EDI 500 Medical Event Reporting

EDI 500 Format

ISA*01*0000000000*01*0000000000*ZZ*ABCDEFGHIJKLMNO*ZZ*123456789012345*101127*1719*U*00400*000003438*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*01Reference Identification1Reference Identification1Reference 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*01235633519201128581152842409811129543230429611133956323853130233291932542 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*01Reference Identification1Reference Identification1Reference Identification QTY*01*2267278*0122606031511872347917186911541866338742381755918391207542218571102747856111226891 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*0118544461532399272422056113031733523289411703729949666032776331312271112876 DTM*001*20120224*1653*01*CC*Date Time Period REF*01*Reference Identification*Description*01Reference Identification1Reference Identification1Reference Identification MEA*9L*1*3228614419*0127830233770481189720916616132759628026158268616566167397200102218091*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*01Reference Identification1Reference Identification1Reference 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*015534748570121786815219126547106322517318632551322215242306*28081*26237270481401317836*01**1S*BM PWK*01*1*6*01*1*Identification Code*Description*11111*AR TRN*1*Reference Identification*Originatin*Reference Identification QTY*01*7713418*012423118028241459517287127331115626117842467417141901124 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*0132205192126491220315591123988171282431792657772763111271261683495951 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. http://www.x12.org