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The formats your data actually arrives in

X12 transactions, HL7 messages, FHIR resources and CMS files, all usable in the same data flows.

EDI X12

Parse HIPAA X12 transactions into structured data, and generate them for your trading partners.

Enrollment and premiums

Claims and payment

Eligibility and claim status

Prior authorization

Acknowledgments and reporting

834

Benefit enrollment and maintenance

What arrives

INS*Y*18*021*28*A***FT~
NM1*IL*1*DOE*JANE~
DTP*348*D8*20270101~

What you get

Member
Jane Doe
Change
New enrollment
Coverage starts
Jan 1, 2027
820

Premium payment

What arrives

BPR*C*1250.00*C*ACH*CCP~
ENT*1**ZZ*REC001~
RMR*II*QHP001*PA*625.00~

What you get

Payment
1,250.00 USD by ACH
Policy
QHP001
Applied
625.00 USD
837P, 837I, 837D

Professional, institutional and dental claims

What arrives

CLM*CLAIM001*150***11:B:1*Y*A*Y*Y~
SV1*HC:G0008*150*UN*1***1~

What you get

Claim
CLAIM001
Billed
150.00 USD
Place of service
Office
Service
G0008, vaccine administration
835

Claim payment and remittance advice

What arrives

CLP*CLAIM001*1*150*120*30*12*PAYER001~
CAS*PR*2*30~

What you get

Claim
CLAIM001
Billed
150.00 USD
Paid
120.00 USD
Patient owes
30.00 USD, coinsurance
275

Additional information to support a claim

What arrives

TRN*1*ACN100001~
CAT*OB***LOI*28570-0~
BIN*2048*JVBERi0xLjQK...~

What you get

Attachment control
ACN100001
Document
Procedure note, LOINC 28570-0
Content
Embedded file
270 / 271

Eligibility inquiry and response

What arrives

EQ*30~
EB*1**30**GOLD PLAN~

What you get

Asked about
Health benefit coverage
Answer
Active coverage
Plan
Gold Plan
276 / 277

Claim status inquiry and response

What arrives

TRN*2*CLAIM001~
STC*A2:20*20270115*WQ*150~

What you get

Claim
CLAIM001
Status
Accepted into adjudication
As of
Jan 15, 2027
278

Prior authorization request and response

What arrives

UM*HS*I*48*11:B**1~
HCR*A1*AUTH0001~

What you get

Request
Initial health services review
Decision
Approved in full
Authorization
AUTH0001
999, TA1

Acknowledgments

What arrives

AK1*HC*1*005010X222A1~
IK5*A~
AK9*A*1*1*1~

What you get

Acknowledges
Claim file, group 1
Result
Accepted
Transactions
1 of 1 accepted
824

Application reporting

What arrives

BGN*11*REF824001*20270115~
OTI*TR*TN*REF001*PROVIDER01*PAYER001~
TED*007*Missing Data~

What you get

Report
REF824001
Result
Transaction rejected
Reason
Missing data

Sample data, shortened for display.

HL7 v2.x

Read and generate clinical and administrative messages. An MLLP listener for real-time feeds is in beta.

Patient administration and scheduling

Orders and results

Financial

ADT

Admit, discharge and transfer

What arrives

EVN|A01|202701011200
PID|1||MRN1001||DOE^JANE
PV1|1|I|4W^401^A

What you get

Patient
Jane Doe
Event
Inpatient admission
Location
Unit 4W, room 401, bed A
SIU

Scheduling

What arrives

SCH||APPT1001|||||FOLLOWUP^Follow-up
PID|1||MRN1001||DOE^JANE

What you get

Appointment
APPT1001
Reason
Follow-up
Patient
Jane Doe
ORM

Orders

What arrives

ORC|NW|ORD1001
OBR|1|ORD1001||2345-7^Glucose^LN

What you get

Order
ORD1001, new
Test
Glucose, LOINC 2345-7
ORU

Observation results

What arrives

OBR|1|ORD1001||2345-7^Glucose^LN
OBX|1|NM|2345-7^Glucose^LN||95|mg/dL|70-99|N|||F

What you get

Test
Glucose
Result
95 mg/dL, normal
Status
Final
VXU

Vaccination updates

What arrives

RXA|0|1|20270115|20270115|140^Influenza^CVX|0.5|mL

What you get

Vaccine
Influenza, CVX 140
Given
Jan 15, 2027
Dose
0.5 mL
DFT

Financial transactions

What arrives

FT1|1|||20270115||CG|G0008^Vaccine administration^HCPCS|||1

What you get

Type
Charge
Service
G0008, vaccine administration
Date
Jan 15, 2027

Sample data, shortened for display.

FHIR R4

Support for the implementation guides payers need for prior authorization and provider directories.

  • Da Vinci PAS, CRD and DTR

    The Prior Authorization API, hosted in your environment.

    See CMS-0057-F coverage

  • Da Vinci PDex

    Publish prior authorization data to your FHIR platform for member access.

  • Da Vinci Plan-Net

    Publish a public provider directory API.

  • FHIR connections

    Connect to external FHIR servers with OAuth 2.0 and SMART Backend Services.

CMS Medicare files

Ingest Medicare Advantage files from CMS, and reconcile them. Built for Medicare Advantage today. Working with Medicaid or Exchange files? Ask us.

  • MMR
  • MMRS
  • MODD
  • DTRR
  • LEPD
  • MSP
  • MCMD
  • OEC
  • COBOHI
  • LISHIST
  • LISPRMD
  • MPWRD
  • COMPRPT

Examples, not a complete list. Ask us about the files you work with.

Have a format we didn't list?

Send us the details, and we will tell you plainly whether Prismaid handles it today.

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