Key Parts of EDI Processing Logic

The key parts of EDI processing logic are listed in Table 2–2.

Table 2–2 Key Parts of EDI Processing

Term	Description	Language Analogy	Java CAPS Component
Structures	Format, segments, loops	Syntax rules	OTD elements and fields
Validations	Data contents “edit” rules	Semantic rules	Not supported by HIPAA PM; handled by a third-party service
Translations (also called mappings)	Reformatting or conversion	Translation	Collaborations, Java Collaboration Definitions (JCDs)
Enveloping	Header and trailer segments	Envelope for a written letter	Special “envelope” OTDs: FunctionalGroupEnv and InterchangeEnv
Acks	Acknowledgments	Return receipt	Specific acknowledgment elements in the OTD

Java CAPS uses structures, translations, enveloping, and acknowledgments, as listed in Table 2–2 to support the HIPAA standard. The remainder of this section explains these terms in greater detail.

OTD Message Structures

The HIPAA OTD Library includes pre-built OTDs for messaging in all supported HIPAA versions. These OTDs can be viewed in the eGate OTD Editor but cannot be modified.

To customize an OTD structure , for example, in order to add a segment or loop , you must first create a .sef file (generally using a third-party application). You then use the SEF OTD wizard to generate the appropriate OTD from a given .sef file.

Translations, Enveloping, and Acknowledgments

Within each HIPAA OTD are Java methods and Java bean nodes for handling translations, enveloping, and acknowledgments. The marshal and unmarshal methods of the two envelope OTDs handle enveloping and de-enveloping.

No prebuilt translations are supplied with the HIPAA OTD Library. You build data translations with an eGate Enterprise Designer user interface called the Java Collaboration Editor (JCE).

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Note –

In eGate, HIPAA translations are called Java Collaboration Definitions (JCDs).

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You may also construct eGate XSLT Collaborations and/or eInsight BPs to perform translations.

Message Information Levels

The levels of information that guide the final format of a specific transaction are:

• HIPAA Protocol : The HIPAA Act mandates a standard structure for each HIPAA TP transaction. Specifically, since HIPAA regulations are law, it is important to follow the guidelines for these transactions as strictly as possible.

• TP Agreements : It is normal for TPs to have individual agreements that supplement the standard guidelines. The specific processing of the transactions in each TP’s individual system can vary from one site to another. As a result, additional documentation providing information about the differences is helpful to the site’s TPs and simplifies implementation. For example, although a certain code might be valid in an implementation guide, a specific TP might not use that code in transactions. In such a case, it is important to include that information in the TP agreement.