configuration

The relationshipCode02 Attribute Generator, by default, has 9 codes. For this sample, only 01 is needed. You will need to modify the Generator configuration so that only 01 is generated. The easiest way to do this when several codes are available is to replace the current Generator with the ConstantGen and enter 01 as a constant value. Complete the steps below: 

  • Click on the relationshipCode02 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 current Generator.



  • Type 01 for the value Parameter and click the Save Generator button.


Step 25d: Modify the policyNumber03 Attribute Generator Configuration

To change the name to match the X12 Syntax, the policyNumber03 Attribute Generator will need to be replaced with the ConstantGen. 

  • Click on the policyNumber03 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 current Generator.



  • Type 351630 for the value Parameter and click the Save Generator button.



Step 25e: Modify the groupName04 Attribute Generator Configuration

To change the name to match the X12 Syntax, a new value will need to be entered for the assigned ConstantGen Generator. 

  • Click on the groupName04 Attribute.



  • Type STATE TEACHERS for the value Parameter and click the Save Generator button.


Step 25f: Modify the indicatorCode09 Attribute Generator Configuration

The indicatorCode09 Attribute Generator, by default, has several codes. For this sample, only CI is needed. You will need to modify the Generator configuration so that only CI is generated. The easiest way to do this when several codes are available is to replace the current Generator with the ConstantGen and enter 01 as a constant value. Complete the steps below: 

  • Click on the identicatorCode09 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 current Generator.



  • Type CI for the value Parameter and click the Save Generator button.


Completed Test Data for SBR_OtherSubscriberInformation_2320V1 Segment


Step 26: DMG_OtherSubscriberDemographicInformation_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 by following the same methods shown throughout this tutorial.


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




Step 27: Add and Configure Attributes for OI_OtherInsuranceCoverageInformation_2320V1

For this example, the OI_OtherInsuranceCoverageInformation_2320V1 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: 

  • oI01 = "empty"
  • oI02 = "empty" 
  • certificationIndicator03 = Y
  • oI04 = "empty"
  • oI05 = "empty"
  • informationCode06 = Y


Step 27a: Add 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 27b: Modify the certificationIdicator03 Attribute Generator Configuration

The certificationIdicator03 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 the certificationIndicator03 Attribute.



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



  • Click the Save Generator button.


Step 27c: Modify the informationCode06 Attribute Generator Configuration

The informationCode06 Attribute Generator. by default, has 2 codes: I 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 the informationCode06 Attribute.



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



  • Click the Save Generator button.


Completed Test Data for OI_OtherInsuranceCoverageInformation_2320V1 Segment



Step 28: Add and Configure NM1_OtherSubscriberName_2330AV1

For this example, the NM1_OtherSubscriberName_2330AV1 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: 

  • typeQualifier = 1
  • nM106 = "empty"
  • nameSuffix107 = "empty"
  • codeQualifier108 = MI
  • insuredIdentifier109 = 222004433
  • nM110 = "empty"
  • nM111 = "empty"
  • nM112 = "empty"

Step 28a: Add 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 28b: 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 the typeQualfier102 Attribute.



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



  • Click the Save Generator button.


Step 28c: Modify the nameSuffix107 Attribute Generator Configuration

The nameSuffix107 Attribute Generator needs to be replaced by the ConstantGen Generator and then set to "empty" Complete the steps below: 

  • Click on the nameSuffix107 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 current Generator.



  • Type #{EMPTY} for the value Parameter and click the Save Generator button.



Step 28d: Modify the codeQualifer108 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 the codeQualfier108 Attribute.



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



  • Click the Save Generator button.



Step 28e: Modify the insuredIdentifier109 Attribute Generator Configuration (Optional)

The value for the insuredIdentifier109 Attribute Generator is automatically synthetically generated. If you want to change it to a specific value (like in this example), you will need to complete the following steps: 

  • Click on the insuredIdentifier109 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 current Generator.



  • Type 222004433 for the value Parameter and click the Save Generator button.


Completed Test Data for NM1_OtherSubscriberName_2330AV1


Step 29: N3_OtherSubscriberAddress_2330A and N4_OtherSubscriberCityStateZIPCode_2330A (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 by following the same methods shown throughout this tutorial.


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



Step 30: Add and Configure Attributes for NM1_OtherPayerName_2330BV1

For this example, the NM1_OtherPayerName_2330BV1 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: 

  • organizationName103 = STATE TEACHERS
  • nM104 = "empty"
  • nM105 = "empty"
  • nM106 = "empty"
  • nM107 = "empty"
  • codeQualifier108 = PI
  • primaryIdentifier109 = 1135
  • nM110 = "empty"
  • nM111 = "empty"
  • nM112 = "empty"


Step 30a: Add 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 30b: Modify the organizationName103 Attribute Generator Configuration

The value for the organizationName103 Attribute Generator is automatically synthetically generated. If you want to change it to a specific value (like in this example), you will need to complete the following steps: 

  • 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 current Generator.



  • Type STATE TEACHERS for the value Parameter and click the Save Generator button.


Step 30c: Modify the codeQualifier108 Attribute Generator Configuration

The codeQualifier108 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 the codeQualfier108 Attribute.



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



  • Click the Save Generator button.


Step 30d: Modify the primaryIdentifier109 Attribute Generator Configuration

The value for the primaryIdentifier109 Attribute Generator is automatically synthetically generated. If you want to change it to a specific value (like in this example), you will need to complete the following steps: 

  • 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 current Generator.



  • Type 1135 for the value Parameter and click the Save Generator button.


Completed Test Data for NM1_OtherPayerName_2330BV1 Segment


Step 31: SV2_InstitutionalServiceLine_2400V1 (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 by following the same methods shown throughout this tutorial.


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




Step 32: DTP_DateServiceDate_2400V1 (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 by following the same methods shown throughout this tutorial.


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