ASC X12 Insurance Subcommittee

Upward/Downward Compatibility
Introductory White Paper


As companies and industries decide to implement technologies or 
contemplate any new endeavor they are confronted with the question of 
"Where to begin?".  This is also true when a business or industry 
decides to implement Electronic Data Interchange (EDI).  There are 
many key elements in an EDI Initiative including but not limited to 
Translation Software, Telecommunications, Implementation Guides, 
Testing, Version Control and Education.  These key components can be 
implemented independently or in conjunction with one another,  
depending on the business need.  Hence, the determination of  
business needs and requirements must be the first task in an EDI 
initiative.  This analysis must assess the current environment as 
well as those that are anticipated or projected to support business 
goals and objectives.  Once this analysis is completed,  any or all 
of the key components can be implemented consistent with the business 
need.   Too often the determination of business needs and 
requirements is overlooked by organizations formulating an EDI 
initiative.  However, this analysis must be the first task.  EDI is 
not just a technical (information system) function but a total 
business process.  A critical factor in the success of any EDI/EC 
initiative is the level of commitment from executive management.   
The connection between the key components of an EDI Initiative can be 
depicted as: 

As illustrated,  each spoke of the wheel represents a key component 
of an EDI initiative.  As EDI evolves other spokes may be added to 
the wheel.  It is envisioned that this wheel will takes us down the 
information highway.

This executive summary is a compendium of  the six key components of 
an EDI Initiative ---  Translation Software, Telecommunications, 
Implementation Guides, Testing, Version Control and Education.  White 
Papers were developed and each subject  is discussed in the 
respective titled area.  The scope of the respective white papers as 
well as their relationship to the overall EDI Initiative is reviewed 


 The primary objective of EDI translation software is to convert ASC 
X12 formats from/ to application formats for integration into an 
application system or business process.  The scope of this white 
paper is to address issues relative to EDI translation software and 
provide insight to the selection/ formulation process of EDI 
translation software for ASC X12 standards.  An example of forms 
utilized in an  Evaluation Process for EDI Translation Software as 
well as the Health Care Industry Guidelines for EDI Translation 
Software are included. 

 Mapping is one of the key functions of translation software.   
Implementation Guides provide insight into the "mapping" from/ to the 
standards from/ to the application formats.  Testing of the standard 
(transaction) occurs after the transaction has been created by the 
translation software.  The transport or the exchange of 
information/data using the X12 standards created from EDI translation 
software is accomplished through Telecommunications.   Version 
Control is particularly significant to translation software since the 
software  must accommodate updates/ release of  the transactions.  
Most vendors of translation software provide formal training sessions 
on their product.


Telecommunications relative to EDI is the transmission or  electronic 
exchange of data between business (trading) partners.  The scope of 
this white paper is to address telecommunications from a business 
perspective relative to the establishment of a facility for  inter-
company exchange of information and the deployment of EDI/ EC in an 
industry.  This paper does not address telecommunications from a 
technical perspective but is cognizant of the technical issues as 
they relate to the business. 

Telecommunications augments the exchange process by being the 
transport mechanism for  the  translated information.  Since major 
portions of the testing process require the exchange of information 
between business partners,  validation of the telecommunication 
facility is a pre-requisite to testing.   Implementation guides 
provide an overview of the entire information exchange process.  They  
address telecommunications from the perspective that the exchange of 
information is subsequent to (outbound transactions)  or  prior to 
(inbound transactions) the translation process. 


The purpose of Implementation Guides relative to transaction sets is 
to convey the intent or use of a transaction pertaining to a business 
scenario(s).  Implementation guides should be version/ release/ 
subrelease specific.  The scope of this white paper is to outline the 
use of implementation guides as a necessary tool for rapid mass 
deployment of standard X12 transaction sets.

Implementation guides become of significant use after the translation 
software is installed and a transaction is ready to be used in a 
business scenario.  An implementation guide provides an overview of 
the entire information exchange process and addresses, in general 
terms,  functions included in telecommunications,  testing,  version 
control and translation software phases.


By definition, a test is a means of examination, trial or proof.  The 
scope of this white paper is to address issues relative to the 
testing of X12 transactions in various scenarios consistent with 
projected use.  Recommendations that best address these issues are 
explored.  An example of formal testing procedures is provided in the 

Testing commences when the information is exchanged and translation 
is completed.  Telecommunication facilities are necessary to either 
retrieve or send information during the testing process.  
Implementation guides provide an overview of the entire information 
exchange process and may also address the testing process for  the 
transaction.  Testing must occur with each update or modification and 
must be addressed in Version Control.


Version Control, relative to EDI,  addresses the management of the 
migration of a business environment from one version/ release of a 
transaction to a subsequent version/ release of the transaction.   
The scope of this white paper is to address version control relative 
to the development of ASC X12 transactions via the X12  process 
especially to support mass deployment of transactions.

Translation software must be able to accommodate the new releases/ 
versions of the transactions within a reasonable period of time.  
Testing is of particular significance since new versions/ releases of 
transactions require a trial period of use prior to implementation.  
Typically implementation guides will correspond to a specific 
version/ release of a transaction and are issued in conjunction with 
the release.


Education concerning EDI must recognize the learning curve involved 
in evolving from a novice EDI user to a fluent EDI user.   The scope 
of this white paper is to address educational EDI issues relative to 
the migration of a business function to the electronic information 
age in the exchange of information among business partners.

Within an EDI initiative,  education must be provided in the overall 
EDI process including  translation, telecommunications, versions/ 
releases and the nuances of testing in an EDI environment.  
Additional education should be targeted toward  the understanding and 
use of specific transaction sets.  Implementation guides should 
augment training that has occurred.  The guides may contain or 
reference an EDI business primer.  This primer should be industry  
specific and address basic EDI concepts.

A time line graphically illustrating the recommendations stipulated 
in the Implementation Guide, Version Control and Testing White Papers 

To reiterate, the following white papers can be used as "Snap Outs" 
or  in conjunction with one another.  Additionally, EDI often serves 
as a catalyst for the seamless processing of information.  Seamless 
processing strives to eliminate manual intervention in the processing 
of data at both partnership sites.  The electronic interchange of 
data serves as a catalyst to "automatically" and "electronically" 
initiate the processing of transmitted data at the receiver's site.  
Through seamless processing, data enters the system electronically.  
Clean data is processed automatically and in it's entirety.  Data in 
error is either corrected through expert systems or through manual 
intervention.  For error-free data,  there is no manual intervention.  
Seamless processing will result from business process re-engineering 
and system re-tooling.  Corporations that properly  couple EDI/ EC 
with business process reengineering can fully realize the maximum 
benefits from their EDI/ EC initiative. 

Comments and suggestions regarding all or any of the White Papers are 
encouraged.  Questions regarding specific information in any of the 
White Papers or other implementation issues can be directed to any of 
the individuals listed below.

Debra T. Obringer       Barbara Redding         Bruce Horn
Veritus Inc.                    HCFA/BPO OPOP DPP               The Associated 
Fifth Ave. Place                LOC 1-H-3 Meadows East          6802 Hillsdale 
Suite 621                       6325 Security Blvd.                     Indianapolis, IN 
Pittsburgh, PA 15222    Baltimore, MD 21207             (317) 692-6154
(412) 255-3111          (410) 966-6155                  (317) 692-6205 fax
(412) 255-5360 fax              (410) 966-5327 fax
EC/ EDI Initiative