X12 5010 EDI to FHIR R4 Transformation

X12 to FHIR Converter

Transform X12 5010 EDI transactions to validated FHIR R4 bundles. Full support for claims, remittance, eligibility, and prior authorization.

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// Convert X12 to FHIR
var result = await Interop
    .X12ToFhirAsync(x12Edi);

// Or with CMS-0057-F compliance
var result = await Interop
    .X12ToFhirAsync(x12Edi,
        OutputFormat.Cms0057F);
Full EDI Coverage

13 X12 5010 Transaction Types

Complete support for healthcare claims and administrative transactions

837P/I/D Claims

Professional, Institutional, Dental

Converts to FHIR Claim resource with CARIN Blue Button profiles

835 Remittance

Payment/Remittance Advice

Converts to ExplanationOfBenefit with payment details

834 Enrollment

Benefit Enrollment

Converts to Coverage and Patient resources

270/271 Eligibility

Eligibility Inquiry/Response

CoverageEligibilityRequest/Response

276/277 Claim Status

Claim Status Request/Response

Converts to ClaimResponse resource

278 Prior Auth

Prior Authorization

Da Vinci PAS 2.0.1 compliant

Also supports: 820 (Payment Order), 275 (Attachments), 277CA (Claims Acknowledgment)

Compliance Ready

CMS-0057-F & CARIN Compliant

Validated against official HL7 FHIR Implementation Guides

CMS-0057-F Compliance

  • Da Vinci PAS 2.0.1 for prior authorization
  • CARIN Blue Button 2.1.0 for claims
  • PDex Provenance tracking
  • Auto-profile selection by transaction type

FHIR Resources Generated

  • Claim (carin-bb-claim)
  • ExplanationOfBenefit (carin-bb-eob)
  • Coverage, Patient, Organization
  • CoverageEligibilityRequest/Response
FAQ

Frequently Asked Questions

InteropSuite supports 13 X12 5010 transaction types: 837P/I/D (claims), 835 (remittance), 834 (enrollment), 270/271 (eligibility), 276/277 (claim status), 278 (prior authorization), 820 (payment), and 275 (attachments).

Yes. InteropSuite supports CMS-0057-F compliance with Da Vinci PAS 2.0.1 profiles for prior authorization (278) and CARIN Blue Button 2.1.0 profiles for claims (837) and remittance (835). Use the OutputFormat.Cms0057F option to enable compliance mode.

X12 835 remittance advice transactions are converted to FHIR ExplanationOfBenefit resources following the CARIN Blue Button 2.1.0 profile. This includes payment information, adjustments, service line details, and payer/payee information.

Yes. InteropSuite automatically detects transaction boundaries (HL loops, TRN segments, BPR segments) and generates separate FHIR bundles for each transaction. One X12 file with 100 claims produces 100 separate FHIR bundles.

X12 837 hierarchical loops (HL) map to FHIR Claim resources: 2000A (billing provider) maps to Claim.provider, 2000B (subscriber) maps to Claim.patient and Coverage, 2300 (claim) maps to Claim details, and 2400 (service lines) map to Claim.item. All resources follow CARIN Blue Button profiles.

The Claims product converts X12 to US Core 6.1.0 profiles suitable for general interoperability. The CMS-0057-F product adds Da Vinci PAS, CARIN Blue Button, and PDex profile compliance required for payers under the CMS Interoperability and Prior Authorization final rule.

X12 835 segments map to FHIR ExplanationOfBenefit: BPR (payment info) maps to payment amount and method, CLP (claim level) maps to total amounts, SVC (service lines) map to item.adjudication, and CAS (adjustments) map to item.adjudication.reason. Provider and patient info populates related resources.

Yes. InteropSuite processes all data 100% offline on your infrastructure. No PHI is transmitted externally. The solution includes AES-256-GCM encryption for quarantined data and complete audit logging for HIPAA compliance documentation.

Yes. X12 278 prior authorization transactions are converted to FHIR Claim and ClaimResponse resources following the Da Vinci Prior Authorization Support (PAS) 2.0.1 Implementation Guide, meeting CMS-0057-F requirements for payer systems.

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Related Resources

X12 Documentation

Technical details on X12 5010 transaction transformation

Sample FHIR Outputs

View example FHIR bundles from X12 sources

Compliance Information

CMS-0057-F and regulatory compliance