The following is the XML file that results from inbound processing of the preceding HIPAA document.
<?xml version="1.0" encoding="ISO-8859-1" ?> <documents> <ValidationReport> <Report> <Success/> </Report> </ValidationReport> <input> <![CDATA[ISA*00*..........*01*SECRET....*ZZ*SUBMITTERS.ID..*ZZ* RECEIVERS.ID...*030101*1253*^*00501*000000905*0*T*:~ GS*HR*SENDER CODE*RECEIVER CODE*19991231*0802*1*X*005010X212~ ST*276*0001*005010X212~ BHT*0010*13*ABC276XXX*20050915*1425~ HL*1**20*1~ NM1*PR*2*ABC INSURANCE*****PI*12345~ HL*2*1*21*1~ NM1*41*2*XYZ SERVICE*****46*X67E~ HL*3*2*19*1~ NM1*1P*2*HOME HOSPITAL*****XX*1666666668~ HL*4*3*22*0~ DMG*D8*19301210*M~ NM1*IL*1*SMITH*FRED****MI*123456789A~ TRN*1*ABCXYZ1~ REF*BLT*111~ REF*EJ*SM123456~ AMT*T3*8513.88~
DTP*472*RD8*20050831-20050906~ HL*5*3*22*0~ DMG*D8*19301115*F~ NM1*IL*1*JONES*MARY****MI*234567890A~ TRN*1*ABCXYZ2~ REF*BLT*111~ REF*EJ*JO234567~ AMT*T3*7599~ DTP*472*RD8*20050731-20050809~ HL*6*2*19*1~ NM1*1P*2*HOME HOSPITAL PHYSICIANS*****XX*1666666668~ HL*7*6*22*1~ NM1*IL*1*MANN*JOHN****MI*345678901~ HL*8*7*23~ DMG*D8*19951101*M~ NM1*QC*1*MANN*JOSEPH~ TRN*1*ABCXYZ3~ REF*EJ*MA345678~ SVC*HC:99203*150*****1~ DTP*472*D8*20050501~ SE*36*0001~ GE*1*1~ IEA*1*000000905~]]> </input> <output> <HIPAA_276_005010X212> <ISA> <_01_Authorization_Information_Qualifier>00 </_01_Authorization_Information_Qualifier> <_02_Authorization_Information>.......... </_02_Authorization_Information> <_03_Security_Information_Qualifier>01 </_03_Security_Information_Qualifier> <_04_Security_Information>SECRET....</_04_Security_Information> <_05_Interchange_ID_Qualifier>ZZ</_05_Interchange_ID_Qualifier> <_06_Interchange_Sender_ID>SUBMITTERS.ID..</_06_Interchange_Sender_ID> <_07_Interchange_ID_Qualifier>ZZ</_07_Interchange_ID_Qualifier> <_08_Interchange_Receiver_ID>RECEIVERS.ID... </_08_Interchange_Receiver_ID> <_09_Interchange_Date>030101</_09_Interchange_Date> <_10_Interchange_Time>1253</_10_Interchange_Time> <_11_Repetition_Separator>^</_11_Repetition_Separator> <_12_Interchange_Control_Version_Number>00501 </_12_Interchange_Control_Version_Number> <_13_Interchange_Control_Number>000000905 </_13_Interchange_Control_Number> <_14_Acknowledgement_Requested>0</_14_Acknowledgement_Requested> <_15_Usage_Indicator>T</_15_Usage_Indicator> <_16_Component_Element_Separator>:</_16_Component_Element_Separator> </ISA> <GS> <_01_Functional_Identifier_Code>HR</_01_Functional_Identifier_Code> <_02_Application_Senders_Code>SENDER CODE</_02_Application_Senders_Code> <_03_Application_Receivers_Code>RECEIVER CODE</_03_Application_Receivers_Code> <_04_Date>19991231</_04_Date> <_05_Time>0802</_05_Time> <_06_Group_Control_Number>1</_06_Group_Control_Number> <_07_Responsible_Agency_Code>X</_07_Responsible_Agency_Code> <_08_Version__Release__Industry_Identifier_Code>005010X212</_08_Version__ Release__Industry_Identifier_Code> </GS> <_276> <ST> <_01_Transaction_Set_Identifier_Code>276 </_01_Transaction_Set_Identifier_Code> <_02_Transaction_Set_Control_Number>0001 </_02_Transaction_Set_Control_Number> <_03_Implementation_Convention_Reference>005010X212 </_03_Implementation_Convention_Reference> </ST> <BHT> <_01_Hierarchical_Structure_Code>0010 </_01_Hierarchical_Structure_Code> <_02_Transaction_Set_Purpose_Code>13 </_02_Transaction_Set_Purpose_Code> <_03_Reference_Identification>ABC276XXX </_03_Reference_Identification> <_04_Date>20050915</_04_Date> <_05_Time>1425</_05_Time> </BHT> <_2000A> <HL> <_01_Hierarchical_ID_Number>1</_01_Hierarchical_ID_Number> <_03_Hierarchical_Level_Code>20</_03_Hierarchical_Level_Code> <_04_Hierarchical_Child_Code>1</_04_Hierarchical_Child_Code> </HL> <_2100A> <NM1> <_01_Entity_Identifier_Code>PR</_01_Entity_Identifier_Code> <_02_Entity_Type_Qualifier>2</_02_Entity_Type_Qualifier> <_03_Name_Last_or_Organization_Name>ABC INSURANCE </_03_Name_Last_or_Organization_Name> <_08_Identification_Code_Qualifier>PI </_08_Identification_Code_Qualifier> <_09_Identification_Code>12345</_09_Identification_Code> </NM1> </_2100A> <_2000B> <HL> <_01_Hierarchical_ID_Number>2</_01_Hierarchical_ID_Number> <_02_Hierarchical_Parent_ID_Number>1</_02_Hierarchical_Parent_ID_Number> <_03_Hierarchical_Level_Code>21</_03_Hierarchical_Level_Code> <_04_Hierarchical_Child_Code>1</_04_Hierarchical_Child_Code> </HL> <_2100B> <NM1> <_01_Entity_Identifier_Code>41</_01_Entity_Identifier_Code> <_02_Entity_Type_Qualifier>2</_02_Entity_Type_Qualifier> <_03_Name_Last_or_Organization_Name>XYZ SERVICE </_03_Name_Last_or_Organization_Name> <_08_Identification_Code_Qualifier>46</_08_Identification_Code_Qualifier> <_09_Identification_Code>X67E</_09_Identification_Code> </NM1> </_2100B> <_2000C> <HL> <_01_Hierarchical_ID_Number>3</_01_Hierarchical_ID_Number> <_02_Hierarchical_Parent_ID_Number>2</_02_Hierarchical_Parent_ID_Number> <_03_Hierarchical_Level_Code>19</_03_Hierarchical_Level_Code> <_04_Hierarchical_Child_Code>1</_04_Hierarchical_Child_Code> </HL> <_2100C> <NM1> <_01_Entity_Identifier_Code>1P</_01_Entity_Identifier_Code> <_02_Entity_Type_Qualifier>2</_02_Entity_Type_Qualifier> <_03_Name_Last_or_Organization_Name>HOME HOSPITAL </_03_Name_Last_or_Organization_Name> <_08_Identification_Code_Qualifier>XX</_08_Identification_Code_Qualifier> <_09_Identification_Code>1666666668</_09_Identification_Code> </NM1> </_2100C> <_2000D> <HL> <_01_Hierarchical_ID_Number>4</_01_Hierarchical_ID_Number> <_02_Hierarchical_Parent_ID_Number>3</_02_Hierarchical_Parent_ID_Number> <_03_Hierarchical_Level_Code>22</_03_Hierarchical_Level_Code> <_04_Hierarchical_Child_Code>0</_04_Hierarchical_Child_Code> </HL> <DMG> <_01_Date_Time_Period_Format_Qualifier>D8 </_01_Date_Time_Period_Format_Qualifier> <_02_Date_Time_Period>19301210</_02_Date_Time_Period> <_03_Gender_Code>M</_03_Gender_Code> </DMG> <_2100D> <NM1> <_01_Entity_Identifier_Code>IL</_01_Entity_Identifier_Code> <_02_Entity_Type_Qualifier>1</_02_Entity_Type_Qualifier> <_03_Name_Last_or_Organization_Name>SMITH</_03_Name_Last_or_Organization_Name> <_04_Name_First>FRED</_04_Name_First> <_08_Identification_Code_Qualifier>MI </_08_Identification_Code_Qualifier> <_09_Identification_Code>123456789A</_09_Identification_Code> </NM1> </_2100D> <_2200D> <TRN> <_01_Trace_Type_Code>1</_01_Trace_Type_Code> <_02_Reference_Identification>ABCXYZ1</_02_Reference_Identification> </TRN> <REF> <_01_Reference_Identification_Qualifier>BLT</_01_Reference_Identification_Qualifier> <_02_Reference_Identification>111</_02_Reference_Identification> </REF> <REF> <_01_Reference_Identification_Qualifier>EJ</_01_Reference_Identification_Qualifier> <_02_Reference_Identification>SM123456</_02_Reference_Identification> </REF> <AMT> <_01_Amount_Qualifier_Code>T3</_01_Amount_Qualifier_Code> <_02_Monetary_Amount>8513.88</_02_Monetary_Amount> </AMT> <DTP> <_01_Date_Time_Qualifier>472</_01_Date_Time_Qualifier> <_02_Date_Time_Period_Format_Qualifier>RD8 </_02_Date_Time_Period_Format_Qualifier> <_03_Date_Time_Period>20050831-20050906</_03_Date_Time_Period> </DTP> </_2200D> </_2000D> <_2000D> <HL> <_01_Hierarchical_ID_Number>5</_01_Hierarchical_ID_Number> <_02_Hierarchical_Parent_ID_Number>3</_02_Hierarchical_Parent_ID_Number> <_03_Hierarchical_Level_Code>22</_03_Hierarchical_Level_Code> <_04_Hierarchical_Child_Code>0</_04_Hierarchical_Child_Code> </HL> <DMG> <_01_Date_Time_Period_Format_Qualifier>D8 </_01_Date_Time_Period_Format_Qualifier> <_02_Date_Time_Period>19301115</_02_Date_Time_Period> <_03_Gender_Code>F</_03_Gender_Code> </DMG> <_2100D> <NM1> <_01_Entity_Identifier_Code>IL</_01_Entity_Identifier_Code> <_02_Entity_Type_Qualifier>1</_02_Entity_Type_Qualifier> <_03_Name_Last_or_Organization_Name>JONES </_03_Name_Last_or_Organization_Name> <_04_Name_First>MARY</_04_Name_First> <_08_Identification_Code_Qualifier>MI</_08_Identification_Code_Qualifier> <_09_Identification_Code>234567890A</_09_Identification_Code> </NM1> </_2100D> <_2200D> <TRN> <_01_Trace_Type_Code>1</_01_Trace_Type_Code> <_02_Reference_Identification>ABCXYZ2</_02_Reference_Identification> </TRN> <REF> <_01_Reference_Identification_Qualifier>BLT </_01_Reference_Identification_Qualifier> <_02_Reference_Identification>111</_02_Reference_Identification> </REF> <REF> <_01_Reference_Identification_Qualifier>EJ </_01_Reference_Identification_Qualifier> <_02_Reference_Identification>JO234567</_02_Reference_Identification> </REF> <AMT> <_01_Amount_Qualifier_Code>T3</_01_Amount_Qualifier_Code> <_02_Monetary_Amount>7599</_02_Monetary_Amount> </AMT> <DTP> <_01_Date_Time_Qualifier>472</_01_Date_Time_Qualifier> <_02_Date_Time_Period_Format_Qualifier>RD8 </_02_Date_Time_Period_Format_Qualifier> <_03_Date_Time_Period>20050731-20050809</_03_Date_Time_Period> </DTP> </_2200D> </_2000D> </_2000C> <_2000C> <HL> <_01_Hierarchical_ID_Number>6</_01_Hierarchical_ID_Number> _02_Hierarchical_Parent_ID_Number>2</_02_Hierarchical_Parent_ID_Number> <_03_Hierarchical_Level_Code>19</_03_Hierarchical_Level_Code> <_04_Hierarchical_Child_Code>1</_04_Hierarchical_Child_Code> </HL> <_2100C> <NM1> <_01_Entity_Identifier_Code>1P</_01_Entity_Identifier_Code> <_02_Entity_Type_Qualifier>2</_02_Entity_Type_Qualifier> <_03_Name_Last_or_Organization_Name>HOME HOSPITAL PHYSICIANS</_03_Name_Last_or_Organization_Name> <_08_Identification_Code_Qualifier>XX</_08_Identification_Code_Qualifier> <_09_Identification_Code>1666666668</_09_Identification_Code> </NM1> </_2100C> <_2000D> <HL> <_01_Hierarchical_ID_Number>7</_01_Hierarchical_ID_Number> <_02_Hierarchical_Parent_ID_Number>6</_02_Hierarchical_Parent_ID_Number> <_03_Hierarchical_Level_Code>22</_03_Hierarchical_Level_Code> <_04_Hierarchical_Child_Code>1</_04_Hierarchical_Child_Code> </HL> <_2100D> <NM1> <_01_Entity_Identifier_Code>IL</_01_Entity_Identifier_Code> <_02_Entity_Type_Qualifier>1</_02_Entity_Type_Qualifier> <_03_Name_Last_or_Organization_Name>MANN </_03_Name_Last_or_Organization_Name> <_04_Name_First>JOHN</_04_Name_First> <_08_Identification_Code_Qualifier>MI</_08_Identification_Code_Qualifier> <_09_Identification_Code>345678901</_09_Identification_Code> </NM1> </_2100D> <_2000E> <HL> <_01_Hierarchical_ID_Number>8</_01_Hierarchical_ID_Number> <_02_Hierarchical_Parent_ID_Number>7</_02_Hierarchical_Parent_ID_Number> <_03_Hierarchical_Level_Code>23</_03_Hierarchical_Level_Code> </HL> <DMG> <_01_Date_Time_Period_Format_Qualifier>D8 </_01_Date_Time_Period_Format_Qualifier> <_02_Date_Time_Period>19951101</_02_Date_Time_Period> <_03_Gender_Code>M</_03_Gender_Code> </DMG> <_2100E> <NM1> <_01_Entity_Identifier_Code>QC</_01_Entity_Identifier_Code> <_02_Entity_Type_Qualifier>1</_02_Entity_Type_Qualifier> <_03_Name_Last_or_Organization_Name>MANN</_03_Name_Last_or_Organization_Name> <_04_Name_First>JOSEPH</_04_Name_First> </NM1> </_2100E> <_2200E> <TRN> <_01_Trace_Type_Code>1</_01_Trace_Type_Code> <_02_Reference_Identification>ABCXYZ3</_02_Reference_Identification> </TRN> <REF> <_01_Reference_Identification_Qualifier>EJ </_01_Reference_Identification_Qualifier> <_02_Reference_Identification>MA345678</_02_Reference_Identification> </REF> <_2210E> <SVC> <C003> <_01_Product_Service_ID_Qualifier>HC</_01_Product_Service_ID_Qualifier> <_02_Product_Service_ID>99203</_02_Product_Service_ID> </C003> <_02_Monetary_Amount>150</_02_Monetary_Amount> <_07_Quantity>1</_07_Quantity> </SVC> <DTP> <_01_Date_Time_Qualifier>472</_01_Date_Time_Qualifier> <_02_Date_Time_Period_Format_Qualifier>D8 </_02_Date_Time_Period_Format_Qualifier> <_03_Date_Time_Period>20050501</_03_Date_Time_Period> </DTP> </_2210E> </_2200E> </_2000E> </_2000D> </_2000C> </_2000B> </_2000A> <SE> <_01_Number_of_Included_Segments>36</_01_Number_of_Included_Segments> <_02_Transaction_Set_Control_Number>0001 </_02_Transaction_Set_Control_Number> </SE> </_276> <GE> <_01_Number_of_Transaction_Sets_Included>1 /_01_Number_of_Transaction_Sets_Included> <_02_Group_Control_Number>1</_02_Group_Control_Number> </GE> <IEA> <_01_Number_of_Included_Functional_Groups>1 </_01_Number_of_Included_Functional_Groups> <_02_Interchange_Control_Number>000000905 </_02_Interchange_Control_Number> </IEA> </HIPAA_276_005010X212> </output> </documents>
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