What is X12 EDI format?

X12 EDI is a data format based on ASC X12 standards developed by the American National Standards Institute (ANSI) Accredited Standards Committee (ASC). It is used to electronically exchange business documents in specified formats between two or more trading partners. X12 EDI releases are known by a version number.

What is an ANSI X12 837 EDI transaction?

The 837 EDI document type is an electronic version of a paper Health Care Claim. Standard EDI formats include X12, ANSI, EDIFACT and its subsets. The 837 EDI document type is used to submit health care claim billing information, encounter information, or both, from health care service providers to payers.

What is the difference between 835 and 837 files?

The 835-transaction set, aka the Health Care Claim Payment and Remittance Advice, is the electronic transmission of healthcare payment/benefit information. When a healthcare service provider submits an 837 Health Care Claim, the insurance plan uses the 835 to help detail the payment to that claim.

What are EDI transactions?

EDI, which stands for electronic data interchange, is the intercompany communication of business documents in a standard format. In EDI transactions, information moves directly from a computer application in one organization to a computer application in another.

What are the disadvantages of EDI?

Disadvantages of EDI EDI systems are extremely expensive making it difficult for small businesses to implement. Many large organizations will only work with others who utilize EDI. This may limit the business small companies are able to do with such organizations and limit trading partners.

What are the types of EDI files?

Types of EDI

• Direct EDI/Point-to-Point. Brought to prominence by Walmart, direct EDI, sometimes called point-to-point EDI, establishes a single connection between two business partners.
• EDI via VAN or EDI Network Services Provider.
• EDI via AS2.
• EDI via FTP/VPN, SFTP, FTPS.
• Web EDI.
• Mobile EDI.
• EDI Outsourcing.
• EDI Software.

What is the 835 electronic transaction?

EDI 835 is electronic version of EOB. The Electronic Remittance Advice (ERA), or 835, is the electronic transaction which provides claim payment information in the HIPAA mandated ACSX12 005010X221A1 Format.

What is a 837 file format?

The 837 file is the standard form for electronically transmitting healthcare claims while the CMS -1500 is the paper form used to bill Medicare Fee For Service businesses. Both of these forms are suitable to file bills with some private and governmental agencies, but most require the 837 file.

What is a 835 transaction?

The 835 Transaction is used primarily by Healthcare insurance plans to make payments to healthcare providers, to provide Explanations of Benefits (EOBs), or both. It has been specified by HIPAA 5010 requirements for the electronic transmission of healthcare payment and benefit information.

What is form 837 is?

The 837 or EDI file is a HIPAA form used by healthcare suppliers and professionals to transmit healthcare claims. Before delving deeper into the 837 form, it’s critical to understand what an EDI file is. EDI stands for the electronic data interchange.