HIPAA X12 to FHIR Conversion Package
Turn the X12 your systems already produce into FHIR R4 resources, on your own servers or behind your own API. Claims, remittance, enrollment, eligibility, claim status, and prior authorization, all on the same engine that validates your X12 today.
- FHIR R4
- One-way: X12 to FHIR
- Runs on the AnyToAny Engine
CMS-0057-F: API requirements generally begin January 1, 2027; applicability and dates depend on payer type. For the 278 and Da Vinci PAS workflow, see the CMS-0057-F Compliance Suite.
Modernize EDI without replacing it
Payers, TPAs, and clearinghouses use the package to put FHIR R4 interfaces in front of existing X12 processing. Your trading partners and adjudication systems keep working; FHIR consumers get resources built from the same transactions.
What converts to what
| X12 transaction | Main FHIR R4 output | Try it |
|---|---|---|
| 837 Professional | Claim, with Patient, Coverage, Condition, Organization, Practitioner | Live demo |
| 837 Institutional | Claim, with the same supporting resources | Live demo |
| 837 Dental | Claim, with the same supporting resources | Evaluation scope |
| 835 Remittance | ClaimResponse and PaymentReconciliation | Live demo |
| 834 Enrollment | Coverage, Patient, RelatedPerson | Evaluation scope |
| 270 / 271 Eligibility | CoverageEligibilityRequest / CoverageEligibilityResponse | Evaluation scope |
| 276 / 277 Claim status | Claim / ClaimResponse | Evaluation scope |
| 278 Prior authorization | Da Vinci PAS Claim and ClaimResponse, with Provenance (source X12 transaction identifiers) | Live demo (request) |
"Live demo" transactions run on built-in synthetic samples in the X12 to FHIR tool (overview: X12 to FHIR online). For the "evaluation scope" rows, mapping assets are available for evaluation; coverage and output acceptance are confirmed against your samples before any commitment. The 820 premium payment is not part of this package.
Deterministic mapping you can inspect
Parse and check
The engine reads the X12 against the 5010 definitions, so structural problems surface before conversion.
Map through RMap
Each transaction maps to the RMap canonical model, then to FHIR R4 through editable mapping definitions.
Emit FHIR
A FHIR R4 Bundle per file. For the 278, Provenance records include the source X12 transaction identifiers for the converted bundle.
Mapping rules are repeatable for a fixed engine version and configuration; generated identifiers and timestamps differ between runs. Native C runtime; performance depends on file size, workload, and configuration.
See real input and output
Synthetic samples only; do not upload PHI. To test your own files, request an evaluation key.
See all tools · Swagger API explorer · Live Sandbox overview
No X12 278 infrastructure? The RMap Module builds Da Vinci PAS FHIR bundles from a simple tabular file, without producing X12 first.
How the package is licensed
AnyToAny Engine
Required. The core engine: single-pass processing, IFD/OFD definitions, and the runtime.
HIPAA X12 to FHIR
This package. The X12-to-FHIR R4 mappings listed above.
RMap Module
Alternative path. Build PAS FHIR bundles from tabular data instead of X12.
The AnyToAny Engine is required for every conversion; each module is licensed separately. For 278 prior authorization, see the CMS-0057-F Compliance Suite.
Map your X12 to FHIR
Send a de-identified sample and the FHIR resources you need. We show you the conversion on your data and the modules it takes.