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>| iWay Software |