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TIBCO Foresight® HIPAA Validator® Desktop Standards and Guidelines Reference
Manual
31 | Supported Guidelines
Document Name
EDISIM
Non-
Addenda
Types 1-2
EDISIM
Addenda
No SVALU
Records
Types 1-2
HIPAA Validator
Desktop or
Instream
Non-Addenda
Types 1-7
HIPAA Validator
Desktop or
Instream
Addenda
No SVALU Recs
Types 1-7
GuidelinePlus
Instream only
Addenda
SVALU Recs
Types 1-7
(PDSA)/
Types 1-2
(PDSX)
PDF
(www.wpc-
edi.com)
Value in GS08
(A1 at end =
Addenda)
Notes
004010X093A1
278
Health Care Services Review Information –
Request for Review
278-A120
278AREQ
41-278RQ
41A278RQ
PDA278RQ
PDX278RQ
X094.pdf
004010X094
004010X094A1
BHT02=13
278
Health Care Services Review Information –
Response to Request for Review
278-A320
278ARES
41-278RP
41A278RP
PDA278RP
PDX278RP
X094.pdf
004010X094
004010X094A1
BHT02=11
820
Payment Order / Remittance Advice
820-A120
820AA120
4010-820
B41A820
PDSA820
PDSX820
X061.pdf
004010X061
004010X061A1
834
Benefit Enrollment and Maintenance
834-A120
834AA120
4010834
B41A834
PDSA834
PDSX834
X095.pdf
004010X095
004010X095A1
835
Health Care Claim Payment/Advice
835-W120
835AW120
4010-835
B41A835
PDSA835
PDSX835
X091.pdf
004010X091
004010X091A1
837
Health Care Claim: Professional
837-Q120
837AQ120
4010837P
B41A837P (*CCI)
PDSA837P (*CCI)
PDSX837P
X098.pdf
004010X098
004010X098A1
Uses SV1 segment
837
Health Care Claim: Dental
837-Q220
837AQ220
4010837D
B41A837D
PDSA837D
PDSX837D
X097.pdf
004010X097
004010X097A1
Uses SV3 segment
837
Health Care Claim: Institutional
837-Q320
837AQ320
4010837I
B41A837I
PDSA837I
PDSX837I
X096.pdf
004010X096
004010X096A1
Uses SV2 segment