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Edi 1

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17 views6 pages

Edi 1

Uploaded by

Sam matthieu
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Healthcare Domain for BA EDI Transactions

EDI Transactions
837 EDI Claims
835 Remittance
Edits and Validations
Reports and Acknowledgements.
837 EDI Claim

Electronic Data Interchange (EDI) Is the computer – to computer exchange


of business data in standard formats. In EDI, information is organized
according to a specified format set by both parties, allowing a "hands - off”
computer transaction that requires no human intervention or rekeying on
either end.

The EDI standards are developed and maintained by the Accredited


Standards Committee (ASC)X12. Thestandards are designed to work across
industry and company boundaries. The x12 standards specify onlythe format
and data content of e-business transactions.
Benefits of EDI includes
Reduce cycle time
Better inventory management
Increased productivity
Reduced costs
Improved accuracy
Improved business relationships
Enhanced customer service
Increased sales
Minimized paper use and storage
Increased cash flow
Healthcare & Health Insurance overview
The HIPAA transactions and code set standardize the electronic exchange of health –
related administrative information, such as claims forms.
The rules are based on electronic data interchange (EDI) standards which allow for the
exchange of information from computer – to – computer without human involvement.
A “ transaction ”is an electronic business document. Under HIPAA, a handful of
standardized transactions will replace hundreds of proprietary , non – standard
transactions currently in use. For example, the HCFA 1500 claim / encounter
transaction.
Each of the HIPAA standard transactions has a name, a number, and a business or
administrative use. Those of importance in medical practice are listed in the table below
Healthcare & Health Insurance overview
Name of transaction Number Business use

Claim/ encounter X12837 For submitting claim to health


plan, insurer ,or other payer

Eligibility inquiry and response X12 270 and 271 For inquiring of a health plan the
status of a patient's eligibility for
benefits and details regarding the
types of servicescovered , and for
receiving information inresponse
from the health plan or payer

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