Electronic Transactions
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Electronic Data Interchange (EDI) is the computer-to-computer transfer of business-to-business document transactions and information between trading partners. Many healthcare partners, payors, vendors and fiscal intermediaries choose EDI as a fast, inexpensive, and safe method for automating the business processes that take place.
Are there standards for exchanging information in healthcare EDI?
The constituencies involved in health care, including healthcare partner organizations, payors, benefit plan sponsors, financial institutions and others have jointly developed and approved specific transaction sets, or standards, for use in sending and receiving healthcare information and transactions electronically. These EDI transaction sets and their associated approved American National Standards Institute (ANSI) ASC X12 transaction set numbers are listed below.
Transaction Name
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ASC X12 Transaction
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Reference
Implementation Guide (IG)
Washington Publishing Co.
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Health Claims and Equivalent Encounter Information
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837
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www.wpc-edi.com/hipaa
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Enrollment and Disenrollment in a Health Plan
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834
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www.wpc-edi.com/hipaa
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Eligibility Inquiry/Response for a Health Plan
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270/271 -real-time only
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www.wpc-edi.com/hipaa
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Healthcare Remittance Advice (ERA)
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835
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www.wpc-edi.com/hipaa
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Health Plan Premium Payments
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820
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www.wpc-edi.com/hipaa
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Health Claim Status
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276/277 -real-time only
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www.wpc-edi.com/hipaa
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Referral Certification and Authorization
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278
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www.wpc-edi.com/hipaa
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Coordination of Benefits
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837
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www.wpc-edi.com/hipaa
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Electronic Attachments
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275/HL7/LOINC
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www.wpc-edi.com/hipaa
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What are the benefits derived from using these standards?
 | Keeping health care affordable to the end consumer. |
| Improving accuracy of information exchanged between healthcare participants, improving the quality of healthcare delivery and its supporting processes. |
| Making enhanced information available to all healthcare participants as appropriate. This access ensures fast, reliable, accurate, secure and detailed information on patients and healthcare partner plans. |
EDI Services is committed to delivering the value that EDI brings to all healthcare participants.
For more information click on the links below:
Private Business - HIPAA Companion Guide - for non-Medicare Part A NEW and migrating trading partners using the Enterprise Gateway/Clearinghouse
Trading Partner Agreement - Required for trading partners beginning to exchange EDI transactions.
Trading Partner Enrollment Form - Required for enrolling in any supported EDI transaction.
Web Claims Submission - Option for exchanging electronic transactions.
EDI Vendor Listing - Required for choosing approved clearinghouse organizations that have successfully tested electronic transactions via the GA Gateway.
Provider Access - for connection to variety of customer service information (Online Patient Eligibility, Benefits, Claim Status and Remits) that is privileged and confidential, accessible with user name and password only
HIPAA - Latest HIPAA News
NPI Bulletins - Latest NPI News
EDI Communications – Vendor & Healthcare Partner Links and Publications
EDI Seminars - Schedule of Provider Outreach Seminars and Events
Latest News – Alerts, reminders, important EDI announcements
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