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Key X12 mapping rules

Updated on April 23, 2021

Activity rules map the X12 message into the X12 page on the clipboard. This table describes each of the activities used in mapping X12 messages (837 example).

Pega Foundation for Healthcare
Rule nameFunction
Class: PegaX12-Data-

Initial activity that starts the processing of an X12 file. This activity is called from the service rule that handles the X12 inbound interface. It reads the message in and breaks it into sub-messages, each containing a functional group (bounded by GS and GE segments). It then calls

X12ParseMessageType for each sub-message for continued processing.

X12ParseMessageTypeThis activity sets the message type and calls the X12ParseMessage activity in the appropriate class to process the message.

Writes an outbound X12 message to a file in a temp folder on the server.

This activity should be modified to customize the output location.

Class: PegaX12-Data-N837

Invokes Parse-Delimited-Rules that parse and map the 837 message into X12 segments and properties on an X12 page on the clipboard. Each Parse-Delimited-Rule parses data elements in a segment. It creates an instance of the PegaX12-Data-N837 data object and calls the following activity:

CreateHCClaimWork to map data to claim work object.

CreateHCClaimWorkPlaceholder activity, implemented in Claims Layer (PegaHCCLM).
X12GenerateProfessionalGenerates the X12 message with a single professional claim from the X12 clipboard structure.

Generates the X12 message with a single institutional claim from the X12

clipboard structure.

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