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Posted 4/29/2014

EDI_Mappings.JPGHow many exactly mappings available in 4010 and 5010 HIPAA Implementation are there?

Yes, it could have been a curious question for many of us, who have been working for years with the fine details of the HIPAA Implementation Guides in EDI operations of the health care industry. To satisfy this curiosity, we at Chiapas EDI Technologies, Inc. have conducted a search and would like to share with you what we have found.

It's not as trivial and simple as counting the different elements presented within the HIPAA Implementation Guides.  For one thing, a single REF identifier segment can portray one of many different values.  Or, a CAS segment containing financial adjustment information could iterate many different times, all of which acts to multiply the original number of possible mappings.  Furthermore, the loops themselves may have a number of allowed repetitions.  And finally, the fact that the whole specification may have Addenda that add or subtract valid mappings can also be an influence.

With all of these variables, it might appear that the exact number of mappings may never be discovered.  However, Chiapas EDI Technologies do have some unique resources to bear on this problem.  As our latest technology freely translates between flat table, XML, and X12 EDI, it stands to reason that all of the variables indicated above must be accounted for in order to carry out this transformation without losing any information along the way.

Here is how the search was conducted.  We limited this search to only the most common specifications for 4010 and 5010: 270, 271, 276, 277 (as well as 277CA for 5010), 278, 820, 834, 835, 837, and for 5010, 999.  Next, we made sure to ignore anything that constitutes as structural metadata and not a discrete, map-able item.  Then, we set a threshold for loop repeats on what defines a new database row or what becomes a new field mapping.  In Chiapas EDI 2012, this threshold is 24 - a loop that repeats 25 times or more will result in new database rows in the decoded output, but a loop that iterates 20 times will instead be decoded on the X axis as new column names.  We call this lateral mapping, and it is very core to how Chiapas EDI Technologies render a hierarchical format to a two-dimensional database structure.

The result of our findings are:  If we were to make a full accounting of all valid, information-carrying elements within the 4010 and 5010 Implementation Guides for all of the common healthcare transactions (excluding 824), there are 88,378 possible mappings.  For 5010 837 Institutional / Dental / Professional, there are 18,468 mappings alone.  Of course, in the usual course of business, trading partners will generally only exchange information using 150 - 200 of these mappings, but if anyone ever challenges you on why submitting a claim is difficult in EDI, feel free to share this information.  

For sure, the flexibility defined within the HIPAA Implementation Guides guarantee that mapping always exists in EDI operations.  And you might have had the idea that mapping is one of the most complex EDI schemas known to man – well, worry no more because Chiapas EDI Technologies have proof!