Documents Sets Healthcare & Pharmaceutical

Healthcare

Before the adoption of the HL7 standards, interfacing two healthcare applications involved negotiations with virtually no ground rules. Vendors would design their own proprietary data exchange and minor differences between vendor formats would become a major source of disagreement and delay. Health Level 7 (HL7) prescribes a standard, structured messaging format for the healthcare industry.

Although it is a structured protocol, HL7 is flexible because it doesn't necessarily recommend that a complete implementation of an interface must include support for the entire hierarchy of protocol features. HL7 is similar to X12 in as much as its architecture is hierarchical, moving from high-level groupings and structures to a set of several hundred data fields. Each level of the hierarchy serves a different organizing purpose.

HL7’s purpose is to facilitate communications in healthcare settings. The primary goal is to provide standards for the exchange of data among healthcare computer applications that eliminate or substantially reduce the custom interface programming and program maintenance that may otherwise be required.

Under HIPAA the US Government has adopted nine of the X12 standards as the EDI protocol to exchange information with healthcare providers regarding health insurance claims। Consequently healthcare providers' information systems operating on HL7 standards need to establish the appropriate interface to the X12 environment.

X12 Transaction Set	#
Benefit Enrollment and Maintenance	834
Health Care Claim	837
Health Care Claim Payment/Advice	835
Health Care Claim Status Notification	277
Health Care Claim Status Request	276
Health Care Eligibility/Benefit Information	271
Health Care Eligibility/Benefit Inquiry	270
Health Care Service Review Information	278
Patient Information	275

Pharmaceutical

This industry which is also covered under HIPAA and by FDA's strict regulations is making ample use of the capabilities and flexibilities afforded by EDI. Mergers between companies (in some cases from different countries) and Electronic Commerce are business situations where EDI with a Data Interface Engine becomes an efficient and effective operational tool. The following table shows a typical application of X12 transactions implemented by a major pharmaceutical company.

Business Group	X12	Description
Accounts Payable	110	Air Freight Details and Invoice
	210	Motor Carrier Freight Details and Invoice
	810	Invoice
	811	Consolidated Service Invoice/Statement
	820	Payment Order/Remittance Advice
	820	Payment Order/Remittance Advice (ACH)
	831	Application Control Totals
	997	Functional Acknowledgement
Accounts Receivable	820	Payment Order/Remittance Advice
	823	Lockbox
	997	Functional Acknowledgment
Consumer	213	Motor Carrier Shipment Status Inquiry
	214	Transportation Carrier Shipment Status Message
	810	Invoice
	850	Purchase Order
	856	Ship Notice/Manifest
	864	Text Message
	875	Grocery Products Purchase Order
	880	Grocery Products Invoice
	997	Functional Acknowledgment
Purchasing	850	Purchase Order
	997	Functional Acknowledgment
Internal Operations	213	Motor Carrier Shipment Status Inquiry
	214	Transportation Carrier Shipment Status Message
	810	Invoice
	832	Price/Sales Catalog
	844	Product Transfer Account Adjustment
	849	Response To Product Transfer Account Adjustment
	850	Purchase Order
	852	Product Activity Data
	997	Functional Acknowledgment