What Are EDI Healthcare Transactions And Why We Need It?

Transaction Set (837) What are EDI Healthcare Transactions, And Why We Need Transaction Set (835) It? Maintenance Set (834) Presented By: HIPAASUITE Insurance Products (820) Table Of CONTENTS Some More Transaction Sets EDI Health Care Claim Eligibili ty/Bene -fit Eligibili ty/Ben- efit Inquiry (270) Claim Status Transaction set (837)---1 Claim Status EDI Retail Pharmacy Claim Transaction (NCPDP Telec ommunications Standard version 5.1)---2 Notific ation (277) Reques t (276) Respon se (271) Enacted by the U.S congress in 1996, the Health Insurance Portability and Accountability Act (HIPAA) was signed by Bill Clinton. The key component of HIPAA is to establish national standards for electronic health care EDI Health Care Claim Payment/Advice Transaction Set (835)---3 transactions and national identifiers for providers, health insurance plans and employers. To improve the efficiency and effectiveness of the North American health care system, these standards encourage the widespread use of EDI in the U.S health care system. Enrollment EDI Benefit and (834)---4 Maintenance Set The Healthcare EDI Transactions are specified on the basis of X12 and the key message types included in these sets include the following. Premium for Products Payment Insurance (820)---5 EDI Health Care Claim Transaction set (837) EDI Health Care This transaction set is used to submit information pertaining to healthcare claim billing, or encounter information, or both, excluding the retail pharmacy claims. These are to be generally sent by healthcare providers to payers, either via direct means or via intermediary billers and claims clearinghouses. Eligibility/Benefit Inquiry (270)---6 EDI Eligibility/Benefit Response (271)----7 Health Care EDI Retail Pharmacy Claim Transaction (NC PDP Telecommunications Standard version 5.1) Care Claim Status Request (276)----8 EDI Health This transaction set is used to submit information regarding retail pharmacy claims to payers by healthcare experts who distribute medications, either directly or via intermediary billers and claims clearinghouses. EDI Health Care Claim Notification Status (277)---9 EDI Health Care Claim Payment/Advice Transaction Set (835) EDI Health Care Service Review (278)---10 This set is either used to make an expense, send out an Explanation of Benefits (EOB) remittance advice, or do both but only from a health insurer to a healthcare provider. This can be done either directly or via a financial establishment. Information EDI Functional EDI Benefit Enrollment and Maintenance Set (834) Acknowledgement Transaction Set (997)---11 This set can be used by employers, government agencies, unions, insurance agencies, etc to enroll members to a payer, i.e. a healthcare organization which pays claims, manages insurance or benefit or product. HIPAASUITE:: Smart EDI * Easy As Pie Service Review Premium Payment for Insurance Products Informa -tion (278) (820) Acknowl This is a set that is used for insurance products. A premium payment is made by ordering a financial establishment to make a edgeme nt Transact payment to a payee. ion Set (997) EDI Healthcare Eligibility /Benefit Inquiry (270) EDI Health Care Claim Status Request (276) This set is used by a provider, recipient of healthcare or an authorized agent to make a request for a healthcare status claim. This is used to inquire about health care benefits and eligibility of a subscriber or dependent EDI Health Care Eligibility/Benefit Response (271). This set is used to respond to a request that inquires about health care benefits and eligibility of a subscriber or dependent. EDI Functional Acknowledgement Transaction Set (997) EDI Health Care Service Review Information (278) The shape styles give you the option to choose from a number of pre-designed colors, lines, and effects that can be applied to your graphics. This can be used for objects, lines, and text. This set transfers healthcare service information - subscriber, patient, demographic, diagnosis or treatment data - certification, notification or reporting of for requesting review, These are the key sets given under EDI transactions. If you have any questions, get in touch with your service outcomes of a healthcare services review. Infograph By: HIPAASUITE