@ediflow/hipaa-x12-005010

HIPAA X12 005010 Standard Definitions - Healthcare Transaction Sets

HIPAA 005010 • 14 Transaction Sets • Healthcare Standard • MIT Licensed • Free

📦 What is this?

This package contains HIPAA X12 005010 standard definitions for use with @ediflow/core.

HIPAA 005010 is the mandated standard for healthcare transactions in the United States, required by the Health Insurance Portability and Accountability Act (HIPAA).

Includes:

• Healthcare transaction set structures (14 transaction sets)
• Segment definitions
• Element definitions
• Composite definitions
• Code lists
• HIPAA-specific syntax rules

Version: 005010 (Mandated 2012) - HIPAA compliance standard

🚀 Installation

# Install core library (required)
npm install @ediflow/core

# This package is internal - install locally
cd packages/hipaa-x12-005010
npm install

📊 Supported Transaction Sets (14)

🏥 Eligibility & Benefits

| Transaction Set | Version | Description | Use Case | |----------------|---------|-------------|----------| | 270 | B1 | Eligibility Inquiry | Check patient coverage | | 271 | B1 | Eligibility Response | Coverage details |

💰 Claims & Remittance

| Transaction Set | Version | Description | Use Case | |----------------|---------|-------------|----------| | 837 | Q1 | Professional Claims (837P) | Physician claims | | 837 | Q2 | Institutional Claims (837I) | Hospital claims | | 837 | Q3 | Dental Claims (837D) | Dental claims | | 835 | W1 | Claims Payment/Remittance | Payment advice |

📋 Claim Status

| Transaction Set | Version | Description | Use Case | |----------------|---------|-------------|----------| | 276 | A1 | Claim Status Inquiry | Check claim status | | 277 | A1 | Claim Status Response | Status details | | 277 | B3 | Claim Acknowledgment | Claim receipt |

🔐 Authorization

| Transaction Set | Version | Description | Use Case | |----------------|---------|-------------|----------| | 278 | A1 | Authorization Request | Prior authorization | | 278 | A3 | Authorization Response | Authorization decision |

👥 Enrollment & Membership

| Transaction Set | Version | Description | Use Case | |----------------|---------|-------------|----------| | 834 | A1 | Benefit Enrollment | Member enrollment | | 820 | A1 | Premium Payment | Premium processing |

✅ Acknowledgments

| Transaction Set | Version | Description | Use Case | |----------------|---------|-------------|----------| | 999 | A1 | Implementation Acknowledgment | HIPAA acknowledgment |

📖 Usage Example

import { DIContainer } from '@ediflow/core';

const container = DIContainer.getInstance();
const parseUseCase = container.resolve('ParseEDIUseCase');
const validateUseCase = container.resolve('ValidateMessageUseCase');

// Parse HIPAA X12 message
const parsed = parseUseCase.execute({
  message: x12String,
  standard: 'X12'
});

// Validate against HIPAA 005010 structure
const validation = validateUseCase.execute({
  message: parsed.message,
  messageType: '837-Q1',  // Professional Claims
  version: '005010',
  repositoryPath: './packages/hipaa-x12-005010/data'
});

if (validation.success) {
  console.log('✅ Valid HIPAA 837P Professional Claim!');
}

📁 Package Contents

@ediflow/hipaa-x12-005010/
└── data/
    ├── codes/                    # Code lists
    ├── composites.json           # Composite elements
    ├── elements.json             # Data elements
    ├── messages/                 # Transaction set structures (14)
    │   ├── 270-B1.json          # Eligibility Inquiry
    │   ├── 271-B1.json          # Eligibility Response
    │   ├── 276-A1.json          # Claim Status Inquiry
    │   ├── 277-A1.json          # Claim Status Response
    │   ├── 277-B3.json          # Claim Acknowledgment
    │   ├── 278-A1.json          # Auth Request
    │   ├── 278-A3.json          # Auth Response
    │   ├── 820-A1.json          # Premium Payment
    │   ├── 834-A1.json          # Enrollment
    │   ├── 835-W1.json          # Remittance
    │   ├── 837-Q1.json          # Professional Claims
    │   ├── 837-Q2.json          # Institutional Claims
    │   ├── 837-Q3.json          # Dental Claims
    │   └── 999-A1.json          # Implementation ACK
    ├── segment-syntax-rules.json # HIPAA-specific rules
    └── segments.json             # Segment definitions

Package Size: ~1.8 MB

🎯 When to Use HIPAA 005010

Use HIPAA 005010 if:

• ✅ Healthcare industry - Medical claims, eligibility, etc.
• ✅ HIPAA compliance - Required by law (US healthcare)
• ✅ Payers/Providers - Insurance companies, hospitals, clinics
• ✅ Clearinghouses - Healthcare data exchange
• ✅ 837/835/270/271 - Healthcare-specific transactions

Use X12 004010 instead if:

• 🔄 Non-healthcare - Retail, logistics, manufacturing
• 🔄 General B2B - Purchase orders, invoices, ASNs

🏥 HIPAA Transaction Overview

Claims Flow

1. 837 → Submit claim (Provider → Payer)
2. 277 → Acknowledge receipt (Payer → Provider)
3. 835 → Payment/remittance (Payer → Provider)

Eligibility Flow

1. 270 → Check eligibility (Provider → Payer)
2. 271 → Eligibility response (Payer → Provider)

Authorization Flow

1. 278 Request → Prior auth request (Provider → Payer)
2. 278 Response → Authorization decision (Payer → Provider)

🆚 Version Comparison

| Version | Year | Use Case | Transaction Sets | |---------|------|----------|-----------------| | 004010 | 2000 | General X12 | 293 | | 005010 | 2012 | HIPAA Healthcare | 310 (14 HIPAA) | | 006040 | 2026 | Latest X12 | 319 |

005010 = 004010 base + HIPAA-specific healthcare enhancements

⚠️ HIPAA Compliance Notes

This package provides HIPAA transaction structure definitions.

For full HIPAA compliance, you must also implement:

• ✅ Security Rules - Encryption, access controls
• ✅ Privacy Rules - PHI protection
• ✅ Transaction Rules - This package helps here!
• ✅ Code Set Rules - ICD-10, CPT, HCPCS
• ✅ Identifier Rules - NPI, EIN

Consult HIPAA legal counsel for compliance requirements.

📦 Related Packages

Core:

• @ediflow/core - Core library (REQUIRED)

Other X12 Standards:

• @ediflow/x12-004010 - 004010 General X12
• @ediflow/x12-006040 - 006040 Latest (Internal)

📚 Documentation

• Quick Start Guide
• Main README
• Architecture

🤝 Contributing

Data corrections or additional transaction sets? We welcome contributions!

• Report issues
• Contribute

📄 License

MIT License - see LICENSE

Note: This license applies to the software only. HIPAA compliance is your responsibility.

🔗 Links

• GitHub: https://github.com/ediflow-lib/core
• ASC X12: https://x12.org
• CMS HIPAA: https://www.cms.gov/regulations-and-guidance/administrative-simplification/hipaa-aca

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