PHP Library for creating EDI X12 ANSI 837 File 5010 Version
A Simple PHP function for creating an EDI X12 ANSI 837 file version 005010X222A1
$res[] = [
'x12_sender_id' => '123456' ## Federal Tax ID
,'x12_reciever_id' => '123456' ## Wharehouse Federal Tax ID not changable
,'x12_version' => '005010X222A1'
,'transcode' => '03' // you can put unique value here
,'batch_number' => '4' // if you're using batch then apply this
,'group_number' => '4'
,'payer_name'=>''
,'payer_code' => ''
,'payer_street' => ''
,'payer_street2' => ''
,'payer_city' => ''
,'payer_state' => ''
,'payer_zip' => ''
,'secondary_payer_name'=>''
,'secondary_payer_code' => ''
,'secondary_payer_street' => ''
,'secondary_payer_street2' => ''
,'secondary_payer_city' => ''
,'secondary_payer_state' => ''
,'secondary_payer_zip' => ''
,'billing_provider_lastname' => ''
,'billing_provider_npi' => ''
,'billing_provider_street' => ''
,'billing_provider_street2' => ' '
,'billing_provider_city' => ''
,'billing_provider_state' =>''
,'billing_provider_zip' => ''
,'billing_provider_pin' => ''
,'billing_provider_federal_taxid' =>''//
,'subscriber_lname' => ''
,'subscriber_fname' => ''
,'subscriber_mname' => ''
,'subscriber_policy_number' => ''
,'subscriber_address' => ''
,'subscriber_address2' => ''
,'subscriber_city' =>''
,'subscriber_state' =>''
,'subscriber_zip' => ''
,'subscriber_relationship' => 'self'
,'subscriber_secondary_group_number' => ''
,'subscriber_secondary_payer_name' => ''
,'subscriber_secondary_insurance_type' => ''
,'subscriber_dob' =>''
,'subscriber_gender' =>'M'
,'ref_physician_lname' => ''
,'ref_physician_fname' => ''
,'ref_physician_mname' => ''
,'ref_physician_npi' => ''
,'referral_number' => ''
,'rendering_provider_lname' => ' '
,'rendering_provider_fname' => ''
,'rendering_provider_mname' => ''
,'rendering_provider_npi' => ''
,'facility_name' =>''
,'facility_npi' => ''
,'facility_address' =>''
,'facility_city' =>''
,'facility_state' =>'MI'
,'facility_zip' => '480736712'
,'submitter_org_name' =>''
,'submitter_tax_id' => '' ## Federal Tax ID
,'submitter_name' => ''
,'submitter_telephone' => ''
,'submitter_email' => ''
,'patient_id' => ''
,'patient_mrn' => ''
,'patient_encounter_date' => ''
,'patient_first_encounter_date' =>''
,'patient_last_visit_date' =>''
,'patient_admission_date' =>''
,'patient_discharge_date' =>''
,'patient_paid_amt' =>'0'
,'prior_auth_code' =>''
,'original_claim_number' =>'' //In case of resubmission have to pass original claim number
,'insurance_type_code' => ''
,'total_amount' => ''
,'claim_type' => '1' // 1 New Claim , 7 Re submission
,'claim_notes' => 'Sample Notes'
,'primary_problem_type_code' =>'ICD9'
,'primary_problem_code' => 'I10'
,'other_diag_list' => [
['icd_type' => 'ICD9','icd_codes' => 'D63.8']
],
'procedure_codes' => [
[ 'cpt_codes' => '99235'
,'cpt_charge' => '284'
,'code_pointer'=>'1'
,'dos' => '20170726'
,'quantity' => 1
,'facility_code'=>'21'
]
]
];
/****************** Element data seperator **************/
$eleDataSep = "*";
/****************** Segment Terminator **************/
$segTer = "~";
/****************** Component Element seperator **************/
$compEleSep = ":"; //or ^
create_x12_837_file($res,$segTer,$eleDataSep,$compEleSep);
echo "Done";
The output file generated have a valid X12 EDI ANSI 837 file , just send the file to your insurance wharehouse
If this project help you reduce time to develop, you can give me a cup of coffee :)
