HIPAA Transaction Guidelines

All the HIPAA guidelines provided with BusinessConnect Container Edition - EDI Protocol HIPAA Edition powered by Instream are located as follows:

  • BCCE-<version>_Home/images/services/cms/bcce-cms/config and BCCE-<version>_Home/images/services/is/bcce-is/config

  • Fsrest mount path

  • bcce-edihipaa-1.1.0_InstallerFolder/samples/sampleDocs/guidelines

Example: Version 5010 guidelines are in the directory: bcce-edihipaa-1.1.0_InstallerFolder/samples/sampleDocs/datafiles/5010_txns

The following table lists the HIPAA transactions and their associated guidelines:

HIPAA Transactions Guidelines

HIPAA Transaction

HIPAA Guideline

00307/003070X070A1/277

PDSA3070277UX070A1.std

00401/004010X092A1/270

PDSA270-B.std (batch)

00401/004010X092A1/270R

PDSA270-RT.std (real-time)

00401/004010X092A1/271

PDSA271.std

00401/004010X093A1/276

PDSA276-B.std (batch)

00401/004010X093A1/276R

PDSA276-RT.std (real-time)

00401/004010X093A1/277

PDSA277.std

00401/004010X094A1/278 (RQ)

PDA278RQ.std

00401/004010X094A1/278 (RSP)

PDA278RP.std

00401/004010X061A1/820

PDSA820.std

00401/004010X095A1/834

PDSA834.std

00401/004010X096A1/837 (I)

PDSA837I.std

00401/004010X097A1/837 (D)

PDSA837D.std

00401/004010X098A1/837 (P)

PDSA837P.std

00404/004040X167/277

PDSA4040277UX167.std

00405/004050X150/277

PDSA4050277X150.std

00405/004050X151/275

PDSA4050275X151.std

00405/004050X166/824

PDSA4050824X166.std

00501/005010X279A1/270

PDSA5010270X279-B.std (batch)

00501/005010X279A1/270R

PDSA5010270X279-RT.std (real-time)

00501/005010X279A1/271

PDSA5010271X279.std

00501/005010X212/276

PDSA5010276X212-B.std (batch)

00501/005010X212/276R

PDSA5010276X212-RT.std (real-time)

00501/005010X212/277

PDSA5010277X212.std

00501/005010X217/278 (RQ)

PDSA5010278X217Q.std

00501/005010X217/278 (RSP)

PDSA5010278X217R.std

00501/005010X218/820

PDSA5010820.std

00501/005010X220A1/834

PDSA5010834.std

00501/005010X221A1/835

PDSA5010835.std

00501/005010X222A1/837 (P)

PDSA5010837P.std

00501/005010X223A2/837 (I)

PDSA5010837I.std

00501/005010X224A2/837 (D)

PDSA5010837D.std

00501/005010X214/277

PDSA5010277CAX214.std

00501/005010X186A1/824

PDSA5010824X186.std

00501/005010X210/275

PDSA5010275X210.std

00501/005010X213/277

PDSA5010277X213.std

Guidelines that are designated as real-time transactions have limits applied as follows:

270 Transaction - number of patients limited to 1

276 Transaction - number of claims limited to 1

Guidelines that are designated as batch transactions have limits applied as follows:

270 Transaction - number of patients limited to 99

276 Transaction - number of claims limited to 99