Moving XML into HIPAA

1
Moving XML into HIPAA
XML The Good,The Bad, and X12N
Gary Beatty Chair X12N Insurance
Subcommittee Gary_at_wpc-edi.com 507-533-8051
2
X12 XML Organization

• X12N Insurance Subcommittee
• TG3 - Transaction Coordination and Modeling Task
  Group
• WG1 PC Transaction Coordination and Modeling
• WG2 Health Care Transaction Coordination and
  Modeling
• WG3 HIPAA Implementation Coordination
• WG4 Object Oriented Modeling
• X12X/TG4 XML Task Group
• ebXML alignment

3
X12N / TG3 / WG4 Object Oriented Modeling
To create and maintain an Object-Oriented Model
for the insurance industry by coordinating with
the domain experts within the Insurance
Subcommittee (X12N) for increased
interoperability of the X12 standards and
implementation guides and assist in the
development of a consistent object oriented tag
dictionary. To liaison with, coordinate, and
monitor XML activities within X12 and other
organizations.

• UML Model Rational Rose
• Name Space Development

4
XMLDifferent and yet the same
Message extract built based on a Schema developed
from X12N 004010X092 (270/271)
Both XML documents convey basic eligibility
information, both are well-formed, and yet the
second one is not based on a standard whereas the
first is based on an X12N implementation guide.
Message extract built based on a different Schema
What about X12?
5
X12 EDI The X12 standard represents a very
structured, positional format that relies on data
elements being in certain positions within a
transmission relative to other data elements. X12
members have spent years developing
industry-specific guidelines for using the X12
standard.
And X12
ST2701234BHT0022131200003292158HL1201
NM1PR2PI123456789HL21211NM11P2
SV987654321HL32220NM1IL1BrownJane
MI345678901EQ30FAMSE101234
6
Where to go from here?
Is it possible that EDI is the cornerstone for
XML B2B standards?

• EDI
• Structure
• Standards
• Data Elements
• Implementation Guides
• XML
• Well-formed
• Tag Names
• DTDs/Schemas

7
Health Care Eligibility Request
X12N 004010X092 270 Transaction Set
ST2701234BHT0022131200003292158HL1201
NM1PR2PI123456789HL21211NM11P2
SV987654321HL32220NM1IL1BrownJane
MI345678901EQ30FAMSE101234
XMLSchema developed from X12N 004010X092
(270/271)
Demo
8
Size Comparison
XML 3K
X12 1K
ST2701234BHT0022131200003292158HL120
1NM1PR2PI123456789HL21211NM11
P2SV987654321HL32220NM1IL1Brown
JaneMI345678901EQ30FAMSE101234
SubscriberLastNameBrown
9
Proposed X12N XML
Excerpt from X12N 270 Implementation Guide
NM1IL1BrownJaneMI345678901
270 Implementation Guide Excerpt with proposed
X12N XML
10
Proposed X12N XML
Excerpt from X12N 270 Implementation Guide
270 Implementation Guide with proposed X12N XML
11
Names Space Tags XML Tag Names

• Determine Data Content vs. Attributes
• Defining X12 syntax in XML

12
(No Transcript)
13
Name Space Tags XML Tag Names

• Determine Data Content vs. Attributes
• Defining X12 syntax in XML
• Consistent Naming Structure
• Coordination between Organizations
• Interoperability
• ANSI HISB Data Registry

14
Conclusion
X12N Implementation Guideswith XML tags
specified and committee-approved, can become the
definitive guide to writing standard-adhering,
open, interoperable schemas, and well-formed XML
documents, just as EDI implementation guides have
served the EDI community for the past 20 years
as the definitive source for writing X12 EDI
compliant transaction sets.