Elements of HIPAA Envelopes

HIPAA messages are all in ASCII text, with the single exception that the BIN segment is binary.

Each HIPAA message is made up of a combination of the following elements:

• Data

• Segments

• Loops

Elements are separated by delimiters. The remainder of this section explains these elements.

Data Elements

The data element is the smallest named unit of information in the HIPAA standard. Data elements can be broken down into types. The distinction between the types is strictly a matter of how they are used.

The types are:

• Simple: If a data element occurs in a segment outside the defined boundaries of a composite data structure, it is called a simple data element.

• Composite: If a data element occurs as an ordinally positioned member of a composite data structure, it is called a composite data element. A telephone number is a simple example of a composite. It has a three-digit area code, which must precede the three-digit central office code, which must precede the final four digits.

Each data element has a unique reference number, and it also has a name, description, data type, and minimum and maximum length.

Segments

A segment is a logical grouping of data elements. In HIPAA, the same segment can be used for different purposes.

This means that a field’s meaning can change based on the segment, for example:

• The NM1 segment is for any name (patient, provider, organization, doctor)

• The DTP segment is for any date (date of birth, discharge date, coverage period)

For more information on the HIPAA enveloping segments, refer to the Web sites provided under Additional HIPAA References.

Loops

Loops are sets of repeating ordered segments.

In HIPAA you can locate elements by specifying:

• Transaction Set ,for example, 270 or 271

• Loop, for example, “info. receiver loop”

• Occurrence of the loop

• Segment, for example, BGN

• Field number, for example, 01

• Occurrence of the segment if it is a repeating segment

Delimiters

In an HIPAA message, the various delimiters are part of the syntax, dividing up the different elements of a message. The delimiters used in a message are defined in the interchange control header, the outermost layer enveloping the message.

For this reason, there is flexibility in the delimiters that are used. No suggested delimiters are recommended as part of the HIPAA standards, but the industry-specific implementation guides do have recommended delimiters.

The default delimiters used by the HIPAA OTD Library are the same as those recommended by the industry-specific implementation guides. These delimiters are shown in Table 2–1.

Table 2–1 Default Delimiters in the HIPAA OTD Library

Type of Delimiter	Default Value
Segment terminator	~ (tilde)
Data element separator	* (asterisk)
Subelement (component) separator	: (colon)

Within eXchange, delimiters are specified at the enveloping level. The delimiters defined for an envelope apply to all transactions in the same business service (a predefined dialog between the two parties).

If you do not specify delimiters and do not override them in the payload transactions fed into FROMINTERNAL, eXchange expects the default delimiters shown in Table 2–1.

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Note –

It is important to note that errors could result if the transmitted data includes any of the characters that have been defined as delimiters. Specifically, the existence of asterisks within transmitted third-party validation data is a known issue in HIPAA and can cause problems with translation.

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See Element Separator for information on the ePM delimiter parameter.