diff --git a/README.md b/README.md index 4227acb..9f7c6d7 100644 --- a/README.md +++ b/README.md @@ -42,37 +42,47 @@ claims.createOrReplaceTempView("edi") ### Creating claim header and line tables from EDI ``` SQL ---flatten EDI format -CREATE TABLE stg_claims to a claim view +--flatten EDI +drop table if exists stg_claims; +CREATE TABLE stg_claims as -select clms, filename, tax_id, sender, transaction_type +select * from ( select *, explode(trnx.Claims) as clms from ( -select filename, tax_id, - fg.`FunctionalGroup.sender` as sender, - fg.`FunctionalGroup.transaction_type` as transaction_type, - explode(fg.`Transactions`) as trnx +select filename, edi_control_number, edi_date, edi_time, +edi_recipient_qualifier_id, edi_sender_qualifier_id, edi_standard_version, +fgs.fg.`FunctionalGroup.control_number` as fg_control_number, +fgs.fg.`FunctionalGroup.date` as fg_date, +fgs.fg.`FunctionalGroup.time` as fg_time, +fgs.fg.`FunctionalGroup.receiver` as fg_receiver, +fgs.fg.`FunctionalGroup.sender` as fg_sender, +fgs.fg.`FunctionalGroup.standard_version` as fg_standard_version, +fgs.fg.`FunctionalGroup.transaction_type` as fg_transaction_type, + explode(fgs.fg.`Transactions`) as trnx from ( select -`edi.sender_tax_id` as tax_id, +`edi.control_number` as edi_control_number, +`edi.date` as edi_date, +`edi.time` as edi_time, +`EDI.recipient_qualifier_id` as edi_recipient_qualifier_id, +`EDI.sender_qualifier_id` as edi_sender_qualifier_id, +`EDI.standard_version` as edi_standard_version, explode(`FuncitonalGroup`) as fg, filename from edi ) fgs ) trnx -) clms; +) clms; ---Create a "Claims Header" table drop table if exists claim_header; create table claim_header as -select filename, -tax_id, -sender, -transaction_type, +select +filename, edi_control_number, edi_date, edi_time, edi_recipient_qualifier_id, edi_sender_qualifier_id, edi_standard_version, +fg_control_number, fg_date, fg_time, fg_receiver, fg_sender, fg_standard_version, fg_transaction_type, clms.claim_header.*, clms.diagnosis.*, clms.payer.*, @@ -96,7 +106,6 @@ clms.providers.*, clms.subscriber.gender_cd as subscriber_gender_cd from stg_claims; ---Create a "Claim Line" table create table claim_line as select filename, claim_id, cl.* from ( @@ -104,7 +113,7 @@ select filename, clms.claim_header.claim_id, explode(clms.claim_lines) as cl from stg_claims -) foo +) foo; ``` @@ -128,7 +137,49 @@ rdd = ( claims = spark.read.json(rdd) #Create Claims tables from the EDI transactions -#... +%sql +--flatten EDI +drop table if exists stg_remittance; +CREATE TABLE stg_remittance +as +select * +from +( +select *, explode(trnx.Claims) as clms +from +( +select filename, edi_control_number, edi_date, edi_time, +edi_recipient_qualifier_id, edi_sender_qualifier_id, edi_standard_version, +fgs.fg.`FunctionalGroup.control_number` as fg_control_number, +fgs.fg.`FunctionalGroup.date` as fg_date, +fgs.fg.`FunctionalGroup.time` as fg_time, +fgs.fg.`FunctionalGroup.receiver` as fg_receiver, +fgs.fg.`FunctionalGroup.sender` as fg_sender, +fgs.fg.`FunctionalGroup.standard_version` as fg_standard_version, +fgs.fg.`FunctionalGroup.transaction_type` as fg_transaction_type, + explode(fgs.fg.`Transactions`) as trnx +from +( +select +`edi.control_number` as edi_control_number, +`edi.date` as edi_date, +`edi.time` as edi_time, +`EDI.recipient_qualifier_id` as edi_recipient_qualifier_id, +`EDI.sender_qualifier_id` as edi_sender_qualifier_id, +`EDI.standard_version` as edi_standard_version, +explode(`FuncitonalGroup`) as fg, +filename +from edi +) fgs +) trnx +) clms ; + +drop table if exists remittance; +create table remittance as +select filename, edi_control_number, edi_date, edi_time, edi_recipient_qualifier_id, edi_sender_qualifier_id, edi_standard_version, +fg_control_number, fg_date, fg_time, fg_receiver, fg_sender, fg_standard_version, fg_transaction_type, +clms.* +from stg_remittance; ``` ![image](images/remittance.png?raw=true) diff --git a/notebooks/ClaimBuilder.ipynb b/notebooks/ClaimBuilder.ipynb deleted file mode 100644 index bca5852..0000000 --- a/notebooks/ClaimBuilder.ipynb +++ /dev/null @@ -1,11938 +0,0 @@ -{ - "cells": [ - { - "cell_type": "code", - "execution_count": 0, - "metadata": { - "application/vnd.databricks.v1+cell": { - "cellMetadata": { - "byteLimit": 2048000, - "rowLimit": 10000 - }, - "inputWidgets": {}, - "nuid": "bb3b295d-7680-486b-aa6b-62724ec33a44", - "showTitle": false, - "title": "" - } - }, - "outputs": [], - "source": [ - "from databricksx12 import *\n", - "from databricksx12.hls import *\n", - "import json, os\n", - "from pyspark.sql.functions import input_file_name\n" - ] - }, - { - "cell_type": "code", - "execution_count": 0, - "metadata": { - "application/vnd.databricks.v1+cell": { - "cellMetadata": { - "byteLimit": 2048000, - "rowLimit": 10000 - }, - "inputWidgets": {}, - "nuid": "5a6f5155-d9d2-4681-8406-7948627dddbf", - "showTitle": false, - "title": "" - } - }, - "outputs": [], - "source": [ - "# Initialize HealthcareManager\n", - "hm = HealthcareManager()\n", - "df = spark.read.text(\"/Volumes/raven_catalog/x12_edi_parser/sampledata/837/*.txt\", wholetext = True)\n", - "\n", - "# Process the DataFrame and convert to RDD\n", - "rdd = (\n", - " df.withColumn(\"filename\", input_file_name()).rdd\n", - " .map(lambda x: (x.asDict().get(\"filename\"),x.asDict().get(\"value\")))\n", - " .map(lambda x: (x[0], EDI(x[1])))\n", - " .map(lambda x: { **{'filename': x[0]}, **hm.to_json(x[1])} )\n", - " .map(lambda x: json.dumps(x))\n", - ")\n", - "\n", - "edi_data = spark.read.json(rdd)" - ] - }, - { - "cell_type": "code", - "execution_count": 0, - "metadata": { - "application/vnd.databricks.v1+cell": { - "cellMetadata": { - "byteLimit": 2048000, - "rowLimit": 10000 - }, - "inputWidgets": {}, - "nuid": "78dab3e9-abef-4c2e-9792-2bdce1c87781", - "showTitle": false, - "title": "" - } - }, - "outputs": [ - { - "output_type": "display_data", - "data": { - "text/html": [ - "
EDI.sender_tax_id | FuncitonalGroup | filename |
---|---|---|
ZZ | List(List(123456789, CLEARINGHOUSE, 20180508:0833, 222, List(List(List(List(List(, , 20, 1805080AV3648339, , , 57:B:1, , ), List(List(1, 1, 20, , , H0003, HC, null, 20180428, D8, 472, 1, UN)), List(, , , F1120, ), List(VANCOUVER, 19881225, D8, M, SUBSCRIBER JOHN J, , WA, 987 65TH PL, 18, 986640001), List(2, CHPWA, PI, COMMUNITY HEALTH PLAN OF WASHINGTON), List(null, List(VANCOUVER, 720000000, EI, Organization, BH CLINIC OF VANCOUVER, 1122334455, , WA, 12345 MAIN ST, , 98662), null, null, null, List(, , , Individual, , , , , , , ), List(, , , Organization, BH CLINIC OF VANCOUVER, 1122334455, , , , , ), List(, , , Individual, PROVIDER JAMES , 1112223338, PE, , , 261QR0405X, )), List(123456789, Organization), List(CLEARINGHOUSE LLC, CLEARINGHOUSE CLIENT SERVICES, List(List(TE, 8005551212), List(FX, 8005551212)), Organization), List(VANCOUVER, 19881225, D8, M, SUBSCRIBER JOHN J, , WA, 987 65TH PL, 18, 986640001))), 222), List(List(List(List(, , 50.1, 1805080AV3648347, , , 57:B:1, , ), List(List(1, 1:2, 50.1, HF, , 96153, HC, null, 20180426, D8, 472, 6, UN)), List(, , , F1520, ), List(VANCOUVER, 19881031, D8, F, PATIENT SUSAN E, , WA, 765 43RD ST, 18, 986640002), List(2, CHPWA, PI, COMMUNITY HEALTH PLAN OF WASHINGTON), List(null, List(VANCOUVER, 720000000, EI, Organization, BH CLINIC OF VANCOUVER, 1122334455, , WA, 12345 MAIN ST, , 98662), null, null, null, List(, , , Individual, , , , , , , ), List(, , , Organization, BH CLINIC OF VANCOUVER, 1122334455, , , , , ), List(, , , Individual, PROVIDER SUSAN , 1112223346, PE, , , 261QR0405X, )), List(123456789, Organization), List(CLEARINGHOUSE LLC, CLEARINGHOUSE CLIENT SERVICES, List(List(TE, 8005551212), List(FX, 8005551212)), Organization), List(VANCOUVER, 19881031, D8, F, PATIENT SUSAN E, , WA, 765 43RD ST, 18, 986640002))), 222), List(List(List(List(, , 11.64, 1805080AV3648340, , , 57:B:1, , ), List(List(1, 1:2, 11.64, HF, , T1017, HC, null, 20180427, D8, 472, 1, UN)), List(, , , F1020, ), List(VANCOUVER, 19881225, D8, M, SUBSCRIBER JOHN J, , WA, 987 65TH PL, 18, 986640001), List(2, CHPWA, PI, COMMUNITY HEALTH PLAN OF WASHINGTON), List(null, List(VANCOUVER, 720000000, EI, Organization, BH CLINIC OF VANCOUVER, 1122334455, , WA, 12345 MAIN ST, , 98662), null, null, null, List(, , , Individual, , , , , , , ), List(, , , Organization, BH CLINIC OF VANCOUVER, 1122334455, , , , , ), List(, , , Individual, PROVIDER SUSAN , 1112223346, PE, , , 261QR0405X, )), List(123456789, Organization), List(CLEARINGHOUSE LLC, CLEARINGHOUSE CLIENT SERVICES, List(List(TE, 8005551212), List(FX, 8005551212)), Organization), List(VANCOUVER, 19881225, D8, M, SUBSCRIBER JOHN J, , WA, 987 65TH PL, 18, 986640001))), 222), List(List(List(List(, , 234, 1805080AV3648353, , , 53:B:1, , ), List(List(1, 1, 234, , , 90853, HC, null, 20180427, D8, 472, 120, UN)), List(, , , F251, ), List(VANCOUVER, 19881031, D8, F, PATIENT SUSAN E, , WA, 765 43RD ST, 18, 986640002), List(2, CHPWA, PI, COMMUNITY HEALTH PLAN OF WASHINGTON), List(null, List(VANCOUVER, 720000000, EI, Organization, BH CLINIC OF VANCOUVER, 1122334455, , WA, 12345 MAIN ST, , 98662), null, null, null, List(, , , Individual, , , , , , , ), List(, , , Organization, BH CLINIC OF VANCOUVER, 1122334455, , , , , ), List(, , , Individual, PROVIDER SUSAN , 1112223346, PE, , , 251S00000X, )), List(123456789, Organization), List(CLEARINGHOUSE LLC, CLEARINGHOUSE CLIENT SERVICES, List(List(TE, 8005551212), List(FX, 8005551212)), Organization), List(VANCOUVER, 19881031, D8, F, PATIENT SUSAN E, , WA, 765 43RD ST, 18, 986640002))), 222), List(List(List(List(, , 20, 1805080AV3648355, , , 57:B:1, , ), List(List(1, 1:2, 20, , , H0003, HC, null, 20180427, D8, 472, 1, UN)), List(, , , F1020, ), List(VANCOUVER, 19881225, D8, M, SUBSCRIBER JOHN J, , WA, 987 65TH PL, 18, 986640001), List(2, CHPWA, PI, COMMUNITY HEALTH PLAN OF WASHINGTON), List(null, List(VANCOUVER, 720000000, EI, Organization, BH CLINIC OF VANCOUVER, 1122334455, , WA, 12345 MAIN ST, , 98662), null, null, null, List(, , , Individual, , , , , , , ), List(, , , Organization, BH CLINIC OF VANCOUVER, 1122334455, , , , , ), List(, , , Individual, PROVIDER JAMES , 1112223338, PE, , , 261QR0405X, )), List(123456789, Organization), List(CLEARINGHOUSE LLC, CLEARINGHOUSE CLIENT SERVICES, List(List(TE, 8005551212), List(FX, 8005551212)), Organization), List(VANCOUVER, 19881225, D8, M, SUBSCRIBER JOHN J, , WA, 987 65TH PL, 18, 986640001))), 222)))) | dbfs:/Volumes/raven_catalog/x12_edi_parser/sampledata/837/CHPW_Claimdata.txt |
ZZ | List(List(OO000011111, 000000005D, 20180710:214339, 222, List(List(List(List(List(, , 1800, ABC11111, D8, , 22:B:1, 20180123, 454), List(List(1, 1, 1800, QZ, , 01710, HC, null, 20180123-20180123, RD8, 472, 88, MJ), List(1, 1, 984, AA,P3, , 00731, HC, null, 20180713-20180713, RD8, 472, 24, MJ), List(1, 1, 1353, AA, , 00840, HC, null, 20180713-20180713, RD8, 472, 62, MJ), List(1, 1, 1230, AA, , 00902, HC, null, 20180713-20180713, RD8, 472, 65, MJ), List(2, 2, 738, 59, , 62322, HC, null, 20180713-20180713, RD8, 472, 1, UN)), List(, , , G5621, ), List(FAKE CITY, 19650101, D8, M, ABCDEFGH IJKLMNOP B, , CA, 123 ADDRESS3, 18, 908021112), List(2, ABCMMPIO, PI, ABCHYI OL POI), List(null, List(FAKE CITY, 123456789, EI, Organization, YYYY HEALTHCARE ABC, 1222222220, , NY, 123 ADDRESS1, , 908021112), null, null, null, List(, , , Individual, ABCD STUVW , 1234567890, , , , , ), List(, , , Organization, ABCDEFG HIJKLMN HOSP, 1122334460, , , , , ), List(, , , Individual, TUVWX MNOPQR , 1234567891, PE, , , 367500000X, )), List(ABCHYI OL POI, Organization), List(ABCDEF, ABCDEF CUSTOMER SOLUTIONS, List(List(TE, 9999999999), List(, )), Organization), List(FAKE CITY, 19650101, D8, M, ABCDEFGH IJKLMNOP B, , CA, 123 ADDRESS3, 18, 908021112)), List(List(, , 984, ABC111112, D8, , 22:B:1, 20180713, 454), List(List(1, 1, 984, AA,P3, , 00731, HC, null, 20180713-20180713, RD8, 472, 24, MJ), List(1, 1, 1353, AA, , 00840, HC, null, 20180713-20180713, RD8, 472, 62, MJ), List(1, 1, 1230, AA, , 00902, HC, null, 20180713-20180713, RD8, 472, 65, MJ), List(2, 2, 738, 59, , 62322, HC, null, 20180713-20180713, RD8, 472, 1, UN)), List(, , , K219, ), List(FAKE CITY, 19760101, D8, F, ABCDEFGH IJKLMNOP B, , CA, 123 ADDRESS7, 18, 908021117), List(2, ABCMMPIO, PI, ABCHYI OL POI), List(null, List(FAKE CITY, 543211234, EI, Organization, ABCDE EFGHIJ GROUP PC, 1222222223, , CA, 123 ADDRESS5, , 908021115), null, null, null, List(, , , Individual, ABCDEFG OPQRST A, 1122334460, , , , , ), List(, , , Organization, ABCDEFG HIJKLMN HOSP, 1122334450, , , , , ), List(, , , Individual, STUVW KLMNOP H, 1122334461, PE, , , 207L00000X, )), List(ABCHYI OL POI, Organization), List(ABCDEF, ABCDEF CUSTOMER SOLUTIONS, List(List(TE, 9999999999), List(, )), Organization), List(FAKE CITY, 19760101, D8, F, ABCDEFGH IJKLMNOP B, , CA, 123 ADDRESS7, 18, 908021117)), List(List(, , 1353, ABC111113, D8, , 22:B:1, 20180713, 454), List(List(1, 1, 1353, AA, , 00840, HC, null, 20180713-20180713, RD8, 472, 62, MJ), List(1, 1, 1230, AA, , 00902, HC, null, 20180713-20180713, RD8, 472, 65, MJ), List(2, 2, 738, 59, , 62322, HC, null, 20180713-20180713, RD8, 472, 1, UN)), List(, , , K4090, ), List(FAKE CITY, 20180409, D8, M, ABCDEFGH IJKLMNOP B, , CA, 123 ADDRESS11, 18, 908021111), List(2, YTHF281123456, PI, ABCHYI OL POI), List(null, List(FAKE CITY, 931013923, EI, Organization, ABCDE EFGHIJ GROUP PC, 1477527786, , CA, 123 ADDRESS9, , 908021119), null, null, null, List(, , , Individual, ABCDEFGH OPQRSTU A, 1122334456, , , , , ), List(, , , Organization, ABCDEFG HIJKLMN HOSP, 1122334458, , , , , ), List(, , , Individual, STUVWX KLMNOPQ H, 1122334457, PE, , , 207L00000X, )), List(ABCHYI OL POI, Organization), List(ABCDEF, ABCDEF CUSTOMER SOLUTIONS, List(List(TE, 9999999999), List(, )), Organization), List(FAKE CITY, 20180409, D8, M, ABCDEFGH IJKLMNOP B, , CA, 123 ADDRESS11, 18, 908021111)), List(List(, , 1968, ABC111114, D8, , 22:B:1, 20180713, 454), List(List(1, 1, 1230, AA, , 00902, HC, null, 20180713-20180713, RD8, 472, 65, MJ), List(2, 2, 738, 59, , 62322, HC, null, 20180713-20180713, RD8, 472, 1, UN)), List(, , , Q423, ), List(FAKE CITY, 20180504, D8, F, ABCDEFGH IJKLMNOP B, , CA, 123 ADDRESS13, 18, 908021113), List(2, YTHF281123456, PI, ABCHYI OL POI), List(null, List(FAKE CITY, 931013923, EI, Organization, ABCDE EFGHIJ GROUP PC, 1477527786, , CA, 123 ADDRESS9, , 908021119), null, null, null, List(, , , Individual, ABCDEFGHI OPQRSTUV A, 1122334455, , , , , ), List(, , , Organization, ABCDEFG HIJKLMN HOSP, 1122334457, , , , , ), List(, , , Individual, STUVWXY KLMNOPQR H, 1122334456, PE, , , 207L00000X, )), List(ABCHYI OL POI, Organization), List(ABCDEF, ABCDEF CUSTOMER SOLUTIONS, List(List(TE, 9999999999), List(, )), Organization), List(FAKE CITY, 20180504, D8, F, ABCDEFGH IJKLMNOP B, , CA, 123 ADDRESS13, 18, 908021113))), 222)))) | dbfs:/Volumes/raven_catalog/x12_edi_parser/sampledata/837/Molina_Mock_UP_837P_File.txt |
ZZ | List(List(421406317, 133052274, 20180807:12022761, 223, List(List(List(List(List(1, 1, 17166.7, TD-R192ICE00087, TM, 01, 11:A:1, 0900, 096), List(List(1, null, 9148, , null, , , 0124, 20180628-20180702, RD8, 472, 4, UN), List(2, null, 48.1, , null, , , 0250, 20180628-20180702, RD8, 472, 28, UN), List(3, null, 133, , null, , , 0260, 20180628-20180702, RD8, 472, 1, UN), List(4, null, 32.9, , null, , , 0300, 20180628-20180702, RD8, 472, 1, UN), List(5, null, 798.5, , null, , , 0301, 20180628-20180702, RD8, 472, 4, UN), List(6, null, 200.6, , null, , , 0305, 20180628-20180702, RD8, 472, 2, UN), List(7, null, 175, , null, , , 0306, 20180628-20180702, RD8, 472, 1, UN), List(8, null, 113.6, , null, , , 0307, 20180628-20180702, RD8, 472, 2, UN), List(9, null, 6517, , null, , , 0351, 20180628-20180702, RD8, 472, 2, UN)), List(F39, , F1319, F39, ), List(Elgin, 19960215, D8, F, TEST MEMBER , , IL, 123 MAIN STREET, 18, 601200001), List(2, 421406317, PI, CENTENE), List(List(, TD-R192ICE00087, D9, Individual, , , , , , , ), List(WOODSTOCK, 999999999, EI, Organization, Test Provider, 9999999999, , IL, 123 MAIN STREET, , 600980000), List(, , , Individual, , , , , , , ), List(, , , Individual, , , , , , , ), List(, , , Individual, , , , , , , ), null, null, null), List(CENTENE CORP, Organization), List(TALEND, SAMBIT, List(List(TE, 3143202264), List(EX, 8099264)), Organization), List(Elgin, 19960215, D8, F, TEST MEMBER , , IL, 123 MAIN STREET, 18, 601200001))), 223)))) | dbfs:/Volumes/raven_catalog/x12_edi_parser/sampledata/837/CC_837I_EDI.txt |
ZZ | List(List(XXXXX, XXXXXXX, 20170617:1741, 222, List(List(List(List(List(, , 140, 1000A, , , 19:B:1, , ), List(List(1, 1, 140, , , 99213, HC, null, 20151124, D8, 472, 1, UN), List(1, 1, 140, , , 99213, HC, null, 20151124, D8, 472, 1, UN)), List(, , , I10, ), List(CHICAGO, 19570111, D8, M, BLOGGS JOE , , IL, 1 SOME BLVD, 18, 606129998), List(2, 12345, PI, PAYER), List(null, List(CHICAGO, 999999999, EI, Organization, BILLING PROVIDER, 1122334455, , IL, 1234 SOME ROAD, , 606739999), null, null, null, List(, , , Individual, , , , , , , ), List(, , , Individual, , , , , , , ), List(, , , Individual, , , , , , , )), List(RECEIVER, Organization), List(SUBMITTER, BOB SMITH, List(List(TE, 4805551212), List(, )), Organization), List(CHICAGO, 19570111, D8, M, BLOGGS JOE , , IL, 1 SOME BLVD, 18, 606129998)), List(List(, , 140, 1001A, , , 19:B:1, , ), List(List(1, 1, 140, , , 99213, HC, null, 20151124, D8, 472, 1, UN)), List(, , , I10, ), List(CHICAGO, 19700601, D8, M, BLOGGS FRED , , IL, 1 ANOTHER STR, 18, 606129998), List(2, 12345, PI, PAYER), List(null, List(CHICAGO, 999999999, EI, Organization, BILLING PROVIDER, 1122334455, , IL, 1234 SOME ROAD, , 606739999), null, null, null, List(, , , Individual, , , , , , , ), List(, , , Individual, , , , , , , ), List(, , , Individual, , , , , , , )), List(RECEIVER, Organization), List(SUBMITTER, BOB SMITH, List(List(TE, 4805551212), List(, )), Organization), List(CHICAGO, 19700601, D8, M, BLOGGS FRED , , IL, 1 ANOTHER STR, 18, 606129998))), 222)))) | dbfs:/Volumes/raven_catalog/x12_edi_parser/sampledata/837/837p.txt |
30 | List(List(421406317, 030240928, 20180807:12022605, 222, List(List(List(List(List(, , 600, TD-R192ICE00094, D8, , 11:B:1, 20180625, 435), List(List(1, 1:2, 300, HO,HQ, 11, H0004, HC, null, 20180625-20180625, RD8, 472, 12, UN), List(2, 1:2, 300, HO,HQ, 11, H0004, HC, null, 20180629-20180629, RD8, 472, 12, UN)), List(, , , F341, ), List(Elgin, 19960215, D8, F, TEST MEMBER , , IL, 123 MAIN STREET, 18, 601200001), List(2, 421406317, PI, CENTENE), List(null, List(WOODSTOCK, 999999999, EI, Organization, Test Provider, 9999999999, , IL, 123 MAIN STREET, , 600980000), null, null, null, List(, , , Individual, , , , , , , ), List(, , , Individual, , , , , , , ), List(, , , Individual, , , , , , , )), List(Centene Corporation, Organization), List(Centene Corporation, Sambit, List(List(TE, 3143202264), List(EX, 8099264)), Organization), List(Elgin, 19960215, D8, F, TEST MEMBER , , IL, 123 MAIN STREET, 18, 601200001))), 222)))) | dbfs:/Volumes/raven_catalog/x12_edi_parser/sampledata/837/CC_837P_EDI.txt |
tax_id | FunctionalGroup |
---|---|
ZZ | List(123456789, CLEARINGHOUSE, 20180508:0833, 222, List(List(List(List(List(, , 20, 1805080AV3648339, , , 57:B:1, , ), List(List(1, 1, 20, , , H0003, HC, null, 20180428, D8, 472, 1, UN)), List(, , , F1120, ), List(VANCOUVER, 19881225, D8, M, SUBSCRIBER JOHN J, , WA, 987 65TH PL, 18, 986640001), List(2, CHPWA, PI, COMMUNITY HEALTH PLAN OF WASHINGTON), List(null, List(VANCOUVER, 720000000, EI, Organization, BH CLINIC OF VANCOUVER, 1122334455, , WA, 12345 MAIN ST, , 98662), null, null, null, List(, , , Individual, , , , , , , ), List(, , , Organization, BH CLINIC OF VANCOUVER, 1122334455, , , , , ), List(, , , Individual, PROVIDER JAMES , 1112223338, PE, , , 261QR0405X, )), List(123456789, Organization), List(CLEARINGHOUSE LLC, CLEARINGHOUSE CLIENT SERVICES, List(List(TE, 8005551212), List(FX, 8005551212)), Organization), List(VANCOUVER, 19881225, D8, M, SUBSCRIBER JOHN J, , WA, 987 65TH PL, 18, 986640001))), 222), List(List(List(List(, , 50.1, 1805080AV3648347, , , 57:B:1, , ), List(List(1, 1:2, 50.1, HF, , 96153, HC, null, 20180426, D8, 472, 6, UN)), List(, , , F1520, ), List(VANCOUVER, 19881031, D8, F, PATIENT SUSAN E, , WA, 765 43RD ST, 18, 986640002), List(2, CHPWA, PI, COMMUNITY HEALTH PLAN OF WASHINGTON), List(null, List(VANCOUVER, 720000000, EI, Organization, BH CLINIC OF VANCOUVER, 1122334455, , WA, 12345 MAIN ST, , 98662), null, null, null, List(, , , Individual, , , , , , , ), List(, , , Organization, BH CLINIC OF VANCOUVER, 1122334455, , , , , ), List(, , , Individual, PROVIDER SUSAN , 1112223346, PE, , , 261QR0405X, )), List(123456789, Organization), List(CLEARINGHOUSE LLC, CLEARINGHOUSE CLIENT SERVICES, List(List(TE, 8005551212), List(FX, 8005551212)), Organization), List(VANCOUVER, 19881031, D8, F, PATIENT SUSAN E, , WA, 765 43RD ST, 18, 986640002))), 222), List(List(List(List(, , 11.64, 1805080AV3648340, , , 57:B:1, , ), List(List(1, 1:2, 11.64, HF, , T1017, HC, null, 20180427, D8, 472, 1, UN)), List(, , , F1020, ), List(VANCOUVER, 19881225, D8, M, SUBSCRIBER JOHN J, , WA, 987 65TH PL, 18, 986640001), List(2, CHPWA, PI, COMMUNITY HEALTH PLAN OF WASHINGTON), List(null, List(VANCOUVER, 720000000, EI, Organization, BH CLINIC OF VANCOUVER, 1122334455, , WA, 12345 MAIN ST, , 98662), null, null, null, List(, , , Individual, , , , , , , ), List(, , , Organization, BH CLINIC OF VANCOUVER, 1122334455, , , , , ), List(, , , Individual, PROVIDER SUSAN , 1112223346, PE, , , 261QR0405X, )), List(123456789, Organization), List(CLEARINGHOUSE LLC, CLEARINGHOUSE CLIENT SERVICES, List(List(TE, 8005551212), List(FX, 8005551212)), Organization), List(VANCOUVER, 19881225, D8, M, SUBSCRIBER JOHN J, , WA, 987 65TH PL, 18, 986640001))), 222), List(List(List(List(, , 234, 1805080AV3648353, , , 53:B:1, , ), List(List(1, 1, 234, , , 90853, HC, null, 20180427, D8, 472, 120, UN)), List(, , , F251, ), List(VANCOUVER, 19881031, D8, F, PATIENT SUSAN E, , WA, 765 43RD ST, 18, 986640002), List(2, CHPWA, PI, COMMUNITY HEALTH PLAN OF WASHINGTON), List(null, List(VANCOUVER, 720000000, EI, Organization, BH CLINIC OF VANCOUVER, 1122334455, , WA, 12345 MAIN ST, , 98662), null, null, null, List(, , , Individual, , , , , , , ), List(, , , Organization, BH CLINIC OF VANCOUVER, 1122334455, , , , , ), List(, , , Individual, PROVIDER SUSAN , 1112223346, PE, , , 251S00000X, )), List(123456789, Organization), List(CLEARINGHOUSE LLC, CLEARINGHOUSE CLIENT SERVICES, List(List(TE, 8005551212), List(FX, 8005551212)), Organization), List(VANCOUVER, 19881031, D8, F, PATIENT SUSAN E, , WA, 765 43RD ST, 18, 986640002))), 222), List(List(List(List(, , 20, 1805080AV3648355, , , 57:B:1, , ), List(List(1, 1:2, 20, , , H0003, HC, null, 20180427, D8, 472, 1, UN)), List(, , , F1020, ), List(VANCOUVER, 19881225, D8, M, SUBSCRIBER JOHN J, , WA, 987 65TH PL, 18, 986640001), List(2, CHPWA, PI, COMMUNITY HEALTH PLAN OF WASHINGTON), List(null, List(VANCOUVER, 720000000, EI, Organization, BH CLINIC OF VANCOUVER, 1122334455, , WA, 12345 MAIN ST, , 98662), null, null, null, List(, , , Individual, , , , , , , ), List(, , , Organization, BH CLINIC OF VANCOUVER, 1122334455, , , , , ), List(, , , Individual, PROVIDER JAMES , 1112223338, PE, , , 261QR0405X, )), List(123456789, Organization), List(CLEARINGHOUSE LLC, CLEARINGHOUSE CLIENT SERVICES, List(List(TE, 8005551212), List(FX, 8005551212)), Organization), List(VANCOUVER, 19881225, D8, M, SUBSCRIBER JOHN J, , WA, 987 65TH PL, 18, 986640001))), 222))) |
ZZ | List(OO000011111, 000000005D, 20180710:214339, 222, List(List(List(List(List(, , 1800, ABC11111, D8, , 22:B:1, 20180123, 454), List(List(1, 1, 1800, QZ, , 01710, HC, null, 20180123-20180123, RD8, 472, 88, MJ), List(1, 1, 984, AA,P3, , 00731, HC, null, 20180713-20180713, RD8, 472, 24, MJ), List(1, 1, 1353, AA, , 00840, HC, null, 20180713-20180713, RD8, 472, 62, MJ), List(1, 1, 1230, AA, , 00902, HC, null, 20180713-20180713, RD8, 472, 65, MJ), List(2, 2, 738, 59, , 62322, HC, null, 20180713-20180713, RD8, 472, 1, UN)), List(, , , G5621, ), List(FAKE CITY, 19650101, D8, M, ABCDEFGH IJKLMNOP B, , CA, 123 ADDRESS3, 18, 908021112), List(2, ABCMMPIO, PI, ABCHYI OL POI), List(null, List(FAKE CITY, 123456789, EI, Organization, YYYY HEALTHCARE ABC, 1222222220, , NY, 123 ADDRESS1, , 908021112), null, null, null, List(, , , Individual, ABCD STUVW , 1234567890, , , , , ), List(, , , Organization, ABCDEFG HIJKLMN HOSP, 1122334460, , , , , ), List(, , , Individual, TUVWX MNOPQR , 1234567891, PE, , , 367500000X, )), List(ABCHYI OL POI, Organization), List(ABCDEF, ABCDEF CUSTOMER SOLUTIONS, List(List(TE, 9999999999), List(, )), Organization), List(FAKE CITY, 19650101, D8, M, ABCDEFGH IJKLMNOP B, , CA, 123 ADDRESS3, 18, 908021112)), List(List(, , 984, ABC111112, D8, , 22:B:1, 20180713, 454), List(List(1, 1, 984, AA,P3, , 00731, HC, null, 20180713-20180713, RD8, 472, 24, MJ), List(1, 1, 1353, AA, , 00840, HC, null, 20180713-20180713, RD8, 472, 62, MJ), List(1, 1, 1230, AA, , 00902, HC, null, 20180713-20180713, RD8, 472, 65, MJ), List(2, 2, 738, 59, , 62322, HC, null, 20180713-20180713, RD8, 472, 1, UN)), List(, , , K219, ), List(FAKE CITY, 19760101, D8, F, ABCDEFGH IJKLMNOP B, , CA, 123 ADDRESS7, 18, 908021117), List(2, ABCMMPIO, PI, ABCHYI OL POI), List(null, List(FAKE CITY, 543211234, EI, Organization, ABCDE EFGHIJ GROUP PC, 1222222223, , CA, 123 ADDRESS5, , 908021115), null, null, null, List(, , , Individual, ABCDEFG OPQRST A, 1122334460, , , , , ), List(, , , Organization, ABCDEFG HIJKLMN HOSP, 1122334450, , , , , ), List(, , , Individual, STUVW KLMNOP H, 1122334461, PE, , , 207L00000X, )), List(ABCHYI OL POI, Organization), List(ABCDEF, ABCDEF CUSTOMER SOLUTIONS, List(List(TE, 9999999999), List(, )), Organization), List(FAKE CITY, 19760101, D8, F, ABCDEFGH IJKLMNOP B, , CA, 123 ADDRESS7, 18, 908021117)), List(List(, , 1353, ABC111113, D8, , 22:B:1, 20180713, 454), List(List(1, 1, 1353, AA, , 00840, HC, null, 20180713-20180713, RD8, 472, 62, MJ), List(1, 1, 1230, AA, , 00902, HC, null, 20180713-20180713, RD8, 472, 65, MJ), List(2, 2, 738, 59, , 62322, HC, null, 20180713-20180713, RD8, 472, 1, UN)), List(, , , K4090, ), List(FAKE CITY, 20180409, D8, M, ABCDEFGH IJKLMNOP B, , CA, 123 ADDRESS11, 18, 908021111), List(2, YTHF281123456, PI, ABCHYI OL POI), List(null, List(FAKE CITY, 931013923, EI, Organization, ABCDE EFGHIJ GROUP PC, 1477527786, , CA, 123 ADDRESS9, , 908021119), null, null, null, List(, , , Individual, ABCDEFGH OPQRSTU A, 1122334456, , , , , ), List(, , , Organization, ABCDEFG HIJKLMN HOSP, 1122334458, , , , , ), List(, , , Individual, STUVWX KLMNOPQ H, 1122334457, PE, , , 207L00000X, )), List(ABCHYI OL POI, Organization), List(ABCDEF, ABCDEF CUSTOMER SOLUTIONS, List(List(TE, 9999999999), List(, )), Organization), List(FAKE CITY, 20180409, D8, M, ABCDEFGH IJKLMNOP B, , CA, 123 ADDRESS11, 18, 908021111)), List(List(, , 1968, ABC111114, D8, , 22:B:1, 20180713, 454), List(List(1, 1, 1230, AA, , 00902, HC, null, 20180713-20180713, RD8, 472, 65, MJ), List(2, 2, 738, 59, , 62322, HC, null, 20180713-20180713, RD8, 472, 1, UN)), List(, , , Q423, ), List(FAKE CITY, 20180504, D8, F, ABCDEFGH IJKLMNOP B, , CA, 123 ADDRESS13, 18, 908021113), List(2, YTHF281123456, PI, ABCHYI OL POI), List(null, List(FAKE CITY, 931013923, EI, Organization, ABCDE EFGHIJ GROUP PC, 1477527786, , CA, 123 ADDRESS9, , 908021119), null, null, null, List(, , , Individual, ABCDEFGHI OPQRSTUV A, 1122334455, , , , , ), List(, , , Organization, ABCDEFG HIJKLMN HOSP, 1122334457, , , , , ), List(, , , Individual, STUVWXY KLMNOPQR H, 1122334456, PE, , , 207L00000X, )), List(ABCHYI OL POI, Organization), List(ABCDEF, ABCDEF CUSTOMER SOLUTIONS, List(List(TE, 9999999999), List(, )), Organization), List(FAKE CITY, 20180504, D8, F, ABCDEFGH IJKLMNOP B, , CA, 123 ADDRESS13, 18, 908021113))), 222))) |
ZZ | List(421406317, 133052274, 20180807:12022761, 223, List(List(List(List(List(1, 1, 17166.7, TD-R192ICE00087, TM, 01, 11:A:1, 0900, 096), List(List(1, null, 9148, , null, , , 0124, 20180628-20180702, RD8, 472, 4, UN), List(2, null, 48.1, , null, , , 0250, 20180628-20180702, RD8, 472, 28, UN), List(3, null, 133, , null, , , 0260, 20180628-20180702, RD8, 472, 1, UN), List(4, null, 32.9, , null, , , 0300, 20180628-20180702, RD8, 472, 1, UN), List(5, null, 798.5, , null, , , 0301, 20180628-20180702, RD8, 472, 4, UN), List(6, null, 200.6, , null, , , 0305, 20180628-20180702, RD8, 472, 2, UN), List(7, null, 175, , null, , , 0306, 20180628-20180702, RD8, 472, 1, UN), List(8, null, 113.6, , null, , , 0307, 20180628-20180702, RD8, 472, 2, UN), List(9, null, 6517, , null, , , 0351, 20180628-20180702, RD8, 472, 2, UN)), List(F39, , F1319, F39, ), List(Elgin, 19960215, D8, F, TEST MEMBER , , IL, 123 MAIN STREET, 18, 601200001), List(2, 421406317, PI, CENTENE), List(List(, TD-R192ICE00087, D9, Individual, , , , , , , ), List(WOODSTOCK, 999999999, EI, Organization, Test Provider, 9999999999, , IL, 123 MAIN STREET, , 600980000), List(, , , Individual, , , , , , , ), List(, , , Individual, , , , , , , ), List(, , , Individual, , , , , , , ), null, null, null), List(CENTENE CORP, Organization), List(TALEND, SAMBIT, List(List(TE, 3143202264), List(EX, 8099264)), Organization), List(Elgin, 19960215, D8, F, TEST MEMBER , , IL, 123 MAIN STREET, 18, 601200001))), 223))) |
ZZ | List(XXXXX, XXXXXXX, 20170617:1741, 222, List(List(List(List(List(, , 140, 1000A, , , 19:B:1, , ), List(List(1, 1, 140, , , 99213, HC, null, 20151124, D8, 472, 1, UN), List(1, 1, 140, , , 99213, HC, null, 20151124, D8, 472, 1, UN)), List(, , , I10, ), List(CHICAGO, 19570111, D8, M, BLOGGS JOE , , IL, 1 SOME BLVD, 18, 606129998), List(2, 12345, PI, PAYER), List(null, List(CHICAGO, 999999999, EI, Organization, BILLING PROVIDER, 1122334455, , IL, 1234 SOME ROAD, , 606739999), null, null, null, List(, , , Individual, , , , , , , ), List(, , , Individual, , , , , , , ), List(, , , Individual, , , , , , , )), List(RECEIVER, Organization), List(SUBMITTER, BOB SMITH, List(List(TE, 4805551212), List(, )), Organization), List(CHICAGO, 19570111, D8, M, BLOGGS JOE , , IL, 1 SOME BLVD, 18, 606129998)), List(List(, , 140, 1001A, , , 19:B:1, , ), List(List(1, 1, 140, , , 99213, HC, null, 20151124, D8, 472, 1, UN)), List(, , , I10, ), List(CHICAGO, 19700601, D8, M, BLOGGS FRED , , IL, 1 ANOTHER STR, 18, 606129998), List(2, 12345, PI, PAYER), List(null, List(CHICAGO, 999999999, EI, Organization, BILLING PROVIDER, 1122334455, , IL, 1234 SOME ROAD, , 606739999), null, null, null, List(, , , Individual, , , , , , , ), List(, , , Individual, , , , , , , ), List(, , , Individual, , , , , , , )), List(RECEIVER, Organization), List(SUBMITTER, BOB SMITH, List(List(TE, 4805551212), List(, )), Organization), List(CHICAGO, 19700601, D8, M, BLOGGS FRED , , IL, 1 ANOTHER STR, 18, 606129998))), 222))) |
30 | List(421406317, 030240928, 20180807:12022605, 222, List(List(List(List(List(, , 600, TD-R192ICE00094, D8, , 11:B:1, 20180625, 435), List(List(1, 1:2, 300, HO,HQ, 11, H0004, HC, null, 20180625-20180625, RD8, 472, 12, UN), List(2, 1:2, 300, HO,HQ, 11, H0004, HC, null, 20180629-20180629, RD8, 472, 12, UN)), List(, , , F341, ), List(Elgin, 19960215, D8, F, TEST MEMBER , , IL, 123 MAIN STREET, 18, 601200001), List(2, 421406317, PI, CENTENE), List(null, List(WOODSTOCK, 999999999, EI, Organization, Test Provider, 9999999999, , IL, 123 MAIN STREET, , 600980000), null, null, null, List(, , , Individual, , , , , , , ), List(, , , Individual, , , , , , , ), List(, , , Individual, , , , , , , )), List(Centene Corporation, Organization), List(Centene Corporation, Sambit, List(List(TE, 3143202264), List(EX, 8099264)), Organization), List(Elgin, 19960215, D8, F, TEST MEMBER , , IL, 123 MAIN STREET, 18, 601200001))), 222))) |
tax_id | receiver | sender | transaction_datetime | transaction_type | Transaction |
---|---|---|---|---|---|
ZZ | 123456789 | CLEARINGHOUSE | 20180508:0833 | 222 | List(List(List(List(, , 20, 1805080AV3648339, , , 57:B:1, , ), List(List(1, 1, 20, , , H0003, HC, null, 20180428, D8, 472, 1, UN)), List(, , , F1120, ), List(VANCOUVER, 19881225, D8, M, SUBSCRIBER JOHN J, , WA, 987 65TH PL, 18, 986640001), List(2, CHPWA, PI, COMMUNITY HEALTH PLAN OF WASHINGTON), List(null, List(VANCOUVER, 720000000, EI, Organization, BH CLINIC OF VANCOUVER, 1122334455, , WA, 12345 MAIN ST, , 98662), null, null, null, List(, , , Individual, , , , , , , ), List(, , , Organization, BH CLINIC OF VANCOUVER, 1122334455, , , , , ), List(, , , Individual, PROVIDER JAMES , 1112223338, PE, , , 261QR0405X, )), List(123456789, Organization), List(CLEARINGHOUSE LLC, CLEARINGHOUSE CLIENT SERVICES, List(List(TE, 8005551212), List(FX, 8005551212)), Organization), List(VANCOUVER, 19881225, D8, M, SUBSCRIBER JOHN J, , WA, 987 65TH PL, 18, 986640001))), 222) |
ZZ | 123456789 | CLEARINGHOUSE | 20180508:0833 | 222 | List(List(List(List(, , 50.1, 1805080AV3648347, , , 57:B:1, , ), List(List(1, 1:2, 50.1, HF, , 96153, HC, null, 20180426, D8, 472, 6, UN)), List(, , , F1520, ), List(VANCOUVER, 19881031, D8, F, PATIENT SUSAN E, , WA, 765 43RD ST, 18, 986640002), List(2, CHPWA, PI, COMMUNITY HEALTH PLAN OF WASHINGTON), List(null, List(VANCOUVER, 720000000, EI, Organization, BH CLINIC OF VANCOUVER, 1122334455, , WA, 12345 MAIN ST, , 98662), null, null, null, List(, , , Individual, , , , , , , ), List(, , , Organization, BH CLINIC OF VANCOUVER, 1122334455, , , , , ), List(, , , Individual, PROVIDER SUSAN , 1112223346, PE, , , 261QR0405X, )), List(123456789, Organization), List(CLEARINGHOUSE LLC, CLEARINGHOUSE CLIENT SERVICES, List(List(TE, 8005551212), List(FX, 8005551212)), Organization), List(VANCOUVER, 19881031, D8, F, PATIENT SUSAN E, , WA, 765 43RD ST, 18, 986640002))), 222) |
ZZ | 123456789 | CLEARINGHOUSE | 20180508:0833 | 222 | List(List(List(List(, , 11.64, 1805080AV3648340, , , 57:B:1, , ), List(List(1, 1:2, 11.64, HF, , T1017, HC, null, 20180427, D8, 472, 1, UN)), List(, , , F1020, ), List(VANCOUVER, 19881225, D8, M, SUBSCRIBER JOHN J, , WA, 987 65TH PL, 18, 986640001), List(2, CHPWA, PI, COMMUNITY HEALTH PLAN OF WASHINGTON), List(null, List(VANCOUVER, 720000000, EI, Organization, BH CLINIC OF VANCOUVER, 1122334455, , WA, 12345 MAIN ST, , 98662), null, null, null, List(, , , Individual, , , , , , , ), List(, , , Organization, BH CLINIC OF VANCOUVER, 1122334455, , , , , ), List(, , , Individual, PROVIDER SUSAN , 1112223346, PE, , , 261QR0405X, )), List(123456789, Organization), List(CLEARINGHOUSE LLC, CLEARINGHOUSE CLIENT SERVICES, List(List(TE, 8005551212), List(FX, 8005551212)), Organization), List(VANCOUVER, 19881225, D8, M, SUBSCRIBER JOHN J, , WA, 987 65TH PL, 18, 986640001))), 222) |
ZZ | 123456789 | CLEARINGHOUSE | 20180508:0833 | 222 | List(List(List(List(, , 234, 1805080AV3648353, , , 53:B:1, , ), List(List(1, 1, 234, , , 90853, HC, null, 20180427, D8, 472, 120, UN)), List(, , , F251, ), List(VANCOUVER, 19881031, D8, F, PATIENT SUSAN E, , WA, 765 43RD ST, 18, 986640002), List(2, CHPWA, PI, COMMUNITY HEALTH PLAN OF WASHINGTON), List(null, List(VANCOUVER, 720000000, EI, Organization, BH CLINIC OF VANCOUVER, 1122334455, , WA, 12345 MAIN ST, , 98662), null, null, null, List(, , , Individual, , , , , , , ), List(, , , Organization, BH CLINIC OF VANCOUVER, 1122334455, , , , , ), List(, , , Individual, PROVIDER SUSAN , 1112223346, PE, , , 251S00000X, )), List(123456789, Organization), List(CLEARINGHOUSE LLC, CLEARINGHOUSE CLIENT SERVICES, List(List(TE, 8005551212), List(FX, 8005551212)), Organization), List(VANCOUVER, 19881031, D8, F, PATIENT SUSAN E, , WA, 765 43RD ST, 18, 986640002))), 222) |
ZZ | 123456789 | CLEARINGHOUSE | 20180508:0833 | 222 | List(List(List(List(, , 20, 1805080AV3648355, , , 57:B:1, , ), List(List(1, 1:2, 20, , , H0003, HC, null, 20180427, D8, 472, 1, UN)), List(, , , F1020, ), List(VANCOUVER, 19881225, D8, M, SUBSCRIBER JOHN J, , WA, 987 65TH PL, 18, 986640001), List(2, CHPWA, PI, COMMUNITY HEALTH PLAN OF WASHINGTON), List(null, List(VANCOUVER, 720000000, EI, Organization, BH CLINIC OF VANCOUVER, 1122334455, , WA, 12345 MAIN ST, , 98662), null, null, null, List(, , , Individual, , , , , , , ), List(, , , Organization, BH CLINIC OF VANCOUVER, 1122334455, , , , , ), List(, , , Individual, PROVIDER JAMES , 1112223338, PE, , , 261QR0405X, )), List(123456789, Organization), List(CLEARINGHOUSE LLC, CLEARINGHOUSE CLIENT SERVICES, List(List(TE, 8005551212), List(FX, 8005551212)), Organization), List(VANCOUVER, 19881225, D8, M, SUBSCRIBER JOHN J, , WA, 987 65TH PL, 18, 986640001))), 222) |
ZZ | OO000011111 | 000000005D | 20180710:214339 | 222 | List(List(List(List(, , 1800, ABC11111, D8, , 22:B:1, 20180123, 454), List(List(1, 1, 1800, QZ, , 01710, HC, null, 20180123-20180123, RD8, 472, 88, MJ), List(1, 1, 984, AA,P3, , 00731, HC, null, 20180713-20180713, RD8, 472, 24, MJ), List(1, 1, 1353, AA, , 00840, HC, null, 20180713-20180713, RD8, 472, 62, MJ), List(1, 1, 1230, AA, , 00902, HC, null, 20180713-20180713, RD8, 472, 65, MJ), List(2, 2, 738, 59, , 62322, HC, null, 20180713-20180713, RD8, 472, 1, UN)), List(, , , G5621, ), List(FAKE CITY, 19650101, D8, M, ABCDEFGH IJKLMNOP B, , CA, 123 ADDRESS3, 18, 908021112), List(2, ABCMMPIO, PI, ABCHYI OL POI), List(null, List(FAKE CITY, 123456789, EI, Organization, YYYY HEALTHCARE ABC, 1222222220, , NY, 123 ADDRESS1, , 908021112), null, null, null, List(, , , Individual, ABCD STUVW , 1234567890, , , , , ), List(, , , Organization, ABCDEFG HIJKLMN HOSP, 1122334460, , , , , ), List(, , , Individual, TUVWX MNOPQR , 1234567891, PE, , , 367500000X, )), List(ABCHYI OL POI, Organization), List(ABCDEF, ABCDEF CUSTOMER SOLUTIONS, List(List(TE, 9999999999), List(, )), Organization), List(FAKE CITY, 19650101, D8, M, ABCDEFGH IJKLMNOP B, , CA, 123 ADDRESS3, 18, 908021112)), List(List(, , 984, ABC111112, D8, , 22:B:1, 20180713, 454), List(List(1, 1, 984, AA,P3, , 00731, HC, null, 20180713-20180713, RD8, 472, 24, MJ), List(1, 1, 1353, AA, , 00840, HC, null, 20180713-20180713, RD8, 472, 62, MJ), List(1, 1, 1230, AA, , 00902, HC, null, 20180713-20180713, RD8, 472, 65, MJ), List(2, 2, 738, 59, , 62322, HC, null, 20180713-20180713, RD8, 472, 1, UN)), List(, , , K219, ), List(FAKE CITY, 19760101, D8, F, ABCDEFGH IJKLMNOP B, , CA, 123 ADDRESS7, 18, 908021117), List(2, ABCMMPIO, PI, ABCHYI OL POI), List(null, List(FAKE CITY, 543211234, EI, Organization, ABCDE EFGHIJ GROUP PC, 1222222223, , CA, 123 ADDRESS5, , 908021115), null, null, null, List(, , , Individual, ABCDEFG OPQRST A, 1122334460, , , , , ), List(, , , Organization, ABCDEFG HIJKLMN HOSP, 1122334450, , , , , ), List(, , , Individual, STUVW KLMNOP H, 1122334461, PE, , , 207L00000X, )), List(ABCHYI OL POI, Organization), List(ABCDEF, ABCDEF CUSTOMER SOLUTIONS, List(List(TE, 9999999999), List(, )), Organization), List(FAKE CITY, 19760101, D8, F, ABCDEFGH IJKLMNOP B, , CA, 123 ADDRESS7, 18, 908021117)), List(List(, , 1353, ABC111113, D8, , 22:B:1, 20180713, 454), List(List(1, 1, 1353, AA, , 00840, HC, null, 20180713-20180713, RD8, 472, 62, MJ), List(1, 1, 1230, AA, , 00902, HC, null, 20180713-20180713, RD8, 472, 65, MJ), List(2, 2, 738, 59, , 62322, HC, null, 20180713-20180713, RD8, 472, 1, UN)), List(, , , K4090, ), List(FAKE CITY, 20180409, D8, M, ABCDEFGH IJKLMNOP B, , CA, 123 ADDRESS11, 18, 908021111), List(2, YTHF281123456, PI, ABCHYI OL POI), List(null, List(FAKE CITY, 931013923, EI, Organization, ABCDE EFGHIJ GROUP PC, 1477527786, , CA, 123 ADDRESS9, , 908021119), null, null, null, List(, , , Individual, ABCDEFGH OPQRSTU A, 1122334456, , , , , ), List(, , , Organization, ABCDEFG HIJKLMN HOSP, 1122334458, , , , , ), List(, , , Individual, STUVWX KLMNOPQ H, 1122334457, PE, , , 207L00000X, )), List(ABCHYI OL POI, Organization), List(ABCDEF, ABCDEF CUSTOMER SOLUTIONS, List(List(TE, 9999999999), List(, )), Organization), List(FAKE CITY, 20180409, D8, M, ABCDEFGH IJKLMNOP B, , CA, 123 ADDRESS11, 18, 908021111)), List(List(, , 1968, ABC111114, D8, , 22:B:1, 20180713, 454), List(List(1, 1, 1230, AA, , 00902, HC, null, 20180713-20180713, RD8, 472, 65, MJ), List(2, 2, 738, 59, , 62322, HC, null, 20180713-20180713, RD8, 472, 1, UN)), List(, , , Q423, ), List(FAKE CITY, 20180504, D8, F, ABCDEFGH IJKLMNOP B, , CA, 123 ADDRESS13, 18, 908021113), List(2, YTHF281123456, PI, ABCHYI OL POI), List(null, List(FAKE CITY, 931013923, EI, Organization, ABCDE EFGHIJ GROUP PC, 1477527786, , CA, 123 ADDRESS9, , 908021119), null, null, null, List(, , , Individual, ABCDEFGHI OPQRSTUV A, 1122334455, , , , , ), List(, , , Organization, ABCDEFG HIJKLMN HOSP, 1122334457, , , , , ), List(, , , Individual, STUVWXY KLMNOPQR H, 1122334456, PE, , , 207L00000X, )), List(ABCHYI OL POI, Organization), List(ABCDEF, ABCDEF CUSTOMER SOLUTIONS, List(List(TE, 9999999999), List(, )), Organization), List(FAKE CITY, 20180504, D8, F, ABCDEFGH IJKLMNOP B, , CA, 123 ADDRESS13, 18, 908021113))), 222) |
ZZ | 421406317 | 133052274 | 20180807:12022761 | 223 | List(List(List(List(1, 1, 17166.7, TD-R192ICE00087, TM, 01, 11:A:1, 0900, 096), List(List(1, null, 9148, , null, , , 0124, 20180628-20180702, RD8, 472, 4, UN), List(2, null, 48.1, , null, , , 0250, 20180628-20180702, RD8, 472, 28, UN), List(3, null, 133, , null, , , 0260, 20180628-20180702, RD8, 472, 1, UN), List(4, null, 32.9, , null, , , 0300, 20180628-20180702, RD8, 472, 1, UN), List(5, null, 798.5, , null, , , 0301, 20180628-20180702, RD8, 472, 4, UN), List(6, null, 200.6, , null, , , 0305, 20180628-20180702, RD8, 472, 2, UN), List(7, null, 175, , null, , , 0306, 20180628-20180702, RD8, 472, 1, UN), List(8, null, 113.6, , null, , , 0307, 20180628-20180702, RD8, 472, 2, UN), List(9, null, 6517, , null, , , 0351, 20180628-20180702, RD8, 472, 2, UN)), List(F39, , F1319, F39, ), List(Elgin, 19960215, D8, F, TEST MEMBER , , IL, 123 MAIN STREET, 18, 601200001), List(2, 421406317, PI, CENTENE), List(List(, TD-R192ICE00087, D9, Individual, , , , , , , ), List(WOODSTOCK, 999999999, EI, Organization, Test Provider, 9999999999, , IL, 123 MAIN STREET, , 600980000), List(, , , Individual, , , , , , , ), List(, , , Individual, , , , , , , ), List(, , , Individual, , , , , , , ), null, null, null), List(CENTENE CORP, Organization), List(TALEND, SAMBIT, List(List(TE, 3143202264), List(EX, 8099264)), Organization), List(Elgin, 19960215, D8, F, TEST MEMBER , , IL, 123 MAIN STREET, 18, 601200001))), 223) |
ZZ | XXXXX | XXXXXXX | 20170617:1741 | 222 | List(List(List(List(, , 140, 1000A, , , 19:B:1, , ), List(List(1, 1, 140, , , 99213, HC, null, 20151124, D8, 472, 1, UN), List(1, 1, 140, , , 99213, HC, null, 20151124, D8, 472, 1, UN)), List(, , , I10, ), List(CHICAGO, 19570111, D8, M, BLOGGS JOE , , IL, 1 SOME BLVD, 18, 606129998), List(2, 12345, PI, PAYER), List(null, List(CHICAGO, 999999999, EI, Organization, BILLING PROVIDER, 1122334455, , IL, 1234 SOME ROAD, , 606739999), null, null, null, List(, , , Individual, , , , , , , ), List(, , , Individual, , , , , , , ), List(, , , Individual, , , , , , , )), List(RECEIVER, Organization), List(SUBMITTER, BOB SMITH, List(List(TE, 4805551212), List(, )), Organization), List(CHICAGO, 19570111, D8, M, BLOGGS JOE , , IL, 1 SOME BLVD, 18, 606129998)), List(List(, , 140, 1001A, , , 19:B:1, , ), List(List(1, 1, 140, , , 99213, HC, null, 20151124, D8, 472, 1, UN)), List(, , , I10, ), List(CHICAGO, 19700601, D8, M, BLOGGS FRED , , IL, 1 ANOTHER STR, 18, 606129998), List(2, 12345, PI, PAYER), List(null, List(CHICAGO, 999999999, EI, Organization, BILLING PROVIDER, 1122334455, , IL, 1234 SOME ROAD, , 606739999), null, null, null, List(, , , Individual, , , , , , , ), List(, , , Individual, , , , , , , ), List(, , , Individual, , , , , , , )), List(RECEIVER, Organization), List(SUBMITTER, BOB SMITH, List(List(TE, 4805551212), List(, )), Organization), List(CHICAGO, 19700601, D8, M, BLOGGS FRED , , IL, 1 ANOTHER STR, 18, 606129998))), 222) |
30 | 421406317 | 030240928 | 20180807:12022605 | 222 | List(List(List(List(, , 600, TD-R192ICE00094, D8, , 11:B:1, 20180625, 435), List(List(1, 1:2, 300, HO,HQ, 11, H0004, HC, null, 20180625-20180625, RD8, 472, 12, UN), List(2, 1:2, 300, HO,HQ, 11, H0004, HC, null, 20180629-20180629, RD8, 472, 12, UN)), List(, , , F341, ), List(Elgin, 19960215, D8, F, TEST MEMBER , , IL, 123 MAIN STREET, 18, 601200001), List(2, 421406317, PI, CENTENE), List(null, List(WOODSTOCK, 999999999, EI, Organization, Test Provider, 9999999999, , IL, 123 MAIN STREET, , 600980000), null, null, null, List(, , , Individual, , , , , , , ), List(, , , Individual, , , , , , , ), List(, , , Individual, , , , , , , )), List(Centene Corporation, Organization), List(Centene Corporation, Sambit, List(List(TE, 3143202264), List(EX, 8099264)), Organization), List(Elgin, 19960215, D8, F, TEST MEMBER , , IL, 123 MAIN STREET, 18, 601200001))), 222) |
tax_id | receiver | sender | transaction_datetime | transaction_type | Claim |
---|---|---|---|---|---|
ZZ | 123456789 | CLEARINGHOUSE | 20180508:0833 | 222 | List(List(, , 20, 1805080AV3648339, , , 57:B:1, , ), List(List(1, 1, 20, , , H0003, HC, null, 20180428, D8, 472, 1, UN)), List(, , , F1120, ), List(VANCOUVER, 19881225, D8, M, SUBSCRIBER JOHN J, , WA, 987 65TH PL, 18, 986640001), List(2, CHPWA, PI, COMMUNITY HEALTH PLAN OF WASHINGTON), List(null, List(VANCOUVER, 720000000, EI, Organization, BH CLINIC OF VANCOUVER, 1122334455, , WA, 12345 MAIN ST, , 98662), null, null, null, List(, , , Individual, , , , , , , ), List(, , , Organization, BH CLINIC OF VANCOUVER, 1122334455, , , , , ), List(, , , Individual, PROVIDER JAMES , 1112223338, PE, , , 261QR0405X, )), List(123456789, Organization), List(CLEARINGHOUSE LLC, CLEARINGHOUSE CLIENT SERVICES, List(List(TE, 8005551212), List(FX, 8005551212)), Organization), List(VANCOUVER, 19881225, D8, M, SUBSCRIBER JOHN J, , WA, 987 65TH PL, 18, 986640001)) |
ZZ | 123456789 | CLEARINGHOUSE | 20180508:0833 | 222 | List(List(, , 50.1, 1805080AV3648347, , , 57:B:1, , ), List(List(1, 1:2, 50.1, HF, , 96153, HC, null, 20180426, D8, 472, 6, UN)), List(, , , F1520, ), List(VANCOUVER, 19881031, D8, F, PATIENT SUSAN E, , WA, 765 43RD ST, 18, 986640002), List(2, CHPWA, PI, COMMUNITY HEALTH PLAN OF WASHINGTON), List(null, List(VANCOUVER, 720000000, EI, Organization, BH CLINIC OF VANCOUVER, 1122334455, , WA, 12345 MAIN ST, , 98662), null, null, null, List(, , , Individual, , , , , , , ), List(, , , Organization, BH CLINIC OF VANCOUVER, 1122334455, , , , , ), List(, , , Individual, PROVIDER SUSAN , 1112223346, PE, , , 261QR0405X, )), List(123456789, Organization), List(CLEARINGHOUSE LLC, CLEARINGHOUSE CLIENT SERVICES, List(List(TE, 8005551212), List(FX, 8005551212)), Organization), List(VANCOUVER, 19881031, D8, F, PATIENT SUSAN E, , WA, 765 43RD ST, 18, 986640002)) |
ZZ | 123456789 | CLEARINGHOUSE | 20180508:0833 | 222 | List(List(, , 11.64, 1805080AV3648340, , , 57:B:1, , ), List(List(1, 1:2, 11.64, HF, , T1017, HC, null, 20180427, D8, 472, 1, UN)), List(, , , F1020, ), List(VANCOUVER, 19881225, D8, M, SUBSCRIBER JOHN J, , WA, 987 65TH PL, 18, 986640001), List(2, CHPWA, PI, COMMUNITY HEALTH PLAN OF WASHINGTON), List(null, List(VANCOUVER, 720000000, EI, Organization, BH CLINIC OF VANCOUVER, 1122334455, , WA, 12345 MAIN ST, , 98662), null, null, null, List(, , , Individual, , , , , , , ), List(, , , Organization, BH CLINIC OF VANCOUVER, 1122334455, , , , , ), List(, , , Individual, PROVIDER SUSAN , 1112223346, PE, , , 261QR0405X, )), List(123456789, Organization), List(CLEARINGHOUSE LLC, CLEARINGHOUSE CLIENT SERVICES, List(List(TE, 8005551212), List(FX, 8005551212)), Organization), List(VANCOUVER, 19881225, D8, M, SUBSCRIBER JOHN J, , WA, 987 65TH PL, 18, 986640001)) |
ZZ | 123456789 | CLEARINGHOUSE | 20180508:0833 | 222 | List(List(, , 234, 1805080AV3648353, , , 53:B:1, , ), List(List(1, 1, 234, , , 90853, HC, null, 20180427, D8, 472, 120, UN)), List(, , , F251, ), List(VANCOUVER, 19881031, D8, F, PATIENT SUSAN E, , WA, 765 43RD ST, 18, 986640002), List(2, CHPWA, PI, COMMUNITY HEALTH PLAN OF WASHINGTON), List(null, List(VANCOUVER, 720000000, EI, Organization, BH CLINIC OF VANCOUVER, 1122334455, , WA, 12345 MAIN ST, , 98662), null, null, null, List(, , , Individual, , , , , , , ), List(, , , Organization, BH CLINIC OF VANCOUVER, 1122334455, , , , , ), List(, , , Individual, PROVIDER SUSAN , 1112223346, PE, , , 251S00000X, )), List(123456789, Organization), List(CLEARINGHOUSE LLC, CLEARINGHOUSE CLIENT SERVICES, List(List(TE, 8005551212), List(FX, 8005551212)), Organization), List(VANCOUVER, 19881031, D8, F, PATIENT SUSAN E, , WA, 765 43RD ST, 18, 986640002)) |
ZZ | 123456789 | CLEARINGHOUSE | 20180508:0833 | 222 | List(List(, , 20, 1805080AV3648355, , , 57:B:1, , ), List(List(1, 1:2, 20, , , H0003, HC, null, 20180427, D8, 472, 1, UN)), List(, , , F1020, ), List(VANCOUVER, 19881225, D8, M, SUBSCRIBER JOHN J, , WA, 987 65TH PL, 18, 986640001), List(2, CHPWA, PI, COMMUNITY HEALTH PLAN OF WASHINGTON), List(null, List(VANCOUVER, 720000000, EI, Organization, BH CLINIC OF VANCOUVER, 1122334455, , WA, 12345 MAIN ST, , 98662), null, null, null, List(, , , Individual, , , , , , , ), List(, , , Organization, BH CLINIC OF VANCOUVER, 1122334455, , , , , ), List(, , , Individual, PROVIDER JAMES , 1112223338, PE, , , 261QR0405X, )), List(123456789, Organization), List(CLEARINGHOUSE LLC, CLEARINGHOUSE CLIENT SERVICES, List(List(TE, 8005551212), List(FX, 8005551212)), Organization), List(VANCOUVER, 19881225, D8, M, SUBSCRIBER JOHN J, , WA, 987 65TH PL, 18, 986640001)) |
ZZ | OO000011111 | 000000005D | 20180710:214339 | 222 | List(List(, , 1800, ABC11111, D8, , 22:B:1, 20180123, 454), List(List(1, 1, 1800, QZ, , 01710, HC, null, 20180123-20180123, RD8, 472, 88, MJ), List(1, 1, 984, AA,P3, , 00731, HC, null, 20180713-20180713, RD8, 472, 24, MJ), List(1, 1, 1353, AA, , 00840, HC, null, 20180713-20180713, RD8, 472, 62, MJ), List(1, 1, 1230, AA, , 00902, HC, null, 20180713-20180713, RD8, 472, 65, MJ), List(2, 2, 738, 59, , 62322, HC, null, 20180713-20180713, RD8, 472, 1, UN)), List(, , , G5621, ), List(FAKE CITY, 19650101, D8, M, ABCDEFGH IJKLMNOP B, , CA, 123 ADDRESS3, 18, 908021112), List(2, ABCMMPIO, PI, ABCHYI OL POI), List(null, List(FAKE CITY, 123456789, EI, Organization, YYYY HEALTHCARE ABC, 1222222220, , NY, 123 ADDRESS1, , 908021112), null, null, null, List(, , , Individual, ABCD STUVW , 1234567890, , , , , ), List(, , , Organization, ABCDEFG HIJKLMN HOSP, 1122334460, , , , , ), List(, , , Individual, TUVWX MNOPQR , 1234567891, PE, , , 367500000X, )), List(ABCHYI OL POI, Organization), List(ABCDEF, ABCDEF CUSTOMER SOLUTIONS, List(List(TE, 9999999999), List(, )), Organization), List(FAKE CITY, 19650101, D8, M, ABCDEFGH IJKLMNOP B, , CA, 123 ADDRESS3, 18, 908021112)) |
ZZ | OO000011111 | 000000005D | 20180710:214339 | 222 | List(List(, , 984, ABC111112, D8, , 22:B:1, 20180713, 454), List(List(1, 1, 984, AA,P3, , 00731, HC, null, 20180713-20180713, RD8, 472, 24, MJ), List(1, 1, 1353, AA, , 00840, HC, null, 20180713-20180713, RD8, 472, 62, MJ), List(1, 1, 1230, AA, , 00902, HC, null, 20180713-20180713, RD8, 472, 65, MJ), List(2, 2, 738, 59, , 62322, HC, null, 20180713-20180713, RD8, 472, 1, UN)), List(, , , K219, ), List(FAKE CITY, 19760101, D8, F, ABCDEFGH IJKLMNOP B, , CA, 123 ADDRESS7, 18, 908021117), List(2, ABCMMPIO, PI, ABCHYI OL POI), List(null, List(FAKE CITY, 543211234, EI, Organization, ABCDE EFGHIJ GROUP PC, 1222222223, , CA, 123 ADDRESS5, , 908021115), null, null, null, List(, , , Individual, ABCDEFG OPQRST A, 1122334460, , , , , ), List(, , , Organization, ABCDEFG HIJKLMN HOSP, 1122334450, , , , , ), List(, , , Individual, STUVW KLMNOP H, 1122334461, PE, , , 207L00000X, )), List(ABCHYI OL POI, Organization), List(ABCDEF, ABCDEF CUSTOMER SOLUTIONS, List(List(TE, 9999999999), List(, )), Organization), List(FAKE CITY, 19760101, D8, F, ABCDEFGH IJKLMNOP B, , CA, 123 ADDRESS7, 18, 908021117)) |
ZZ | OO000011111 | 000000005D | 20180710:214339 | 222 | List(List(, , 1353, ABC111113, D8, , 22:B:1, 20180713, 454), List(List(1, 1, 1353, AA, , 00840, HC, null, 20180713-20180713, RD8, 472, 62, MJ), List(1, 1, 1230, AA, , 00902, HC, null, 20180713-20180713, RD8, 472, 65, MJ), List(2, 2, 738, 59, , 62322, HC, null, 20180713-20180713, RD8, 472, 1, UN)), List(, , , K4090, ), List(FAKE CITY, 20180409, D8, M, ABCDEFGH IJKLMNOP B, , CA, 123 ADDRESS11, 18, 908021111), List(2, YTHF281123456, PI, ABCHYI OL POI), List(null, List(FAKE CITY, 931013923, EI, Organization, ABCDE EFGHIJ GROUP PC, 1477527786, , CA, 123 ADDRESS9, , 908021119), null, null, null, List(, , , Individual, ABCDEFGH OPQRSTU A, 1122334456, , , , , ), List(, , , Organization, ABCDEFG HIJKLMN HOSP, 1122334458, , , , , ), List(, , , Individual, STUVWX KLMNOPQ H, 1122334457, PE, , , 207L00000X, )), List(ABCHYI OL POI, Organization), List(ABCDEF, ABCDEF CUSTOMER SOLUTIONS, List(List(TE, 9999999999), List(, )), Organization), List(FAKE CITY, 20180409, D8, M, ABCDEFGH IJKLMNOP B, , CA, 123 ADDRESS11, 18, 908021111)) |
ZZ | OO000011111 | 000000005D | 20180710:214339 | 222 | List(List(, , 1968, ABC111114, D8, , 22:B:1, 20180713, 454), List(List(1, 1, 1230, AA, , 00902, HC, null, 20180713-20180713, RD8, 472, 65, MJ), List(2, 2, 738, 59, , 62322, HC, null, 20180713-20180713, RD8, 472, 1, UN)), List(, , , Q423, ), List(FAKE CITY, 20180504, D8, F, ABCDEFGH IJKLMNOP B, , CA, 123 ADDRESS13, 18, 908021113), List(2, YTHF281123456, PI, ABCHYI OL POI), List(null, List(FAKE CITY, 931013923, EI, Organization, ABCDE EFGHIJ GROUP PC, 1477527786, , CA, 123 ADDRESS9, , 908021119), null, null, null, List(, , , Individual, ABCDEFGHI OPQRSTUV A, 1122334455, , , , , ), List(, , , Organization, ABCDEFG HIJKLMN HOSP, 1122334457, , , , , ), List(, , , Individual, STUVWXY KLMNOPQR H, 1122334456, PE, , , 207L00000X, )), List(ABCHYI OL POI, Organization), List(ABCDEF, ABCDEF CUSTOMER SOLUTIONS, List(List(TE, 9999999999), List(, )), Organization), List(FAKE CITY, 20180504, D8, F, ABCDEFGH IJKLMNOP B, , CA, 123 ADDRESS13, 18, 908021113)) |
ZZ | 421406317 | 133052274 | 20180807:12022761 | 223 | List(List(1, 1, 17166.7, TD-R192ICE00087, TM, 01, 11:A:1, 0900, 096), List(List(1, null, 9148, , null, , , 0124, 20180628-20180702, RD8, 472, 4, UN), List(2, null, 48.1, , null, , , 0250, 20180628-20180702, RD8, 472, 28, UN), List(3, null, 133, , null, , , 0260, 20180628-20180702, RD8, 472, 1, UN), List(4, null, 32.9, , null, , , 0300, 20180628-20180702, RD8, 472, 1, UN), List(5, null, 798.5, , null, , , 0301, 20180628-20180702, RD8, 472, 4, UN), List(6, null, 200.6, , null, , , 0305, 20180628-20180702, RD8, 472, 2, UN), List(7, null, 175, , null, , , 0306, 20180628-20180702, RD8, 472, 1, UN), List(8, null, 113.6, , null, , , 0307, 20180628-20180702, RD8, 472, 2, UN), List(9, null, 6517, , null, , , 0351, 20180628-20180702, RD8, 472, 2, UN)), List(F39, , F1319, F39, ), List(Elgin, 19960215, D8, F, TEST MEMBER , , IL, 123 MAIN STREET, 18, 601200001), List(2, 421406317, PI, CENTENE), List(List(, TD-R192ICE00087, D9, Individual, , , , , , , ), List(WOODSTOCK, 999999999, EI, Organization, Test Provider, 9999999999, , IL, 123 MAIN STREET, , 600980000), List(, , , Individual, , , , , , , ), List(, , , Individual, , , , , , , ), List(, , , Individual, , , , , , , ), null, null, null), List(CENTENE CORP, Organization), List(TALEND, SAMBIT, List(List(TE, 3143202264), List(EX, 8099264)), Organization), List(Elgin, 19960215, D8, F, TEST MEMBER , , IL, 123 MAIN STREET, 18, 601200001)) |
ZZ | XXXXX | XXXXXXX | 20170617:1741 | 222 | List(List(, , 140, 1000A, , , 19:B:1, , ), List(List(1, 1, 140, , , 99213, HC, null, 20151124, D8, 472, 1, UN), List(1, 1, 140, , , 99213, HC, null, 20151124, D8, 472, 1, UN)), List(, , , I10, ), List(CHICAGO, 19570111, D8, M, BLOGGS JOE , , IL, 1 SOME BLVD, 18, 606129998), List(2, 12345, PI, PAYER), List(null, List(CHICAGO, 999999999, EI, Organization, BILLING PROVIDER, 1122334455, , IL, 1234 SOME ROAD, , 606739999), null, null, null, List(, , , Individual, , , , , , , ), List(, , , Individual, , , , , , , ), List(, , , Individual, , , , , , , )), List(RECEIVER, Organization), List(SUBMITTER, BOB SMITH, List(List(TE, 4805551212), List(, )), Organization), List(CHICAGO, 19570111, D8, M, BLOGGS JOE , , IL, 1 SOME BLVD, 18, 606129998)) |
ZZ | XXXXX | XXXXXXX | 20170617:1741 | 222 | List(List(, , 140, 1001A, , , 19:B:1, , ), List(List(1, 1, 140, , , 99213, HC, null, 20151124, D8, 472, 1, UN)), List(, , , I10, ), List(CHICAGO, 19700601, D8, M, BLOGGS FRED , , IL, 1 ANOTHER STR, 18, 606129998), List(2, 12345, PI, PAYER), List(null, List(CHICAGO, 999999999, EI, Organization, BILLING PROVIDER, 1122334455, , IL, 1234 SOME ROAD, , 606739999), null, null, null, List(, , , Individual, , , , , , , ), List(, , , Individual, , , , , , , ), List(, , , Individual, , , , , , , )), List(RECEIVER, Organization), List(SUBMITTER, BOB SMITH, List(List(TE, 4805551212), List(, )), Organization), List(CHICAGO, 19700601, D8, M, BLOGGS FRED , , IL, 1 ANOTHER STR, 18, 606129998)) |
30 | 421406317 | 030240928 | 20180807:12022605 | 222 | List(List(, , 600, TD-R192ICE00094, D8, , 11:B:1, 20180625, 435), List(List(1, 1:2, 300, HO,HQ, 11, H0004, HC, null, 20180625-20180625, RD8, 472, 12, UN), List(2, 1:2, 300, HO,HQ, 11, H0004, HC, null, 20180629-20180629, RD8, 472, 12, UN)), List(, , , F341, ), List(Elgin, 19960215, D8, F, TEST MEMBER , , IL, 123 MAIN STREET, 18, 601200001), List(2, 421406317, PI, CENTENE), List(null, List(WOODSTOCK, 999999999, EI, Organization, Test Provider, 9999999999, , IL, 123 MAIN STREET, , 600980000), null, null, null, List(, , , Individual, , , , , , , ), List(, , , Individual, , , , , , , ), List(, , , Individual, , , , , , , )), List(Centene Corporation, Organization), List(Centene Corporation, Sambit, List(List(TE, 3143202264), List(EX, 8099264)), Organization), List(Elgin, 19960215, D8, F, TEST MEMBER , , IL, 123 MAIN STREET, 18, 601200001)) |
tax_id | receiver | sender | transaction_datetime | transaction_type | admission_src_cd | admission_type | claim_amount | claim_id | date_format | discharge_status_cd | facility_type_code | service_date | service_time | admitting_dx_cd | external_injury_dx_cd | other_dx_cds | principal_dx_cd | reason_visit_dx_cd | city | dob | dob_format | gender_cd | name | patient_relationship_cd | state | street | subscriber_relationship_cd | zip | business_entity_type | payer_identifier | payer_identifier_cd | payer_name | attending | billing | facility | operating | other | referring | service_facility | servicing |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
ZZ | 123456789 | CLEARINGHOUSE | 20180508:0833 | 222 | 20 | 1805080AV3648339 | 57:B:1 | F1120 | VANCOUVER | 19881225 | D8 | M | SUBSCRIBER JOHN J | WA | 987 65TH PL | 18 | 986640001 | 2 | CHPWA | PI | COMMUNITY HEALTH PLAN OF WASHINGTON | null | List(VANCOUVER, 720000000, EI, Organization, BH CLINIC OF VANCOUVER, 1122334455, , WA, 12345 MAIN ST, , 98662) | null | null | null | List(, , , Individual, , , , , , , ) | List(, , , Organization, BH CLINIC OF VANCOUVER, 1122334455, , , , , ) | List(, , , Individual, PROVIDER JAMES , 1112223338, PE, , , 261QR0405X, ) | |||||||||||
ZZ | 123456789 | CLEARINGHOUSE | 20180508:0833 | 222 | 50.1 | 1805080AV3648347 | 57:B:1 | F1520 | VANCOUVER | 19881031 | D8 | F | PATIENT SUSAN E | WA | 765 43RD ST | 18 | 986640002 | 2 | CHPWA | PI | COMMUNITY HEALTH PLAN OF WASHINGTON | null | List(VANCOUVER, 720000000, EI, Organization, BH CLINIC OF VANCOUVER, 1122334455, , WA, 12345 MAIN ST, , 98662) | null | null | null | List(, , , Individual, , , , , , , ) | List(, , , Organization, BH CLINIC OF VANCOUVER, 1122334455, , , , , ) | List(, , , Individual, PROVIDER SUSAN , 1112223346, PE, , , 261QR0405X, ) | |||||||||||
ZZ | 123456789 | CLEARINGHOUSE | 20180508:0833 | 222 | 11.64 | 1805080AV3648340 | 57:B:1 | F1020 | VANCOUVER | 19881225 | D8 | M | SUBSCRIBER JOHN J | WA | 987 65TH PL | 18 | 986640001 | 2 | CHPWA | PI | COMMUNITY HEALTH PLAN OF WASHINGTON | null | List(VANCOUVER, 720000000, EI, Organization, BH CLINIC OF VANCOUVER, 1122334455, , WA, 12345 MAIN ST, , 98662) | null | null | null | List(, , , Individual, , , , , , , ) | List(, , , Organization, BH CLINIC OF VANCOUVER, 1122334455, , , , , ) | List(, , , Individual, PROVIDER SUSAN , 1112223346, PE, , , 261QR0405X, ) | |||||||||||
ZZ | 123456789 | CLEARINGHOUSE | 20180508:0833 | 222 | 234 | 1805080AV3648353 | 53:B:1 | F251 | VANCOUVER | 19881031 | D8 | F | PATIENT SUSAN E | WA | 765 43RD ST | 18 | 986640002 | 2 | CHPWA | PI | COMMUNITY HEALTH PLAN OF WASHINGTON | null | List(VANCOUVER, 720000000, EI, Organization, BH CLINIC OF VANCOUVER, 1122334455, , WA, 12345 MAIN ST, , 98662) | null | null | null | List(, , , Individual, , , , , , , ) | List(, , , Organization, BH CLINIC OF VANCOUVER, 1122334455, , , , , ) | List(, , , Individual, PROVIDER SUSAN , 1112223346, PE, , , 251S00000X, ) | |||||||||||
ZZ | 123456789 | CLEARINGHOUSE | 20180508:0833 | 222 | 20 | 1805080AV3648355 | 57:B:1 | F1020 | VANCOUVER | 19881225 | D8 | M | SUBSCRIBER JOHN J | WA | 987 65TH PL | 18 | 986640001 | 2 | CHPWA | PI | COMMUNITY HEALTH PLAN OF WASHINGTON | null | List(VANCOUVER, 720000000, EI, Organization, BH CLINIC OF VANCOUVER, 1122334455, , WA, 12345 MAIN ST, , 98662) | null | null | null | List(, , , Individual, , , , , , , ) | List(, , , Organization, BH CLINIC OF VANCOUVER, 1122334455, , , , , ) | List(, , , Individual, PROVIDER JAMES , 1112223338, PE, , , 261QR0405X, ) | |||||||||||
ZZ | OO000011111 | 000000005D | 20180710:214339 | 222 | 1800 | ABC11111 | D8 | 22:B:1 | 20180123 | 454 | G5621 | FAKE CITY | 19650101 | D8 | M | ABCDEFGH IJKLMNOP B | CA | 123 ADDRESS3 | 18 | 908021112 | 2 | ABCMMPIO | PI | ABCHYI OL POI | null | List(FAKE CITY, 123456789, EI, Organization, YYYY HEALTHCARE ABC, 1222222220, , NY, 123 ADDRESS1, , 908021112) | null | null | null | List(, , , Individual, ABCD STUVW , 1234567890, , , , , ) | List(, , , Organization, ABCDEFG HIJKLMN HOSP, 1122334460, , , , , ) | List(, , , Individual, TUVWX MNOPQR , 1234567891, PE, , , 367500000X, ) | ||||||||
ZZ | OO000011111 | 000000005D | 20180710:214339 | 222 | 984 | ABC111112 | D8 | 22:B:1 | 20180713 | 454 | K219 | FAKE CITY | 19760101 | D8 | F | ABCDEFGH IJKLMNOP B | CA | 123 ADDRESS7 | 18 | 908021117 | 2 | ABCMMPIO | PI | ABCHYI OL POI | null | List(FAKE CITY, 543211234, EI, Organization, ABCDE EFGHIJ GROUP PC, 1222222223, , CA, 123 ADDRESS5, , 908021115) | null | null | null | List(, , , Individual, ABCDEFG OPQRST A, 1122334460, , , , , ) | List(, , , Organization, ABCDEFG HIJKLMN HOSP, 1122334450, , , , , ) | List(, , , Individual, STUVW KLMNOP H, 1122334461, PE, , , 207L00000X, ) | ||||||||
ZZ | OO000011111 | 000000005D | 20180710:214339 | 222 | 1353 | ABC111113 | D8 | 22:B:1 | 20180713 | 454 | K4090 | FAKE CITY | 20180409 | D8 | M | ABCDEFGH IJKLMNOP B | CA | 123 ADDRESS11 | 18 | 908021111 | 2 | YTHF281123456 | PI | ABCHYI OL POI | null | List(FAKE CITY, 931013923, EI, Organization, ABCDE EFGHIJ GROUP PC, 1477527786, , CA, 123 ADDRESS9, , 908021119) | null | null | null | List(, , , Individual, ABCDEFGH OPQRSTU A, 1122334456, , , , , ) | List(, , , Organization, ABCDEFG HIJKLMN HOSP, 1122334458, , , , , ) | List(, , , Individual, STUVWX KLMNOPQ H, 1122334457, PE, , , 207L00000X, ) | ||||||||
ZZ | OO000011111 | 000000005D | 20180710:214339 | 222 | 1968 | ABC111114 | D8 | 22:B:1 | 20180713 | 454 | Q423 | FAKE CITY | 20180504 | D8 | F | ABCDEFGH IJKLMNOP B | CA | 123 ADDRESS13 | 18 | 908021113 | 2 | YTHF281123456 | PI | ABCHYI OL POI | null | List(FAKE CITY, 931013923, EI, Organization, ABCDE EFGHIJ GROUP PC, 1477527786, , CA, 123 ADDRESS9, , 908021119) | null | null | null | List(, , , Individual, ABCDEFGHI OPQRSTUV A, 1122334455, , , , , ) | List(, , , Organization, ABCDEFG HIJKLMN HOSP, 1122334457, , , , , ) | List(, , , Individual, STUVWXY KLMNOPQR H, 1122334456, PE, , , 207L00000X, ) | ||||||||
ZZ | 421406317 | 133052274 | 20180807:12022761 | 223 | 1 | 1 | 17166.7 | TD-R192ICE00087 | TM | 01 | 11:A:1 | 0900 | 096 | F39 | F1319 | F39 | Elgin | 19960215 | D8 | F | TEST MEMBER | IL | 123 MAIN STREET | 18 | 601200001 | 2 | 421406317 | PI | CENTENE | List(, TD-R192ICE00087, D9, Individual, , , , , , , ) | List(WOODSTOCK, 999999999, EI, Organization, Test Provider, 9999999999, , IL, 123 MAIN STREET, , 600980000) | List(, , , Individual, , , , , , , ) | List(, , , Individual, , , , , , , ) | List(, , , Individual, , , , , , , ) | null | null | null | |||
ZZ | XXXXX | XXXXXXX | 20170617:1741 | 222 | 140 | 1000A | 19:B:1 | I10 | CHICAGO | 19570111 | D8 | M | BLOGGS JOE | IL | 1 SOME BLVD | 18 | 606129998 | 2 | 12345 | PI | PAYER | null | List(CHICAGO, 999999999, EI, Organization, BILLING PROVIDER, 1122334455, , IL, 1234 SOME ROAD, , 606739999) | null | null | null | List(, , , Individual, , , , , , , ) | List(, , , Individual, , , , , , , ) | List(, , , Individual, , , , , , , ) | |||||||||||
ZZ | XXXXX | XXXXXXX | 20170617:1741 | 222 | 140 | 1001A | 19:B:1 | I10 | CHICAGO | 19700601 | D8 | M | BLOGGS FRED | IL | 1 ANOTHER STR | 18 | 606129998 | 2 | 12345 | PI | PAYER | null | List(CHICAGO, 999999999, EI, Organization, BILLING PROVIDER, 1122334455, , IL, 1234 SOME ROAD, , 606739999) | null | null | null | List(, , , Individual, , , , , , , ) | List(, , , Individual, , , , , , , ) | List(, , , Individual, , , , , , , ) | |||||||||||
30 | 421406317 | 030240928 | 20180807:12022605 | 222 | 600 | TD-R192ICE00094 | D8 | 11:B:1 | 20180625 | 435 | F341 | Elgin | 19960215 | D8 | F | TEST MEMBER | IL | 123 MAIN STREET | 18 | 601200001 | 2 | 421406317 | PI | CENTENE | null | List(WOODSTOCK, 999999999, EI, Organization, Test Provider, 9999999999, , IL, 123 MAIN STREET, , 600980000) | null | null | null | List(, , , Individual, , , , , , , ) | List(, , , Individual, , , , , , , ) | List(, , , Individual, , , , , , , ) |
claim_id | claim_line_number | dg_cd_pntr | line_chrg_amt | modifier_cds | place_of_service | prcdr_cd | prcdr_cd_type | revenue_cd | service_date | service_date_format | service_time | units | units_measurement |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
1805080AV3648339 | 1 | 1 | 20 | H0003 | HC | null | 20180428 | D8 | 472 | 1 | UN | ||
1805080AV3648347 | 1 | 1:2 | 50.1 | HF | 96153 | HC | null | 20180426 | D8 | 472 | 6 | UN | |
1805080AV3648340 | 1 | 1:2 | 11.64 | HF | T1017 | HC | null | 20180427 | D8 | 472 | 1 | UN | |
1805080AV3648353 | 1 | 1 | 234 | 90853 | HC | null | 20180427 | D8 | 472 | 120 | UN | ||
1805080AV3648355 | 1 | 1:2 | 20 | H0003 | HC | null | 20180427 | D8 | 472 | 1 | UN | ||
ABC11111 | 1 | 1 | 1800 | QZ | 01710 | HC | null | 20180123-20180123 | RD8 | 472 | 88 | MJ | |
ABC11111 | 1 | 1 | 984 | AA,P3 | 00731 | HC | null | 20180713-20180713 | RD8 | 472 | 24 | MJ | |
ABC11111 | 1 | 1 | 1353 | AA | 00840 | HC | null | 20180713-20180713 | RD8 | 472 | 62 | MJ | |
ABC11111 | 1 | 1 | 1230 | AA | 00902 | HC | null | 20180713-20180713 | RD8 | 472 | 65 | MJ | |
ABC11111 | 2 | 2 | 738 | 59 | 62322 | HC | null | 20180713-20180713 | RD8 | 472 | 1 | UN | |
ABC111112 | 1 | 1 | 984 | AA,P3 | 00731 | HC | null | 20180713-20180713 | RD8 | 472 | 24 | MJ | |
ABC111112 | 1 | 1 | 1353 | AA | 00840 | HC | null | 20180713-20180713 | RD8 | 472 | 62 | MJ | |
ABC111112 | 1 | 1 | 1230 | AA | 00902 | HC | null | 20180713-20180713 | RD8 | 472 | 65 | MJ | |
ABC111112 | 2 | 2 | 738 | 59 | 62322 | HC | null | 20180713-20180713 | RD8 | 472 | 1 | UN | |
ABC111113 | 1 | 1 | 1353 | AA | 00840 | HC | null | 20180713-20180713 | RD8 | 472 | 62 | MJ | |
ABC111113 | 1 | 1 | 1230 | AA | 00902 | HC | null | 20180713-20180713 | RD8 | 472 | 65 | MJ | |
ABC111113 | 2 | 2 | 738 | 59 | 62322 | HC | null | 20180713-20180713 | RD8 | 472 | 1 | UN | |
ABC111114 | 1 | 1 | 1230 | AA | 00902 | HC | null | 20180713-20180713 | RD8 | 472 | 65 | MJ | |
ABC111114 | 2 | 2 | 738 | 59 | 62322 | HC | null | 20180713-20180713 | RD8 | 472 | 1 | UN | |
TD-R192ICE00087 | 1 | null | 9148 | null | 0124 | 20180628-20180702 | RD8 | 472 | 4 | UN | |||
TD-R192ICE00087 | 2 | null | 48.1 | null | 0250 | 20180628-20180702 | RD8 | 472 | 28 | UN | |||
TD-R192ICE00087 | 3 | null | 133 | null | 0260 | 20180628-20180702 | RD8 | 472 | 1 | UN | |||
TD-R192ICE00087 | 4 | null | 32.9 | null | 0300 | 20180628-20180702 | RD8 | 472 | 1 | UN | |||
TD-R192ICE00087 | 5 | null | 798.5 | null | 0301 | 20180628-20180702 | RD8 | 472 | 4 | UN | |||
TD-R192ICE00087 | 6 | null | 200.6 | null | 0305 | 20180628-20180702 | RD8 | 472 | 2 | UN | |||
TD-R192ICE00087 | 7 | null | 175 | null | 0306 | 20180628-20180702 | RD8 | 472 | 1 | UN | |||
TD-R192ICE00087 | 8 | null | 113.6 | null | 0307 | 20180628-20180702 | RD8 | 472 | 2 | UN | |||
TD-R192ICE00087 | 9 | null | 6517 | null | 0351 | 20180628-20180702 | RD8 | 472 | 2 | UN | |||
1000A | 1 | 1 | 140 | 99213 | HC | null | 20151124 | D8 | 472 | 1 | UN | ||
1000A | 1 | 1 | 140 | 99213 | HC | null | 20151124 | D8 | 472 | 1 | UN | ||
1001A | 1 | 1 | 140 | 99213 | HC | null | 20151124 | D8 | 472 | 1 | UN | ||
TD-R192ICE00094 | 1 | 1:2 | 300 | HO,HQ | 11 | H0004 | HC | null | 20180625-20180625 | RD8 | 472 | 12 | UN |
TD-R192ICE00094 | 2 | 1:2 | 300 | HO,HQ | 11 | H0004 | HC | null | 20180629-20180629 | RD8 | 472 | 12 | UN |