AI-Assisted Development

NCPDP EDI Translator API with Intelligent Parsing

Pharmacy Benefit Management Ecosystem

Overview

Built an internal NCPDP D.0 EDI translation capability for a PBM ecosystem, enabling downstream applications and services to convert inbound D.0 claim files into normalized JSON with consistent validation and extensibility. The system uses AI-assisted validation logic for handling non-standard segments and partner-specific variations, dramatically reducing manual exception handling and integration time.

Client Profile

IndustryHealthcare / Pharmacy Benefits Management (PBM)

RegionNorth America

HeadquartersUnited States (Midwest)

OperationsMulti-state (national plan coverage)

Company SizeMid-to-large PBM / Claims Processor

Core MissionAdminister pharmacy benefits and claims adjudication for health plans and employer groups.

Key Services

Real-time Claim AdjudicationBenefits AdministrationIntegrations HubCompliance & Audit Readiness

The Challenge

Duplicated parsing logic with inconsistent validation

Partner-specific parsing that was difficult to maintain

Need for a low-latency lightweight private API

Requirement to support custom segments in D.0 files

Need to invoke translation DLLs from Python-based services

Solution Architecture

Built on EdiFabric (.NET) with a customization layer supporting non-standard/custom D.0 segments and partner-specific variations. Custom templates and translator adapters map EDI loops/segments into a stable JSON contract, with schema validation, AI-assisted error detection for edge cases, and clear error reporting.

Deployed as an AWS serverless private API using API Gateway (Private) and AWS Lambda (.NET runtime). For interoperability with Python-based services, a Python package using pythonnet invokes the .NET library functions.

Architecture Diagram — NCPDP EDI Translator API

Features & Capabilities

Low-Latency Private API

Serverless translation endpoint accessible only within organization's VPC

Standardized JSON Output

Consistent schema across all downstream applications

Reusable Translation Engine

Exposed as .NET DLL and Python library via pythonnet

AI-Assisted Validation

Intelligent error detection for malformed segments and edge-case claim formats

Custom Segment Support

Handles non-standard or partner-specific D.0 segments

Predictable Error Handling

Clear, structured error messages for invalid/missing fields

Extensible Architecture

New partners or segment variations added without code changes

Observability-Ready

Structured logging, metrics hooks, and traceability

Technology Stack

Runtime

AWS Lambda (.NET runtime)

API Layer

API Gateway (Private API, VPC-scoped)

EDI Parser

EdiFabric (.NET) with custom templates + adapter pattern

Cross-Platform

pythonnet (Python <> .NET interop)

Containerization

Docker (for Lambda container images)

CI/CD

GitOps via GitHub Actions

Observability

CloudWatch Logs, structured JSON logging, metric exports

Security

VPC endpoints, IAM roles, TLS encryption, audit logging

Security & Compliance

Private Network Access

API only accessible from within the VPC

Encrypted Transport

TLS 1.3 enforced at API Gateway and Lambda

Least Privilege IAM Roles

Lambda functions use minimal permissions

Data Isolation

No PHI stored in logs; only claim IDs and metadata logged

Audit Trail

All requests logged with timestamp, source IP, request ID, outcome

Immutable logging

Results & Impact

Parsing Consolidation

Eliminated duplicated logic across all downstream teams

Integration Time

Reduced by 60% for new consumers

Throughput

100+ claims/sec (peak), <100ms latency

Reusability

Used by 8+ internal services across .NET and Python ecosystems

Operational Overhead

Zero — fully serverless

Duration~6 months (April 2024 completion)

CategoryAI-Assisted Development

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