EDI Generator

https://github.com/cadenshokat/EDI-Generator

This project is a simple Electronic Data Interchange (EDI) message generator for healthcare billing. It generates paired 837 (claim) and 835 (payment) messages based on randomized inputs. The generated files are stored in a designated output folder and can be used for testing or educational purposes.

• Here are links to the official 835/837 formats with descriptions of each field for better understanding:
  • 835 - https://datainsight.health/edi/payments/comprehensive/
  • 837 - https://datainsight.health/edi/claims/comprehensive/

Overview

How It Works

• Name Loading:
  The script reads lists of male, female, and surname names from text files (located in ../names-surnames-list/) to randomly generate patient names.

• Random Data Generation:
  It selects random insurance information, provider details, service dates, claim amounts, and payment amounts using helper functions.

  • Insurance and provider data are pulled from dictionaries defined in constants.py.
  • Dates, times, and claim numbers are generated randomly to simulate realistic data.

• EDI Message Creation:
  Two main types of EDI messages are created:

  • 837 Message: Contains the claim details including patient and provider information.
  • 835 Message: Contains payment information along with service line details and adjustments.

  The generation functions build segments according to a simplified structure of the 837/835 standards. The segments include ISA, GS, ST, and additional segments specific to claim and payment information.

• Output:
  Change the NUM_MESSAGES variable to output the desired amount of 835/837 files. Generated EDI files are saved in the output directory (../edi_messages). The script creates this directory if it does not already exist.

Main Files

• edi_generator.py:
  The primary script that contains all the logic to generate the 837 and 835 messages. It:

  • Loads names from external text files.
  • Generates random data for claims and payments.
  • Writes the generated EDI messages into separate files in the output directory.

• constants.py:
  Contains dictionaries with pre-defined data:

  • Insurance Payers: Expanded details for various insurance companies.
  • Provider NPIs: Details of healthcare providers including their NPIs and addresses.
  • Adjustment Codes: A list of adjustment groups and their respective reason codes used in EDI adjustments.

How to Run the Project

Prerequisites

• Python:
  Ensure that Python (version 3.x) is installed on your computer.

• Text Files:
  Make sure the following files (or similar ones) exist in the expected directories:

  • ../names-surnames-list/male-names-list.txt
  • ../names-surnames-list/female-names-list.txt
  • ../names-surnames-list/surnames-list.txt

  These files are used to generate random patient names.

• edi_messages:
  The edi_messages directory is included in the repository for display purposes. Delete this directory after cloning/downloading this repository and before running your code. If it is not deleted, it may cause confusion within the code.

Running the Script

This guide explains how to clone or download the EDI Generator project for users of all experience levels.

For Beginners: Downloading the Project Without Git

If you’re not familiar with Git or prefer not to use it, follow these steps:

1. Locate the Repository:

   • Open your web browser and navigate to the project's GitHub page (or the hosting site where the repository is available).

2. Download as a ZIP:

   • Look for a button or link labeled “Code” or “Download.”
   • Click on Download ZIP. This will download the entire project as a compressed ZIP file.

3. Extract the Files:

   • Once downloaded, locate the ZIP file on your computer.
   • Right-click the file and select “Extract All…” (Windows) or use your preferred extraction tool (macOS/Linux).
   • Ensure that the extracted directory retains the correct structure:
     • The main folder should contain edi_generator.py, constants.py, and a folder (e.g., names-surnames-list) with the required text files.

For Intermediate to Advanced Users: Using Git to Clone the Repository

If you have Git installed, cloning the repository is quick and allows you to easily update your local copy with future changes:

1. Verify Git Installation:

   • Open your terminal (Command Prompt, PowerShell, or any shell on Linux/macOS).
   • Run the command:

     git --version

   • If Git is installed, you should see the version number. If not, download and install Git from git-scm.com.

2. Clone the Repository:

   • Navigate to the directory where you want to store the project. For example:

     cd ~/projects

   • Use the git clone command along with the repository URL. For example:

     git clone https://github.com/yourusername/edi-generator.git

   • This command creates a folder named edi-generator (or the repository name) containing all project files.

3. Verify the Directory Structure:

   • After cloning, change to the project directory:

     cd edi-generator

   • Ensure that files like edi_generator.py and constants.py are in the root directory, and that the names-surnames-list folder is present with the necessary text files.

Run the code

Regardless of the cloning method, make sure to:

• Check the File Structure:
  Verify that the expected directories (like ../names-surnames-list for name files) and output folders (../edi_messages) are correctly positioned relative to the main script.

  If the output directory exists from a previous run, consider deleting it before running the script to avoid conflicts.

• Read the Documentation:
  Review any README or documentation files included in the repository to understand dependencies, configuration options, or additional setup steps.

• Run the Project:
  Open a terminal in the project directory and execute:

  python edi_generator.py