Helping Meet Tailored Customer Needs
What is HIPAA and its application for EDI transactions?
The Health Insurance Portability and Accountability Act of 1996 or (HIPAA) as it is known is a federal regulation that mandates national standards for electronic health care transactions, amongst its other provisions. Few of the transactions adopted under HIPAA for EDI of health care data include:
The Accredited Standards Committee X12 (ASC X12) is responsible for defining the transaction standards and these standards are enforced and administered by the Centers for Medicare & Medicaid Services (CMS).
How does EDI apply to a Provider?
Few types of organizations named by HIPAA as covered entities include – health care clearinghouses, health plans and certain health care providers. Under HIPAA specified regulations, any covered entity that conducts any of the adopted standard transactions, is required to adhere to the format and content requirements of each and every transaction. The current standards version is 5010.
What EDI transactions does Connvertex support for provider segment?
- 837I Health Care Claim (Institutional)
- 837P Health Care Claim (Professional)
- 835 Health Care Claim Payment/Advice
- 999 Functional Acknowledgment
- U277 Unsolicited Claim Acknowledgment
- 277CA Health Care Claim Acknowledgment
- 270/271 Health Care Eligibility/Benefit Request and Response