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EDI 500

EDI 500 Medical Event Reporting:

EDI 500 Format:

ISA*00*          *00*          *01*1234567890     *01*999999999      *120126*1211*U*00401*000000165*0*P*\
GS*MM*1234567890     *999999999      *20120126*1211*1*T*004010
ST*500*0001
BGN*00*Reference Identification*20120224*1653*01*Reference Identification*01*1*00
NM1*01*1*Name Last or Organization Name*Name First*Name Middle*Name Prefi*Name Suffi*1*Identification Code*01*01
N2*Name*Name
N3*Address Information*Address Information
N3*Address Information*Address Information
N4*City Name*ST*POSTAL CODE*COU*A*Location Identifier
REF*01*Reference Identification*Description*01\Reference Identification\01\Reference Identification\01\Reference Identification
PER*1A*Name*AA*Communication Number*AA*Communication Number*AA*Communication Number*Contact Inquiry Refe
DTM*001*20120224*1653*01*CC*Date Time Period
QTY*01*338*01\2356335\19201\01\285811528424098\1\01\12954\323042961\01\13395632\3853\01\3023329193254\2
TRN*1*Reference Identification*Originatin*Reference Identification
LM*10*Source Subquali
LQ*0*Industry Code
HL*1**1*0
LM*10*Source Subquali
LQ*0*Industry Code
DTM*001*20120224*1653200*01*CC*Date Time Period
REF*01*Reference Identification*Description*01\Reference Identification\01\Reference Identification\01\Reference Identification
QTY*01*2267278*01\2260603\15\01\1872347917\18691154\01\86633874238\175591839\01\207542\21857\01\102747856111\226891
MTX*AAA*Message Text*Message Text*AA
LIN*Assigned Identificat*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID
PID*F*01*10*Product Desc*Description*1S*Source Subquali*N*LAN
QTY*01*124654*01\18544461532399\272422056\01\13031733523\28941\01\703729949666032\7763313\01\2\271\01\12\876
DTM*001*20120224*1653*01*CC*Date Time Period
REF*01*Reference Identification*Description*01\Reference Identification\01\Reference Identification\01\Reference Identification
MEA*9L*1*3228614419*01\2783023\377048\01\1897209\16616\01\3275962802615\82686\01\6566167397\2001022\01\809\1*3001922*232841920162*01**1S*BM
TRN*1*Reference Identification*Originatin*Reference Identification
MTX*AAA*Message Text*Message Text*AA
NM1*01*1*Name Last or Organization Name*Name First*Name Middle*Name Prefi*Name Suffi*1*Identification Code*01*01
N2*Name*Name
N3*Address Information*Address Information
N4*City Name*ST*POSTAL CODE*COU*A*Location Identifier
REF*01*Reference Identification*Description*01\Reference Identification\01\Reference Identification\01\Reference Identification
PER*1A*Name*AA*Communication Number*AA*Communication Number*AA*Communication Number*Contact Inquiry Refe
DTM*001*20120224*1653200*01*CC*Date Time Period
DMG*CC*Date Time Period*A*A*7*1*COU*1*26502
MEA*9L*1*2182276832*01\553\474857012\01\78\68\01\5219126547\1063225173\01\86\3255\01\3222\15242306*28081*26237270481401317836*01**1S*BM
PWK*01*1*6*01*1*Identification Code*Description*1\1\1\1\1*AR
TRN*1*Reference Identification*Originatin*Reference Identification
QTY*01*7713418*01\24\23\01\1802824\1459517287\01\273\31\01\1562611784\246741714\01\90112\4
LM*10*Source Subquali
LQ*0*Industry Code
PID*F*01*10*Product Desc*Description*1S*Source Subquali*N*LAN
DTM*001*20120224*16532100*01*CC*Date Time Period
QTY*01*2881116*01\3220519\2\01\264912\20315591\01\23988\17\01\28243179\2657772763\01\1127126\1683495951
MTX*AAA*Message Text*Message Text*AA
DTM*001*20120224*165321*01*CC*Date Time Period
CTT*214129*456275*85191521*01*7267276*01*Description
SE*50*0001
GE*1*1
IEA*1*000000165

EDI 500 Specification:

This X12 Transaction Set contains the format and establishes the data contents of the Medical Event Reporting Transaction Set (500) for use within the context of an Electronic Data Interchange (EDI) environment. This standard can be used to make voluntary, mandatory, baseline, annual and semi-annual reports on medication and medical device adverse effects and product problems.

Sources
Accredited Standards Committee X12. ASC X12 Standard [Table Data].
Data Interchange Standards Association, Inc., Falls Church, VA.


Page Title: Learn about the EDI 500 Medical Event Reporting