Transaction Examples.

What follows are examples of transactions for a ficticious client named Mickey Mouse.

001.01 - Batch Header

001.01|20150701|1001|053

020.05 - Consumer Demographics

020.05|A|412|053|AADLLDJ11P7|99882214|Mouse|Mickey|E|2|1928-10-13||010|||999|13|123-45-6789|9|123456789WA

035.06 - Consumer Periodics

035.06|A|412|053|EKP8MDNVTDS|99882214|2015-10-14|8|8|12|50|31|C|A|C|G|0.00|0

070.04 - Inpatient Services

See HIPAA Transactions

120.03 - Outpatient Services

See HIPAA Transactions. Example 837P below.

121.01 - Co-Occurring Disorder

121.01|A|412|053|7PSCMDNW048|99882214|2014-11-05|B|0|0|0|

130.02 - Cascade Merge

130.02|A|412|053|RX85GR4729K|99882214|11222387

131.01 - Cascade Delete

131.01|D|412|053||11222387

162.02 - ITA Hearing

162.02|A|412|053|GR47NBTN5G3|99882214|09-12-15|1|662|31|31|15-6-99794-3

810.00 - Consumer Address

810.00|C|412|053|AI3GMDOED5I|99882214||123 Main Street|Anytown|WA|98037|(206)555-1212||||||2015-01-07|

815.00 - Least Restrictive Alternative/Order

815.00|A|412|053|QKSIMDPWGBT|99882214|2014-12-10|2015-03-10|31|14-2-95162-1|90|X|Compass Health|X|Compass Health||||||||

830.00 - Client Crisis Plan

830.00|A|412|053|KKQQMDPIRA7|99882214|2014-12-10|N|Mickey is diabetic, which affects his mood. Staff at his AFH help manage his diabetes. Client decompensates rapidly if his medication regimen is interrupted.|N|

836.00 - Clinician Crisis Plan

836.00|A|412|053|LK98F4F6GH7|99882214|2015-09-08|3|2|4|3|3|4|2|3|2|2|N|N|Y|N|N|Y|Y|Has a fear of getting hands dirty. Is always wearing gloves. Feels must keep pristine white.|N|N|N|N|N|Scampers away when frightened by those outside close circle of friends. Has lived in many homes over the years.|Has a close circle of friends that relies on when faced with troubling situations.|Crises seem to be resolved happily when friends are involved.|Contact his friends Donald and Goofy.|N|Y|Minnie Mouse|(360) 555-1234|N|Donald Duck|(360) 555-4321|Yes, dog named pluto.|Compass Health|Dr. Beverly Crusher|None known|None known

845.00 - LOCUS

845.00|A|412|053|PI8BMDPIW84|99882214|7151|2014-12-21|3|3|3|2|2|3|2|18|3|3|

846.00 - CALOCUS

846.00|A|412|053|WKUKMDNUT7Z|99882214|8523|2015-06-08|2|2|1|2|2|2|1||12|1|1|

855.00 - VOA Call Outs

855.00|A|412|143|DNUWBMDPT7Z|99882214|2015-10-15|21:35|12589|DISPLO|DISPST|37|2|Y|

865.00 - DMHP Investigation

865.00|A|412|053|DN732MDPT72|99882214|2015-10-15|21:35|12589|2015-10-15|22:47|37|Y|1|Y|N|N|N|N|742|9|9|3

870.01 - First Offered/Referral

870.01|A|412|053|ESF0MDNV576|99882214|2015-04-04|10:00|10|2015-04-23|11:00|2KLERTK03A6

875.00 - ICRS - Voluntary

875.00|A|412|053|DNESF234T72|99882214|2015-10-14|09:35|12458|N|N|2015-10-14|13:21|37|3||9|3|Y

880.00 - Staff Detail

880.00|A|412|053|MDNV5107EKP||000012347|06-16-83||01|09||||||||1572345825|Mouse|Minnie|08|1|13|||||(360) 555-1212 X258963

885.00 - Stabilization/Triage Guest Data

885.00|A|412|053|P2SSF234XQ4|99882214|Y|N||11|2|37|01|2015-10-14

901.00 - Global Alert

901.00|A|412|053|YXQ4MDNVBQT|99882214|2015-04-30|2015-05-10|Crisis Alert||||

902.00 - Omnibus Episode Information

902.00|C|412|053|P2SCMDNVXJA|99882214|EPISO|2014-10-01|2015-06-12|5164|5|34

905.00 - Request for Service Additional Information

905.00|A|412|143|SCMTHL3FGM5|99882214|X|284|SCMTHL3FGM5||PHYSN

906.00 - Assessment Information

906.00|A|412|053|2SBGMDNYX4J|99882214|2KLERTK03A6|11

907.00 - First Routine Appointment

907.00|A|412|053|9UY4MDNZK0I|99882214|2KLERTK03A6|00|2015-07-01|10:10|2015-07-01|10:10

908.00 - First Routine Face-to-Face Appointment

908.00|A|412|053|AI3GMDO10FB|99882214|10

930.00 - 180-Day Review

930.00|A|412|053|MXMKMDOIXDX|99882214|2015-06-01|2014-12-15|1|X||||||||

940.00 - Jail Episodes

940.00|C|412|053|67B7SXFBON2|99882214|00002|JAIL|2015-09-04||131|04|2015-08-15||2|1|

951.00 - Additional Authorization Information

951.00|A|412|053|3ER46GG4562|99882214||2015-10-01|1|Client called and said he wanted an appt. No show listed for Sept 12. Asked him about it and he finally said "I thought it was for the next day."|N|1||Presenting Problem Date: 2015-10-01 GUID# DM24MWO9BTX Has depressed mood. Long term depression, with recent isolation, regular thoughts of suicide (no attempts), and risk of termination at work due to excessive use of sick days.|N|Y|Y|N|N|N|N|N|N|N|N|N|Client reports having Diabetes and hypertension|4|2||

960.00 - Authorization Request

See HIPAA Transactions. Example 278 Request below.

999.00 - Un-Correctable Error Resolution

05310557.edi|020.05|A|053|NAP8KNECMDO|11222387|234|Invalid P1 ID Format in PIC for Consumer Demographics Record for PN [11222387] from ORG [053].|2015-09-10|5|Record should not have been sent. Submitted cascade delete.

Example Return File

This is an example return file based on some of the transactions above that would be included in a .EDI file.

837P - Encounter Reporting

This is an example 837P file reporting a Request for Service encounter.

ISA*00*          *00*          *ZZ*10084          *ZZ*412            *160427*1520*^*00501*000000007*1*P*:~GS*HC*10084*412*20160427*1520*000000007*X*005010X222A1~ST*837*000000001*005010X222A1~BHT*0019*00*000000001*20160427*1520*000000007*RP~NM1*41*2*Evergreen Manor*****46*10084~PER*IC*Submitter Person Name*TE*4255551212~NM1*40*2*NSMHA*****46*412~HL*1**20*1~PRV*BI*PXC*261QR0405X~NM1*85*2*Evergreen Manor*****XX*1124159157~N3*2601 Summit Avenue~N4*Everett*WA*98201~REF*EI*91-6712345~HL*2*1*22*0~SBR*P*18*99882214******MC~NM1*IL*1*Mouse*Mickey*E***MI*123456789WA~N3*123 Main Street~N4*Anytown*WA*98037~DMG*D8*19281013*3~NM1*PR*2*NSHMA*****PI*412~CLM*WD9RE76EJK7*0***99:B:1*Y*A*Y*Y*C~HI*ABK:F99~LX*1~SV1*HC:H0046:UB*0*MJ*30***1~DTP*472*D8*20160317~REF*6R*IJ6F~NTE*ADD*00001:RFS:08:100:31~NM1*82*1*Mouse*Minnie* ***XX*1572345825~NM1*77*2*Evergreen Manor*****XX*1124159157~N3*2601 Summit Avenue~N4*Everett*WA*98201~SE*30*000000001~GE*1*000000007~IEA*1*000000007~

278 - Authorization Request

This is an example 278 Request file requesting authorization for services.

ISA*00*          *00*          *ZZ*053            *ZZ*412            *151901*0700*^*00501*000001002*0*P*:~GS*HI*053*412*20151001*0700*1002*X*005010X217~ST*278*000024090*005010X217~BHT*00007*13*42625*20151001*0858~HL*1**20*1~NM1*X3*2*NSMHA*****PI*412~HL*2*1*21*1~NM1*1P*1*Mouse*Minnie****XX*1572345825~REF*1J*043~N3*3322 Broadway~N4*Everett*WA*982014425~PER*IC**TE*4255556804*FX*4255556855~HL*3*2*22*1~NM1*IL*1******MI*99882214~REF*NQ*123456789WA~HL*4*3*EV*1~TRN*1*RFE3487HJYR*0000000001*916712345~UM*HS*I*A4******Y*~DTP*AAH*RD8*20151001-201600930~HI*ABK:F3113:D8:20150630~PWK*06*EL***AC*3ER46GG4562~NM1*SJ*2*Compass Health*****XX*1730136201~SE*21*000024090~GE*1*1002~IEA*1*000001002~