EDI 276 Data Transformation Documentation

EDI 276 Data Transformation

Create and transform EDI messages using the JSON format of the EDI.

Our current supported EDI version: 005010

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EDI 276 Request to JSON Response

Transforms an EDI 276 message into JSON.

post https://api-edi.splinxtechnologies.com/v1/edi-transformation/edi276-to-json

Request headers

Authentication

To make REST API calls, make sure to include your account's email and password in a Base64 encrypted format in the Basic authentication scheme. The value is <Account-Email> and <Account-Password>

LicenseId

Sample request

EDI 276 Copy

ISA*00*          *00*          *ZZ*SUBMITTERS ID  *ZZ*RECEIVERS ID   *220412*1253*^*00501*000000001*0*P*:~GS*HS*SENDER CODE*RECEIVER CODE*20220412*1513*002*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*1666666661~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*1666666666~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*002~IEA*1*000000001~

Sample response

JSON Copy

{
  "InterchangeControlHeaderSegment": {
    "ISA_01_AuthorizationInformationQualifier_ID": "00",
    "ISA_02_AuthorizationInformation_AN": "          ",
    "ISA_03_SecurityInformationQualifier_ID": "00",
    "ISA_04_SecurityInformation_AN": "          ",
    "ISA_05_InterchangeIDQualifier_ID": "ZZ",
    "ISA_06_InterchangeSenderID_AN": "SUBMITTERS ID  ",
    "ISA_07_InterchangeIDQualifier_ID": "ZZ",
    "ISA_08_InterchangeReceiverID_AN": "RECEIVERS ID   ",
    "ISA_09_InterchangeDate_DT": "220412",
    "ISA_10_InterchangeTime_TM": "1253",
    "ISA_11_RepetitionSeparator": "^",
    "ISA_12_InterchangeControlVersionNumber_ID": "00501",
    "ISA_13_InterchangeControlNumber_N": "000000001",
    "ISA_14_AcknowledgmentRequest_ID": "0",
    "ISA_15_InterchangeUsageIndicator_ID": "P",
    "ISA_16_ComponentElementSeparator": ":"
  },
  "FunctionalGroups": [
    {
      "FunctionalGroupHeaderSegment": {
        "GS_01_FunctionalIdentifierCode_ID": "HS",
        "GS_02_ApplicationSendersCode_AN": "SENDER CODE",
        "GS_03_ApplicationReceiversCode_AN": "RECEIVER CODE",
        "GS_04_Date_DT": "20220412",
        "GS_05_Time_TM": "1513",
        "GS_06_GroupControlNumber_N": "002",
        "GS_07_ResponsibleAgencyCode_ID": "X",
        "GS_08_VersionReleaseIndustryIdentifierCode_AN": "005010X212"
      },
      "TransactionSets": [
        {
          "TransactionSetHeader": {
            "ST_01_TransactionSetIdentifierCode_ID": "276",
            "ST_02_TransactionSetControlNumber_AN": "0001",
            "ST_03_ImplementationConventionReference_AN": "005010X212"
          },
          "BeginningOfHierarchicalTransaction": {
            "BHT_01_HierarchicalStructureCode_ID": "0010",
            "BHT_02_TransactionSetPurposeCode_ID": "13",
            "BHT_03_ReferenceIdentification_AN": "ABC276XXX",
            "BHT_04_Date_DT": "20050915",
            "BHT_05_Time_TM": "1425",
            "BHT_06_TransactionTypeCode_ID": null
          },
          "InformationSourceLevel_Loop_2000A": [
            {
              "InformationSourceLevel": {
                "HL_01_HierarchicalIDNumber_AN": "1",
                "HL_02_HierarchicalParentIDNumber_AN": null,
                "HL_03_HierarchicalLevelCode_ID": "20",
                "HL_04_HierarchicalChildCode_ID": "1"
              },
              "PayerName_Loop_2100A": {
                "PayerName": {
                  "NM1_01_EntityIdentifierCode_ID": "PR",
                  "NM1_02_EntityTypeQualifier_ID": "2",
                  "NM1_03_NameLastOrOrganizationName_AN": "ABC INSURANCE",
                  "NM1_04_NameFirst_AN": null,
                  "NM1_05_NameMiddle_AN": null,
                  "NM1_06_NamePrefix_AN": null,
                  "NM1_07_NameSuffix_AN": null,
                  "NM1_08_IdentificationCodeQualifier_ID": "PI",
                  "NM1_09_IdentificationCode_AN": "12345",
                  "NM1_10_EntityRelationshipCode_ID": null,
                  "NM1_11_EntityIdentifierCode_ID": null,
                  "NM1_12_NameLastOrOrganizationName_AN": null
                }
              },
              "InformationReceiverLevel_Loop_2000B": [
                {
                  "InformationReceiverLevel": {
                    "HL_01_HierarchicalIDNumber_AN": "2",
                    "HL_02_HierarchicalParentIDNumber_AN": "1",
                    "HL_03_HierarchicalLevelCode_ID": "21",
                    "HL_04_HierarchicalChildCode_ID": "1"
                  },
                  "InformationReceiverName_Loop_2100B": {
                    "InformationReceiverName": {
                      "NM1_01_EntityIdentifierCode_ID": "41",
                      "NM1_02_EntityTypeQualifier_ID": "2",
                      "NM1_03_NameLastOrOrganizationName_AN": "XYZ SERVICE",
                      "NM1_04_NameFirst_AN": null,
                      "NM1_05_NameMiddle_AN": null,
                      "NM1_06_NamePrefix_AN": null,
                      "NM1_07_NameSuffix_AN": null,
                      "NM1_08_IdentificationCodeQualifier_ID": "46",
                      "NM1_09_IdentificationCode_AN": "X67E",
                      "NM1_10_EntityRelationshipCode_ID": null,
                      "NM1_11_EntityIdentifierCode_ID": null,
                      "NM1_12_NameLastOrOrganizationName_AN": null
                    }
                  },
                  "ServiceProviderLevel_Loop_2000C": [
                    {
                      "ServiceProviderLevel": {
                        "HL_01_HierarchicalIDNumber_AN": "3",
                        "HL_02_HierarchicalParentIDNumber_AN": "2",
                        "HL_03_HierarchicalLevelCode_ID": "19",
                        "HL_04_HierarchicalChildCode_ID": "1"
                      },
                      "ProviderName_Loop_2100C": [
                        {
                          "ProviderName": {
                            "NM1_01_EntityIdentifierCode_ID": "1P",
                            "NM1_02_EntityTypeQualifier_ID": "2",
                            "NM1_03_NameLastOrOrganizationName_AN": "HOME HOSPITAL",
                            "NM1_04_NameFirst_AN": null,
                            "NM1_05_NameMiddle_AN": null,
                            "NM1_06_NamePrefix_AN": null,
                            "NM1_07_NameSuffix_AN": null,
                            "NM1_08_IdentificationCodeQualifier_ID": "XX",
                            "NM1_09_IdentificationCode_AN": "1666666661",
                            "NM1_10_EntityRelationshipCode_ID": null,
                            "NM1_11_EntityIdentifierCode_ID": null,
                            "NM1_12_NameLastOrOrganizationName_AN": null
                          }
                        }
                      ],
                      "SubscriberLevel_Loop_2000D": [
                        {
                          "SubscriberLevel": {
                            "HL_01_HierarchicalIDNumber_AN": "4",
                            "HL_02_HierarchicalParentIDNumber_AN": "3",
                            "HL_03_HierarchicalLevelCode_ID": "22",
                            "HL_04_HierarchicalChildCode_ID": "0"
                          },
                          "SubscriberDemographicInformation": {
                            "DMG_01_DateTimePeriodFormatQualifier_ID": "D8",
                            "DMG_02_DateTimePeriod_AN": "19301210",
                            "DMG_03_GenderCode_ID": "M",
                            "DMG_04_MaritalStatusCode_ID": null,
                            "DMG_05_CompositeRaceOrEthnicityInformation": null,
                            "DMG_06_CitizenshipStatusCode_ID": null,
                            "DMG_07_CountryCode_ID": null,
                            "DMG_08_BasisOfVerificationCode_ID": null,
                            "DMG_09_Quantity_R": null,
                            "DMG_10_CodeListQualifierCode_ID": null,
                            "DMG_11_IndustryCode_AN": null
                          },
                          "SubscriberName_Loop_2100D": {
                            "SubscriberName": {
                              "NM1_01_EntityIdentifierCode_ID": "IL",
                              "NM1_02_EntityTypeQualifier_ID": "1",
                              "NM1_03_NameLastOrOrganizationName_AN": "SMITH",
                              "NM1_04_NameFirst_AN": "FRED",
                              "NM1_05_NameMiddle_AN": null,
                              "NM1_06_NamePrefix_AN": null,
                              "NM1_07_NameSuffix_AN": null,
                              "NM1_08_IdentificationCodeQualifier_ID": "MI",
                              "NM1_09_IdentificationCode_AN": "123456789A",
                              "NM1_10_EntityRelationshipCode_ID": null,
                              "NM1_11_EntityIdentifierCode_ID": null,
                              "NM1_12_NameLastOrOrganizationName_AN": null
                            }
                          },
                          "ClaimStatusTrackingNumber_Loop_2200D": [
                            {
                              "ClaimStatusTrackingNumber": {
                                "TRN_01_TraceTypeCode_ID": "1",
                                "TRN_02_ReferenceIdentification_AN": "ABCXYZ1",
                                "TRN_03_OriginatingCompanyIdentifier_AN": null,
                                "TRN_04_ReferenceIdentification_AN": null
                              },
                              "PayerClaimControlNumber": {
                                "REF_01_ReferenceIdentificationQualifier_ID": "BLT",
                                "REF_02_ReferenceIdentification_AN": "111",
                                "REF_03_Description_AN": null,
                                "REF_04_ReferenceIdentifier": null
                              },
                              "InstitutionalBillTypeIdentification": {
                                "REF_01_ReferenceIdentificationQualifier_ID": "EJ",
                                "REF_02_ReferenceIdentification_AN": "SM123456",
                                "REF_03_Description_AN": null,
                                "REF_04_ReferenceIdentifier": null
                              },
                              "ApplicationOrLocationSystemIdentifier": null,
                              "GroupNumber": null,
                              "PatientControlNumber": null,
                              "PharmacyPrescriptionNumber": null,
                              "ClaimIdentificationNumberForClearinghousesAndOtherTransmissionIntermediaries": null,
                              "ClaimSubmittedCharges": {
                                "AMT_01_AmountQualifierCode_ID": "T3",
                                "AMT_02_MonetaryAmount_R": "8513.88",
                                "AMT_03_CreditDebitFlagCode_ID": null
                              },
                              "ClaimServiceDate": {
                                "DTP_01_DateTimeQualifier_ID": "472",
                                "DTP_02_DateTimePeriodFormatQualifier_ID": "RD8",
                                "DTP_03_DateTimePeriod_AN": "20050831-20050906"
                              },
                              "ServiceLineInformation_Loop_2210D": [
                                {
                                  "ServiceLineInformation": null,
                                  "ServiceLineItemIdentification": null,
                                  "ServiceLineDate": null
                                }
                              ]
                            }
                          ]
                        },
                        {
                          "SubscriberLevel": {
                            "HL_01_HierarchicalIDNumber_AN": "5",
                            "HL_02_HierarchicalParentIDNumber_AN": "3",
                            "HL_03_HierarchicalLevelCode_ID": "22",
                            "HL_04_HierarchicalChildCode_ID": "0"
                          },
                          "SubscriberDemographicInformation": {
                            "DMG_01_DateTimePeriodFormatQualifier_ID": "D8",
                            "DMG_02_DateTimePeriod_AN": "19301115",
                            "DMG_03_GenderCode_ID": "F",
                            "DMG_04_MaritalStatusCode_ID": null,
                            "DMG_05_CompositeRaceOrEthnicityInformation": null,
                            "DMG_06_CitizenshipStatusCode_ID": null,
                            "DMG_07_CountryCode_ID": null,
                            "DMG_08_BasisOfVerificationCode_ID": null,
                            "DMG_09_Quantity_R": null,
                            "DMG_10_CodeListQualifierCode_ID": null,
                            "DMG_11_IndustryCode_AN": null
                          },
                          "SubscriberName_Loop_2100D": {
                            "SubscriberName": {
                              "NM1_01_EntityIdentifierCode_ID": "IL",
                              "NM1_02_EntityTypeQualifier_ID": "1",
                              "NM1_03_NameLastOrOrganizationName_AN": "JONES",
                              "NM1_04_NameFirst_AN": "MARY",
                              "NM1_05_NameMiddle_AN": null,
                              "NM1_06_NamePrefix_AN": null,
                              "NM1_07_NameSuffix_AN": null,
                              "NM1_08_IdentificationCodeQualifier_ID": "MI",
                              "NM1_09_IdentificationCode_AN": "234567890A",
                              "NM1_10_EntityRelationshipCode_ID": null,
                              "NM1_11_EntityIdentifierCode_ID": null,
                              "NM1_12_NameLastOrOrganizationName_AN": null
                            }
                          },
                          "ClaimStatusTrackingNumber_Loop_2200D": [
                            {
                              "ClaimStatusTrackingNumber": {
                                "TRN_01_TraceTypeCode_ID": "1",
                                "TRN_02_ReferenceIdentification_AN": "ABCXYZ2",
                                "TRN_03_OriginatingCompanyIdentifier_AN": null,
                                "TRN_04_ReferenceIdentification_AN": null
                              },
                              "PayerClaimControlNumber": {
                                "REF_01_ReferenceIdentificationQualifier_ID": "BLT",
                                "REF_02_ReferenceIdentification_AN": "111",
                                "REF_03_Description_AN": null,
                                "REF_04_ReferenceIdentifier": null
                              },
                              "InstitutionalBillTypeIdentification": {
                                "REF_01_ReferenceIdentificationQualifier_ID": "EJ",
                                "REF_02_ReferenceIdentification_AN": "JO234567",
                                "REF_03_Description_AN": null,
                                "REF_04_ReferenceIdentifier": null
                              },
                              "ApplicationOrLocationSystemIdentifier": null,
                              "GroupNumber": null,
                              "PatientControlNumber": null,
                              "PharmacyPrescriptionNumber": null,
                              "ClaimIdentificationNumberForClearinghousesAndOtherTransmissionIntermediaries": null,
                              "ClaimSubmittedCharges": {
                                "AMT_01_AmountQualifierCode_ID": "T3",
                                "AMT_02_MonetaryAmount_R": "7599",
                                "AMT_03_CreditDebitFlagCode_ID": null
                              },
                              "ClaimServiceDate": {
                                "DTP_01_DateTimeQualifier_ID": "472",
                                "DTP_02_DateTimePeriodFormatQualifier_ID": "RD8",
                                "DTP_03_DateTimePeriod_AN": "20050731-20050809"
                              },
                              "ServiceLineInformation_Loop_2210D": [
                                {
                                  "ServiceLineInformation": null,
                                  "ServiceLineItemIdentification": null,
                                  "ServiceLineDate": null
                                }
                              ]
                            }
                          ]
                        }
                      ],
                      "DependentLevel_Loop_2000E": [
                        {
                          "DependentLevel": null,
                          "DependentDemographicInformation": null,
                          "DependentName_Loop_2100E": {
                            "DependentName": null
                          },
                          "ClaimStatusTrackingNumber_Loop_2200E": [
                            {
                              "ClaimStatusTrackingNumber": null,
                              "PayerClaimControlNumber": null,
                              "InstitutionalBillTypeIdentification": null,
                              "ApplicationOrLocationSystemIdentifier": null,
                              "GroupNumber": null,
                              "PatientControlNumber": null,
                              "PharmacyPrescriptionNumber": null,
                              "ClaimIdentificationNumberForClearinghousesAndOtherTransmissionIntermediaries": null,
                              "ClaimSubmittedCharges": null,
                              "ClaimServiceDate": null,
                              "ServiceLineInformation_Loop_2210E": [
                                {
                                  "ServiceLineInformation": null,
                                  "ServiceLineItemIdentification": null,
                                  "ServiceLineDate": null
                                }
                              ]
                            }
                          ]
                        }
                      ]
                    },
                    {
                      "ServiceProviderLevel": {
                        "HL_01_HierarchicalIDNumber_AN": "6",
                        "HL_02_HierarchicalParentIDNumber_AN": "2",
                        "HL_03_HierarchicalLevelCode_ID": "19",
                        "HL_04_HierarchicalChildCode_ID": "1"
                      },
                      "ProviderName_Loop_2100C": [
                        {
                          "ProviderName": {
                            "NM1_01_EntityIdentifierCode_ID": "1P",
                            "NM1_02_EntityTypeQualifier_ID": "2",
                            "NM1_03_NameLastOrOrganizationName_AN": "HOME HOSPITAL PHYSICIANS",
                            "NM1_04_NameFirst_AN": null,
                            "NM1_05_NameMiddle_AN": null,
                            "NM1_06_NamePrefix_AN": null,
                            "NM1_07_NameSuffix_AN": null,
                            "NM1_08_IdentificationCodeQualifier_ID": "XX",
                            "NM1_09_IdentificationCode_AN": "1666666666",
                            "NM1_10_EntityRelationshipCode_ID": null,
                            "NM1_11_EntityIdentifierCode_ID": null,
                            "NM1_12_NameLastOrOrganizationName_AN": null
                          }
                        }
                      ],
                      "SubscriberLevel_Loop_2000D": [
                        {
                          "SubscriberLevel": {
                            "HL_01_HierarchicalIDNumber_AN": "7",
                            "HL_02_HierarchicalParentIDNumber_AN": "6",
                            "HL_03_HierarchicalLevelCode_ID": "22",
                            "HL_04_HierarchicalChildCode_ID": "1"
                          },
                          "SubscriberDemographicInformation": null,
                          "SubscriberName_Loop_2100D": {
                            "SubscriberName": {
                              "NM1_01_EntityIdentifierCode_ID": "IL",
                              "NM1_02_EntityTypeQualifier_ID": "1",
                              "NM1_03_NameLastOrOrganizationName_AN": "MANN",
                              "NM1_04_NameFirst_AN": "JOHN",
                              "NM1_05_NameMiddle_AN": null,
                              "NM1_06_NamePrefix_AN": null,
                              "NM1_07_NameSuffix_AN": null,
                              "NM1_08_IdentificationCodeQualifier_ID": "MI",
                              "NM1_09_IdentificationCode_AN": "345678901",
                              "NM1_10_EntityRelationshipCode_ID": null,
                              "NM1_11_EntityIdentifierCode_ID": null,
                              "NM1_12_NameLastOrOrganizationName_AN": null
                            }
                          },
                          "ClaimStatusTrackingNumber_Loop_2200D": [
                            {
                              "ClaimStatusTrackingNumber": null,
                              "PayerClaimControlNumber": null,
                              "InstitutionalBillTypeIdentification": null,
                              "ApplicationOrLocationSystemIdentifier": null,
                              "GroupNumber": null,
                              "PatientControlNumber": null,
                              "PharmacyPrescriptionNumber": null,
                              "ClaimIdentificationNumberForClearinghousesAndOtherTransmissionIntermediaries": null,
                              "ClaimSubmittedCharges": null,
                              "ClaimServiceDate": null,
                              "ServiceLineInformation_Loop_2210D": [
                                {
                                  "ServiceLineInformation": null,
                                  "ServiceLineItemIdentification": null,
                                  "ServiceLineDate": null
                                }
                              ]
                            }
                          ]
                        }
                      ],
                      "DependentLevel_Loop_2000E": [
                        {
                          "DependentLevel": {
                            "HL_01_HierarchicalIDNumber_AN": "8",
                            "HL_02_HierarchicalParentIDNumber_AN": "7",
                            "HL_03_HierarchicalLevelCode_ID": "23",
                            "HL_04_HierarchicalChildCode_ID": null
                          },
                          "DependentDemographicInformation": {
                            "DMG_01_DateTimePeriodFormatQualifier_ID": "D8",
                            "DMG_02_DateTimePeriod_AN": "19951101",
                            "DMG_03_GenderCode_ID": "M",
                            "DMG_04_MaritalStatusCode_ID": null,
                            "DMG_05_CompositeRaceOrEthnicityInformation": null,
                            "DMG_06_CitizenshipStatusCode_ID": null,
                            "DMG_07_CountryCode_ID": null,
                            "DMG_08_BasisOfVerificationCode_ID": null,
                            "DMG_09_Quantity_R": null,
                            "DMG_10_CodeListQualifierCode_ID": null,
                            "DMG_11_IndustryCode_AN": null
                          },
                          "DependentName_Loop_2100E": {
                            "DependentName": {
                              "NM1_01_EntityIdentifierCode_ID": "QC",
                              "NM1_02_EntityTypeQualifier_ID": "1",
                              "NM1_03_NameLastOrOrganizationName_AN": "MANN",
                              "NM1_04_NameFirst_AN": "JOSEPH",
                              "NM1_05_NameMiddle_AN": null,
                              "NM1_06_NamePrefix_AN": null,
                              "NM1_07_NameSuffix_AN": null,
                              "NM1_08_IdentificationCodeQualifier_ID": null,
                              "NM1_09_IdentificationCode_AN": null,
                              "NM1_10_EntityRelationshipCode_ID": null,
                              "NM1_11_EntityIdentifierCode_ID": null,
                              "NM1_12_NameLastOrOrganizationName_AN": null
                            }
                          },
                          "ClaimStatusTrackingNumber_Loop_2200E": [
                            {
                              "ClaimStatusTrackingNumber": {
                                "TRN_01_TraceTypeCode_ID": "1",
                                "TRN_02_ReferenceIdentification_AN": "ABCXYZ3",
                                "TRN_03_OriginatingCompanyIdentifier_AN": null,
                                "TRN_04_ReferenceIdentification_AN": null
                              },
                              "PayerClaimControlNumber": {
                                "REF_01_ReferenceIdentificationQualifier_ID": "EJ",
                                "REF_02_ReferenceIdentification_AN": "MA345678",
                                "REF_03_Description_AN": null,
                                "REF_04_ReferenceIdentifier": null
                              },
                              "InstitutionalBillTypeIdentification": null,
                              "ApplicationOrLocationSystemIdentifier": null,
                              "GroupNumber": null,
                              "PatientControlNumber": null,
                              "PharmacyPrescriptionNumber": null,
                              "ClaimIdentificationNumberForClearinghousesAndOtherTransmissionIntermediaries": null,
                              "ClaimSubmittedCharges": null,
                              "ClaimServiceDate": null,
                              "ServiceLineInformation_Loop_2210E": [
                                {
                                  "ServiceLineInformation": {
                                    "SVC_01_CompositeMedicalProcedureIdentifier": {
                                      "C003_01_ProductServiceIDQualifier_ID": "HC",
                                      "C003_02_ProductServiceID_AN": "99203",
                                      "C003_03_ProcedureModifier_AN": null,
                                      "C003_04_ProcedureModifier_AN": null,
                                      "C003_05_ProcedureModifier_AN": null,
                                      "C003_06_ProcedureModifier_AN": null,
                                      "C003_07_Description_AN": null,
                                      "C003_08_ProductServiceID_AN": null
                                    },
                                    "SVC_02_MonetaryAmount_R": "150",
                                    "SVC_03_MonetaryAmount_R": null,
                                    "SVC_04_ProductServiceId_AN": null,
                                    "SVC_05_Quantity_R": null,
                                    "SVC_06_CompositeMedicalProcedureIdentifier": null,
                                    "SVC_07_Quantity_R": "1"
                                  },
                                  "ServiceLineItemIdentification": null,
                                  "ServiceLineDate": {
                                    "DTP_01_DateTimeQualifier_ID": "472",
                                    "DTP_02_DateTimePeriodFormatQualifier_ID": "D8",
                                    "DTP_03_DateTimePeriod_AN": "20050501"
                                  }
                                }
                              ]
                            }
                          ]
                        }
                      ]
                    }
                  ]
                }
              ]
            }
          ],
          "TransactionSetTrailer": {
            "SE_01_NumberOfIncludedSegments_N": "36",
            "SE_02_TransactionSetControlNumber_AN": "0001"
          }
        }
      ],
      "FunctionalGroupTrailerSegment": {
        "GE_01_NumberOfTransactionSetsIncluded_N": "1",
        "GE_02_GroupControlNumber_N": "002"
      }
    }
  ],
  "InterchangeControlTrailerSegment": {
    "IEA_01_NumberOfIncludedFunctionalGroups_N": "1",
    "IEA_02_InterchangeControlNumber_N": "000000001"
  }
}

JSON Request to EDI 276 Response

Transforms JSON into an EDI 276 message.

post https://api-edi.splinxtechnologies.com/v1/edi-transformation/json-to-edi276

Request headers

Authentication

To make REST API calls, make sure to include your account's email and password in a Base64 encrypted format in the Basic authentication scheme. The value is <Account-Email> and <Account-Password>

LicenseId

Sample request

JSON Copy

{
  "InterchangeControlHeaderSegment": {
    "ISA_01_AuthorizationInformationQualifier_ID": "00",
    "ISA_02_AuthorizationInformation_AN": "          ",
    "ISA_03_SecurityInformationQualifier_ID": "00",
    "ISA_04_SecurityInformation_AN": "          ",
    "ISA_05_InterchangeIDQualifier_ID": "ZZ",
    "ISA_06_InterchangeSenderID_AN": "SUBMITTERS ID  ",
    "ISA_07_InterchangeIDQualifier_ID": "ZZ",
    "ISA_08_InterchangeReceiverID_AN": "RECEIVERS ID   ",
    "ISA_09_InterchangeDate_DT": "220412",
    "ISA_10_InterchangeTime_TM": "1253",
    "ISA_11_RepetitionSeparator": "^",
    "ISA_12_InterchangeControlVersionNumber_ID": "00501",
    "ISA_13_InterchangeControlNumber_N": "000000001",
    "ISA_14_AcknowledgmentRequest_ID": "0",
    "ISA_15_InterchangeUsageIndicator_ID": "P",
    "ISA_16_ComponentElementSeparator": ":"
  },
  "FunctionalGroups": [
    {
      "FunctionalGroupHeaderSegment": {
        "GS_01_FunctionalIdentifierCode_ID": "HS",
        "GS_02_ApplicationSendersCode_AN": "SENDER CODE",
        "GS_03_ApplicationReceiversCode_AN": "RECEIVER CODE",
        "GS_04_Date_DT": "20220412",
        "GS_05_Time_TM": "1513",
        "GS_06_GroupControlNumber_N": "002",
        "GS_07_ResponsibleAgencyCode_ID": "X",
        "GS_08_VersionReleaseIndustryIdentifierCode_AN": "005010X212"
      },
      "TransactionSets": [
        {
          "TransactionSetHeader": {
            "ST_01_TransactionSetIdentifierCode_ID": "276",
            "ST_02_TransactionSetControlNumber_AN": "0001",
            "ST_03_ImplementationConventionReference_AN": "005010X212"
          },
          "BeginningOfHierarchicalTransaction": {
            "BHT_01_HierarchicalStructureCode_ID": "0010",
            "BHT_02_TransactionSetPurposeCode_ID": "13",
            "BHT_03_ReferenceIdentification_AN": "ABC276XXX",
            "BHT_04_Date_DT": "20050915",
            "BHT_05_Time_TM": "1425",
            "BHT_06_TransactionTypeCode_ID": null
          },
          "InformationSourceLevel_Loop_2000A": [
            {
              "InformationSourceLevel": {
                "HL_01_HierarchicalIDNumber_AN": "1",
                "HL_02_HierarchicalParentIDNumber_AN": null,
                "HL_03_HierarchicalLevelCode_ID": "20",
                "HL_04_HierarchicalChildCode_ID": "1"
              },
              "PayerName_Loop_2100A": {
                "PayerName": {
                  "NM1_01_EntityIdentifierCode_ID": "PR",
                  "NM1_02_EntityTypeQualifier_ID": "2",
                  "NM1_03_NameLastOrOrganizationName_AN": "ABC INSURANCE",
                  "NM1_04_NameFirst_AN": null,
                  "NM1_05_NameMiddle_AN": null,
                  "NM1_06_NamePrefix_AN": null,
                  "NM1_07_NameSuffix_AN": null,
                  "NM1_08_IdentificationCodeQualifier_ID": "PI",
                  "NM1_09_IdentificationCode_AN": "12345",
                  "NM1_10_EntityRelationshipCode_ID": null,
                  "NM1_11_EntityIdentifierCode_ID": null,
                  "NM1_12_NameLastOrOrganizationName_AN": null
                }
              },
              "InformationReceiverLevel_Loop_2000B": [
                {
                  "InformationReceiverLevel": {
                    "HL_01_HierarchicalIDNumber_AN": "2",
                    "HL_02_HierarchicalParentIDNumber_AN": "1",
                    "HL_03_HierarchicalLevelCode_ID": "21",
                    "HL_04_HierarchicalChildCode_ID": "1"
                  },
                  "InformationReceiverName_Loop_2100B": {
                    "InformationReceiverName": {
                      "NM1_01_EntityIdentifierCode_ID": "41",
                      "NM1_02_EntityTypeQualifier_ID": "2",
                      "NM1_03_NameLastOrOrganizationName_AN": "XYZ SERVICE",
                      "NM1_04_NameFirst_AN": null,
                      "NM1_05_NameMiddle_AN": null,
                      "NM1_06_NamePrefix_AN": null,
                      "NM1_07_NameSuffix_AN": null,
                      "NM1_08_IdentificationCodeQualifier_ID": "46",
                      "NM1_09_IdentificationCode_AN": "X67E",
                      "NM1_10_EntityRelationshipCode_ID": null,
                      "NM1_11_EntityIdentifierCode_ID": null,
                      "NM1_12_NameLastOrOrganizationName_AN": null
                    }
                  },
                  "ServiceProviderLevel_Loop_2000C": [
                    {
                      "ServiceProviderLevel": {
                        "HL_01_HierarchicalIDNumber_AN": "3",
                        "HL_02_HierarchicalParentIDNumber_AN": "2",
                        "HL_03_HierarchicalLevelCode_ID": "19",
                        "HL_04_HierarchicalChildCode_ID": "1"
                      },
                      "ProviderName_Loop_2100C": [
                        {
                          "ProviderName": {
                            "NM1_01_EntityIdentifierCode_ID": "1P",
                            "NM1_02_EntityTypeQualifier_ID": "2",
                            "NM1_03_NameLastOrOrganizationName_AN": "HOME HOSPITAL",
                            "NM1_04_NameFirst_AN": null,
                            "NM1_05_NameMiddle_AN": null,
                            "NM1_06_NamePrefix_AN": null,
                            "NM1_07_NameSuffix_AN": null,
                            "NM1_08_IdentificationCodeQualifier_ID": "XX",
                            "NM1_09_IdentificationCode_AN": "1666666661",
                            "NM1_10_EntityRelationshipCode_ID": null,
                            "NM1_11_EntityIdentifierCode_ID": null,
                            "NM1_12_NameLastOrOrganizationName_AN": null
                          }
                        }
                      ],
                      "SubscriberLevel_Loop_2000D": [
                        {
                          "SubscriberLevel": {
                            "HL_01_HierarchicalIDNumber_AN": "4",
                            "HL_02_HierarchicalParentIDNumber_AN": "3",
                            "HL_03_HierarchicalLevelCode_ID": "22",
                            "HL_04_HierarchicalChildCode_ID": "0"
                          },
                          "SubscriberDemographicInformation": {
                            "DMG_01_DateTimePeriodFormatQualifier_ID": "D8",
                            "DMG_02_DateTimePeriod_AN": "19301210",
                            "DMG_03_GenderCode_ID": "M",
                            "DMG_04_MaritalStatusCode_ID": null,
                            "DMG_05_CompositeRaceOrEthnicityInformation": null,
                            "DMG_06_CitizenshipStatusCode_ID": null,
                            "DMG_07_CountryCode_ID": null,
                            "DMG_08_BasisOfVerificationCode_ID": null,
                            "DMG_09_Quantity_R": null,
                            "DMG_10_CodeListQualifierCode_ID": null,
                            "DMG_11_IndustryCode_AN": null
                          },
                          "SubscriberName_Loop_2100D": {
                            "SubscriberName": {
                              "NM1_01_EntityIdentifierCode_ID": "IL",
                              "NM1_02_EntityTypeQualifier_ID": "1",
                              "NM1_03_NameLastOrOrganizationName_AN": "SMITH",
                              "NM1_04_NameFirst_AN": "FRED",
                              "NM1_05_NameMiddle_AN": null,
                              "NM1_06_NamePrefix_AN": null,
                              "NM1_07_NameSuffix_AN": null,
                              "NM1_08_IdentificationCodeQualifier_ID": "MI",
                              "NM1_09_IdentificationCode_AN": "123456789A",
                              "NM1_10_EntityRelationshipCode_ID": null,
                              "NM1_11_EntityIdentifierCode_ID": null,
                              "NM1_12_NameLastOrOrganizationName_AN": null
                            }
                          },
                          "ClaimStatusTrackingNumber_Loop_2200D": [
                            {
                              "ClaimStatusTrackingNumber": {
                                "TRN_01_TraceTypeCode_ID": "1",
                                "TRN_02_ReferenceIdentification_AN": "ABCXYZ1",
                                "TRN_03_OriginatingCompanyIdentifier_AN": null,
                                "TRN_04_ReferenceIdentification_AN": null
                              },
                              "PayerClaimControlNumber": {
                                "REF_01_ReferenceIdentificationQualifier_ID": "BLT",
                                "REF_02_ReferenceIdentification_AN": "111",
                                "REF_03_Description_AN": null,
                                "REF_04_ReferenceIdentifier": null
                              },
                              "InstitutionalBillTypeIdentification": {
                                "REF_01_ReferenceIdentificationQualifier_ID": "EJ",
                                "REF_02_ReferenceIdentification_AN": "SM123456",
                                "REF_03_Description_AN": null,
                                "REF_04_ReferenceIdentifier": null
                              },
                              "ApplicationOrLocationSystemIdentifier": null,
                              "GroupNumber": null,
                              "PatientControlNumber": null,
                              "PharmacyPrescriptionNumber": null,
                              "ClaimIdentificationNumberForClearinghousesAndOtherTransmissionIntermediaries": null,
                              "ClaimSubmittedCharges": {
                                "AMT_01_AmountQualifierCode_ID": "T3",
                                "AMT_02_MonetaryAmount_R": "8513.88",
                                "AMT_03_CreditDebitFlagCode_ID": null
                              },
                              "ClaimServiceDate": {
                                "DTP_01_DateTimeQualifier_ID": "472",
                                "DTP_02_DateTimePeriodFormatQualifier_ID": "RD8",
                                "DTP_03_DateTimePeriod_AN": "20050831-20050906"
                              },
                              "ServiceLineInformation_Loop_2210D": [
                                {
                                  "ServiceLineInformation": null,
                                  "ServiceLineItemIdentification": null,
                                  "ServiceLineDate": null
                                }
                              ]
                            }
                          ]
                        },
                        {
                          "SubscriberLevel": {
                            "HL_01_HierarchicalIDNumber_AN": "5",
                            "HL_02_HierarchicalParentIDNumber_AN": "3",
                            "HL_03_HierarchicalLevelCode_ID": "22",
                            "HL_04_HierarchicalChildCode_ID": "0"
                          },
                          "SubscriberDemographicInformation": {
                            "DMG_01_DateTimePeriodFormatQualifier_ID": "D8",
                            "DMG_02_DateTimePeriod_AN": "19301115",
                            "DMG_03_GenderCode_ID": "F",
                            "DMG_04_MaritalStatusCode_ID": null,
                            "DMG_05_CompositeRaceOrEthnicityInformation": null,
                            "DMG_06_CitizenshipStatusCode_ID": null,
                            "DMG_07_CountryCode_ID": null,
                            "DMG_08_BasisOfVerificationCode_ID": null,
                            "DMG_09_Quantity_R": null,
                            "DMG_10_CodeListQualifierCode_ID": null,
                            "DMG_11_IndustryCode_AN": null
                          },
                          "SubscriberName_Loop_2100D": {
                            "SubscriberName": {
                              "NM1_01_EntityIdentifierCode_ID": "IL",
                              "NM1_02_EntityTypeQualifier_ID": "1",
                              "NM1_03_NameLastOrOrganizationName_AN": "JONES",
                              "NM1_04_NameFirst_AN": "MARY",
                              "NM1_05_NameMiddle_AN": null,
                              "NM1_06_NamePrefix_AN": null,
                              "NM1_07_NameSuffix_AN": null,
                              "NM1_08_IdentificationCodeQualifier_ID": "MI",
                              "NM1_09_IdentificationCode_AN": "234567890A",
                              "NM1_10_EntityRelationshipCode_ID": null,
                              "NM1_11_EntityIdentifierCode_ID": null,
                              "NM1_12_NameLastOrOrganizationName_AN": null
                            }
                          },
                          "ClaimStatusTrackingNumber_Loop_2200D": [
                            {
                              "ClaimStatusTrackingNumber": {
                                "TRN_01_TraceTypeCode_ID": "1",
                                "TRN_02_ReferenceIdentification_AN": "ABCXYZ2",
                                "TRN_03_OriginatingCompanyIdentifier_AN": null,
                                "TRN_04_ReferenceIdentification_AN": null
                              },
                              "PayerClaimControlNumber": {
                                "REF_01_ReferenceIdentificationQualifier_ID": "BLT",
                                "REF_02_ReferenceIdentification_AN": "111",
                                "REF_03_Description_AN": null,
                                "REF_04_ReferenceIdentifier": null
                              },
                              "InstitutionalBillTypeIdentification": {
                                "REF_01_ReferenceIdentificationQualifier_ID": "EJ",
                                "REF_02_ReferenceIdentification_AN": "JO234567",
                                "REF_03_Description_AN": null,
                                "REF_04_ReferenceIdentifier": null
                              },
                              "ApplicationOrLocationSystemIdentifier": null,
                              "GroupNumber": null,
                              "PatientControlNumber": null,
                              "PharmacyPrescriptionNumber": null,
                              "ClaimIdentificationNumberForClearinghousesAndOtherTransmissionIntermediaries": null,
                              "ClaimSubmittedCharges": {
                                "AMT_01_AmountQualifierCode_ID": "T3",
                                "AMT_02_MonetaryAmount_R": "7599",
                                "AMT_03_CreditDebitFlagCode_ID": null
                              },
                              "ClaimServiceDate": {
                                "DTP_01_DateTimeQualifier_ID": "472",
                                "DTP_02_DateTimePeriodFormatQualifier_ID": "RD8",
                                "DTP_03_DateTimePeriod_AN": "20050731-20050809"
                              },
                              "ServiceLineInformation_Loop_2210D": [
                                {
                                  "ServiceLineInformation": null,
                                  "ServiceLineItemIdentification": null,
                                  "ServiceLineDate": null
                                }
                              ]
                            }
                          ]
                        }
                      ],
                      "DependentLevel_Loop_2000E": [
                        {
                          "DependentLevel": null,
                          "DependentDemographicInformation": null,
                          "DependentName_Loop_2100E": {
                            "DependentName": null
                          },
                          "ClaimStatusTrackingNumber_Loop_2200E": [
                            {
                              "ClaimStatusTrackingNumber": null,
                              "PayerClaimControlNumber": null,
                              "InstitutionalBillTypeIdentification": null,
                              "ApplicationOrLocationSystemIdentifier": null,
                              "GroupNumber": null,
                              "PatientControlNumber": null,
                              "PharmacyPrescriptionNumber": null,
                              "ClaimIdentificationNumberForClearinghousesAndOtherTransmissionIntermediaries": null,
                              "ClaimSubmittedCharges": null,
                              "ClaimServiceDate": null,
                              "ServiceLineInformation_Loop_2210E": [
                                {
                                  "ServiceLineInformation": null,
                                  "ServiceLineItemIdentification": null,
                                  "ServiceLineDate": null
                                }
                              ]
                            }
                          ]
                        }
                      ]
                    },
                    {
                      "ServiceProviderLevel": {
                        "HL_01_HierarchicalIDNumber_AN": "6",
                        "HL_02_HierarchicalParentIDNumber_AN": "2",
                        "HL_03_HierarchicalLevelCode_ID": "19",
                        "HL_04_HierarchicalChildCode_ID": "1"
                      },
                      "ProviderName_Loop_2100C": [
                        {
                          "ProviderName": {
                            "NM1_01_EntityIdentifierCode_ID": "1P",
                            "NM1_02_EntityTypeQualifier_ID": "2",
                            "NM1_03_NameLastOrOrganizationName_AN": "HOME HOSPITAL PHYSICIANS",
                            "NM1_04_NameFirst_AN": null,
                            "NM1_05_NameMiddle_AN": null,
                            "NM1_06_NamePrefix_AN": null,
                            "NM1_07_NameSuffix_AN": null,
                            "NM1_08_IdentificationCodeQualifier_ID": "XX",
                            "NM1_09_IdentificationCode_AN": "1666666666",
                            "NM1_10_EntityRelationshipCode_ID": null,
                            "NM1_11_EntityIdentifierCode_ID": null,
                            "NM1_12_NameLastOrOrganizationName_AN": null
                          }
                        }
                      ],
                      "SubscriberLevel_Loop_2000D": [
                        {
                          "SubscriberLevel": {
                            "HL_01_HierarchicalIDNumber_AN": "7",
                            "HL_02_HierarchicalParentIDNumber_AN": "6",
                            "HL_03_HierarchicalLevelCode_ID": "22",
                            "HL_04_HierarchicalChildCode_ID": "1"
                          },
                          "SubscriberDemographicInformation": null,
                          "SubscriberName_Loop_2100D": {
                            "SubscriberName": {
                              "NM1_01_EntityIdentifierCode_ID": "IL",
                              "NM1_02_EntityTypeQualifier_ID": "1",
                              "NM1_03_NameLastOrOrganizationName_AN": "MANN",
                              "NM1_04_NameFirst_AN": "JOHN",
                              "NM1_05_NameMiddle_AN": null,
                              "NM1_06_NamePrefix_AN": null,
                              "NM1_07_NameSuffix_AN": null,
                              "NM1_08_IdentificationCodeQualifier_ID": "MI",
                              "NM1_09_IdentificationCode_AN": "345678901",
                              "NM1_10_EntityRelationshipCode_ID": null,
                              "NM1_11_EntityIdentifierCode_ID": null,
                              "NM1_12_NameLastOrOrganizationName_AN": null
                            }
                          },
                          "ClaimStatusTrackingNumber_Loop_2200D": [
                            {
                              "ClaimStatusTrackingNumber": null,
                              "PayerClaimControlNumber": null,
                              "InstitutionalBillTypeIdentification": null,
                              "ApplicationOrLocationSystemIdentifier": null,
                              "GroupNumber": null,
                              "PatientControlNumber": null,
                              "PharmacyPrescriptionNumber": null,
                              "ClaimIdentificationNumberForClearinghousesAndOtherTransmissionIntermediaries": null,
                              "ClaimSubmittedCharges": null,
                              "ClaimServiceDate": null,
                              "ServiceLineInformation_Loop_2210D": [
                                {
                                  "ServiceLineInformation": null,
                                  "ServiceLineItemIdentification": null,
                                  "ServiceLineDate": null
                                }
                              ]
                            }
                          ]
                        }
                      ],
                      "DependentLevel_Loop_2000E": [
                        {
                          "DependentLevel": {
                            "HL_01_HierarchicalIDNumber_AN": "8",
                            "HL_02_HierarchicalParentIDNumber_AN": "7",
                            "HL_03_HierarchicalLevelCode_ID": "23",
                            "HL_04_HierarchicalChildCode_ID": null
                          },
                          "DependentDemographicInformation": {
                            "DMG_01_DateTimePeriodFormatQualifier_ID": "D8",
                            "DMG_02_DateTimePeriod_AN": "19951101",
                            "DMG_03_GenderCode_ID": "M",
                            "DMG_04_MaritalStatusCode_ID": null,
                            "DMG_05_CompositeRaceOrEthnicityInformation": null,
                            "DMG_06_CitizenshipStatusCode_ID": null,
                            "DMG_07_CountryCode_ID": null,
                            "DMG_08_BasisOfVerificationCode_ID": null,
                            "DMG_09_Quantity_R": null,
                            "DMG_10_CodeListQualifierCode_ID": null,
                            "DMG_11_IndustryCode_AN": null
                          },
                          "DependentName_Loop_2100E": {
                            "DependentName": {
                              "NM1_01_EntityIdentifierCode_ID": "QC",
                              "NM1_02_EntityTypeQualifier_ID": "1",
                              "NM1_03_NameLastOrOrganizationName_AN": "MANN",
                              "NM1_04_NameFirst_AN": "JOSEPH",
                              "NM1_05_NameMiddle_AN": null,
                              "NM1_06_NamePrefix_AN": null,
                              "NM1_07_NameSuffix_AN": null,
                              "NM1_08_IdentificationCodeQualifier_ID": null,
                              "NM1_09_IdentificationCode_AN": null,
                              "NM1_10_EntityRelationshipCode_ID": null,
                              "NM1_11_EntityIdentifierCode_ID": null,
                              "NM1_12_NameLastOrOrganizationName_AN": null
                            }
                          },
                          "ClaimStatusTrackingNumber_Loop_2200E": [
                            {
                              "ClaimStatusTrackingNumber": {
                                "TRN_01_TraceTypeCode_ID": "1",
                                "TRN_02_ReferenceIdentification_AN": "ABCXYZ3",
                                "TRN_03_OriginatingCompanyIdentifier_AN": null,
                                "TRN_04_ReferenceIdentification_AN": null
                              },
                              "PayerClaimControlNumber": {
                                "REF_01_ReferenceIdentificationQualifier_ID": "EJ",
                                "REF_02_ReferenceIdentification_AN": "MA345678",
                                "REF_03_Description_AN": null,
                                "REF_04_ReferenceIdentifier": null
                              },
                              "InstitutionalBillTypeIdentification": null,
                              "ApplicationOrLocationSystemIdentifier": null,
                              "GroupNumber": null,
                              "PatientControlNumber": null,
                              "PharmacyPrescriptionNumber": null,
                              "ClaimIdentificationNumberForClearinghousesAndOtherTransmissionIntermediaries": null,
                              "ClaimSubmittedCharges": null,
                              "ClaimServiceDate": null,
                              "ServiceLineInformation_Loop_2210E": [
                                {
                                  "ServiceLineInformation": {
                                    "SVC_01_CompositeMedicalProcedureIdentifier": {
                                      "C003_01_ProductServiceIDQualifier_ID": "HC",
                                      "C003_02_ProductServiceID_AN": "99203",
                                      "C003_03_ProcedureModifier_AN": null,
                                      "C003_04_ProcedureModifier_AN": null,
                                      "C003_05_ProcedureModifier_AN": null,
                                      "C003_06_ProcedureModifier_AN": null,
                                      "C003_07_Description_AN": null,
                                      "C003_08_ProductServiceID_AN": null
                                    },
                                    "SVC_02_MonetaryAmount_R": "150",
                                    "SVC_03_MonetaryAmount_R": null,
                                    "SVC_04_ProductServiceId_AN": null,
                                    "SVC_05_Quantity_R": null,
                                    "SVC_06_CompositeMedicalProcedureIdentifier": null,
                                    "SVC_07_Quantity_R": "1"
                                  },
                                  "ServiceLineItemIdentification": null,
                                  "ServiceLineDate": {
                                    "DTP_01_DateTimeQualifier_ID": "472",
                                    "DTP_02_DateTimePeriodFormatQualifier_ID": "D8",
                                    "DTP_03_DateTimePeriod_AN": "20050501"
                                  }
                                }
                              ]
                            }
                          ]
                        }
                      ]
                    }
                  ]
                }
              ]
            }
          ],
          "TransactionSetTrailer": {
            "SE_01_NumberOfIncludedSegments_N": "36",
            "SE_02_TransactionSetControlNumber_AN": "0001"
          }
        }
      ],
      "FunctionalGroupTrailerSegment": {
        "GE_01_NumberOfTransactionSetsIncluded_N": "1",
        "GE_02_GroupControlNumber_N": "002"
      }
    }
  ],
  "InterchangeControlTrailerSegment": {
    "IEA_01_NumberOfIncludedFunctionalGroups_N": "1",
    "IEA_02_InterchangeControlNumber_N": "000000001"
  }
}

Sample response

EDI 276 Copy

ISA*00*          *00*          *ZZ*SUBMITTERS ID  *ZZ*RECEIVERS ID   *220412*1253*^*00501*000000001*0*P*:~GS*HS*SENDER CODE*RECEIVER CODE*20220412*1513*002*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*1666666661~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*1666666666~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*002~IEA*1*000000001~

Healthcare EDIs

EDI 270 ^SJ (Patient Eligibility Request)

EDI 271 ^SJ (Patient Eligibility Request)

EDI 276 (Claim Status Request)

EDI 277 (Claim Status Response)

EDI 834 (Patient Enrollment)

EDI 835 ^SJ (Claim Payment and Advice)

EDI 837 (Claims)

Acknowledgment EDIs

EDI 997 ^SJ (Functional Acknowledgment)

EDI 999 ^SJ (Implementation Acknowledgment)

Freight and Shipping EDIs

EDI 404 (Rail Carrier Shipment Information)

EDI 410 (Rail Carrier Freight Details and Invoice)