DDE File

The DDE file supplies the values for the elements in the 275 that is created by the Translator Attachment Adapter.

The DDE file is an XML representation of your data. It must contain X12-required segments such as TRN, NM1, and BIN or BDS. The file is used to populate the created 275 transaction.

Here is an example of a DDE file. 

<?xml version="1.0" encoding="UTF-8" standalone="no" ?>
<T-275 xmlns="http://www.tibco.com/ns/Foresight/2010/20" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
  <ISA>
    <InterchangeControlHeader>
      <AuthorizationInfoQual_ISA_01>00</AuthorizationInfoQual_ISA_01>
      <AuthorizationInfo_ISA_02>          </AuthorizationInfo_ISA_02>
      <SecurityInfoQual_ISA_03>00</SecurityInfoQual_ISA_03>
      <SecurityInfo_ISA_04>          </SecurityInfo_ISA_04>
      <InterchangeIdQual_ISA_05>ZZ</InterchangeIdQual_ISA_05>
      <InterchangeSenderId_ISA_06>HILLSDALEHOSP  </InterchangeSenderId_ISA_06>
      <InterchangeIdQual_ISA_07>ZZ</InterchangeIdQual_ISA_07>
      <InterchangeReceiverId_ISA_08>HORIZONE       </InterchangeReceiverId_ISA_08>
      <InterchangeDate_ISA_09>110707</InterchangeDate_ISA_09>
      <InterchangeTime_ISA_10>0843</InterchangeTime_ISA_10>
      <RepetitionSeparator_ISA_11>^</RepetitionSeparator_ISA_11>
      <InterchangeControlVersionNumber_ISA_12>00401</InterchangeControlVersionNumber_ISA_12>
      <InterchangeControlNumber_ISA_13>000000001</InterchangeControlNumber_ISA_13>
      <AcknowledgmentRequested_ISA_14>0</AcknowledgmentRequested_ISA_14>
      <InterchangeUsageIndicator_ISA_15>T</InterchangeUsageIndicator_ISA_15>
      <ComponentElementSeparator_ISA_16>:</ComponentElementSeparator_ISA_16>
    </InterchangeControlHeader>
  </ISA>
  <GS>
    <FunctionalGroupHeader>
      <FunctionalIdCode_GS_01>PI</FunctionalIdCode_GS_01>
      <ApplicationSendersCode_GS_02>HILLSDALEHOSP</ApplicationSendersCode_GS_02>
      <ApplicationReceiversCode_GS_03>HORIZONE</ApplicationReceiversCode_GS_03>
      <Date_GS_04>20110707</Date_GS_04>
      <Time_GS_05>084319</Time_GS_05>
      <GroupControlNumber_GS_06>0</GroupControlNumber_GS_06>
      <ResponsibleAgencyCode_GS_07>X</ResponsibleAgencyCode_GS_07>
      <VersionReleaseIndustryIdCode_GS_08>005010X210</VersionReleaseIndustryIdCode_GS_08>
    </FunctionalGroupHeader>
  </GS>
  <_50_75TransactionSetHeader_1>
    <TransactionSetIdCode_1_01>275</TransactionSetIdCode_1_01>
    <TransactionSetControlNumber_1_02>0001</TransactionSetControlNumber_1_02>
    <ImplementationConventionReference_1_03>005010X210</ImplementationConventionReference_1_03>
  </_50_75TransactionSetHeader_1>
  <BeginningSegment_2>
    <TransactionSetPurposeCode_2_01>02</TransactionSetPurposeCode_2_01>
    <ReferenceId_2_02>20110707084231-000000026</ReferenceId_2_02>
    <Date_2_03>20090707</Date_2_03>
  </BeginningSegment_2>
  <PayerNameLoop1000A_5>
    <PayerName_5>
      <EntityIdCode_5_01>PR</EntityIdCode_5_01>
      <EntityTypeQual_5_02>2</EntityTypeQual_5_02>
      <NameLastOrOrgName_5_03>HILLSDALEHOSP</NameLastOrOrgName_5_03>
      <IdCodeQual_5_08>PI</IdCodeQual_5_08>
      <IdCode_5_09>866004791</IdCode_5_09>
    </PayerName_5>
    <PayerContactInfo_9>
      <ContactFunctionCode_9_01>IC</ContactFunctionCode_9_01>
    </PayerContactInfo_9>
  </PayerNameLoop1000A_5>
  <SubmitterInfoLoop1000B_28>
    <SubmitterInfo_28>
      <EntityIdCode_28_01>41</EntityIdCode_28_01>
      <EntityTypeQual_28_02>2</EntityTypeQual_28_02>
      <NameLastOrOrgName_28_03>HILLSDALEHOSPITALS</NameLastOrOrgName_28_03>
      <NameFirst_28_04 xsi:nil="true"/>
      <NameMiddle_28_05 xsi:nil="true"/>
      <IdCodeQual_28_08>46</IdCodeQual_28_08>
      <IdCode_28_09>888888888888888</IdCode_28_09>
    </SubmitterInfo_28>
  </SubmitterInfoLoop1000B_28>
  <ProviderNameInfoLoop1000C_38>
    <ProviderNameInfo_38>
      <EntityIdCode_38_01>1P</EntityIdCode_38_01>
      <EntityTypeQual_38_02>1</EntityTypeQual_38_02>
      <NameLastOrOrgName_38_03>HILLSDALEXRAYS</NameLastOrOrgName_38_03>
      <NameFirst_38_04 xsi:nil="true"/>
      <NameMiddle_38_05 xsi:nil="true"/>
      <NameSuffix_38_07 xsi:nil="true"/>
      <IdCodeQual_38_08>XX</IdCodeQual_38_08>
      <IdCode_38_09>2749422277</IdCode_38_09>
    </ProviderNameInfo_38>
    <ProviderIdLoop1100C_45>
      <ProviderId_45>
        <EntityIdCode_45_01>1P</EntityIdCode_45_01>
      </ProviderId_45>
      <ProviderAddr_46>
        <AddrInfo_46_01>234 CENTRAL AVE</AddrInfo_46_01>
      </ProviderAddr_46>
      <ProviderCityStateZipCode_47>
        <CityName_47_01>HILLSDALE</CityName_47_01>
        <StateOrProvinceCode_47_02>NJ</StateOrProvinceCode_47_02>
        <PostalCode_47_03>07642</PostalCode_47_03>
      </ProviderCityStateZipCode_47>
    </ProviderIdLoop1100C_45>
  </ProviderNameInfoLoop1000C_38>
  <PatientNameLoop1000D_48>
    <PatientName_48>
      <EntityIdCode_48_01>QC</EntityIdCode_48_01>
      <EntityTypeQual_48_02>1</EntityTypeQual_48_02>
      <NameLastOrOrgName_48_03>ADAMS</NameLastOrOrgName_48_03>
      <NameFirst_48_04>ANN</NameFirst_48_04>
      <NameMiddle_48_05 xsi:nil="true"/>
      <NameSuffix_48_07 xsi:nil="true"/>
      <IdCodeQual_48_08>MI</IdCodeQual_48_08>
      <IdCode_48_09>111111111</IdCode_48_09>
    </PatientName_48>
    <PatientControlNumber_53>
      <ReferenceIdQual_53_01>EJ</ReferenceIdQual_53_01>
      <ReferenceId_53_02>PC111111111</ReferenceId_53_02>
    </PatientControlNumber_53>
    <MedicalRecordIdNumber_59>
      <ReferenceIdQual_59_01>EA</ReferenceIdQual_59_01>
      <ReferenceId_59_02>MRN111111111</ReferenceId_59_02>
    </MedicalRecordIdNumber_59>
    <ClaimServiceDate_54>
      <DateTimeQual_54_01>472</DateTimeQual_54_01>
      <DateTimePeriodFormatQual_54_02>D8</DateTimePeriodFormatQual_54_02>
      <DateTimePeriod_54_03>110601</DateTimePeriod_54_03>
    </ClaimServiceDate_54>
  </PatientNameLoop1000D_48>
  <AssignedNumberLoop2000A_15>
    <AssignedNumber_15>
      <AssignedNumber_15_01>1</AssignedNumber_15_01>
    </AssignedNumber_15>
    <PayerClaimControlNumberProviderAttachmentControlNumber_16>
      <TraceTypeCode_16_01>1</TraceTypeCode_16_01>
      <ReferenceId_16_02>PI-Add130KBJPG_PROV_ATTACH-CNTRL-TRN02-MLENGTH 50!</ReferenceId_16_02>
    </PayerClaimControlNumberProviderAttachmentControlNumber_16>
    <AdditionalInfoSubmissionDateLoop2100B_63>
      <AdditionalInfoSubmissionDate_63>
        <DateTimeQual_63_01>368</DateTimeQual_63_01>
        <DateTimePeriodFormatQual_63_02>D8</DateTimePeriodFormatQual_63_02>
        <DateTimePeriod_63_03>20110707</DateTimePeriod_63_03>
      </AdditionalInfoSubmissionDate_63>
      <CategoryOfPatientInfoService_64>
        <ReportTypeCode_64_01>AE</ReportTypeCode_64_01>
        <ReportTransmissionCode_64_02>MB</ReportTransmissionCode_64_02>
      </CategoryOfPatientInfoService_64>
      <ElectronicFormatIdLoop2110B_66>
        <ElectronicFormatId_66>
          <SecurityLevelCode_66_01>05</SecurityLevelCode_66_01>
        </ElectronicFormatId_66>
        <BinaryDataSegment_67>
          <LengthOfBinaryData_67_01>188208</LengthOfBinaryData_67_01>
          <BinaryData_67_02>placeholder</BinaryData_67_02>
        </BinaryDataSegment_67>
      </ElectronicFormatIdLoop2110B_66>
    </AdditionalInfoSubmissionDateLoop2100B_63>
  </AssignedNumberLoop2000A_15>
  <TransactionSetTrailer_27>
    <NumberOfIncludedSegments_27_01>20</NumberOfIncludedSegments_27_01>
    <TransactionSetControlNumber_27_02>0001</TransactionSetControlNumber_27_02>
  </TransactionSetTrailer_27>
  <GS>
    <FunctionalGroupTrailer>
      <NumberOfTransactionSetsIncluded_GE_01>1</NumberOfTransactionSetsIncluded_GE_01>
      <GroupControlNumber_GE_02>0</GroupControlNumber_GE_02>
    </FunctionalGroupTrailer>
  </GS>
  <ISA>
    <InterchangeControlTrailer>
      <NumberOfIncludedFunctionalGroups_IEA_01>1</NumberOfIncludedFunctionalGroups_IEA_01>
      <InterchangeControlNumber_IEA_02>000000001</InterchangeControlNumber_IEA_02>
    </InterchangeControlTrailer>
  </ISA>
</T-275>