EDI & Transactions
835s, 837s, clearinghouses and electronic workflows. 12 entries.
A clearinghouse is an intermediary that receives claim files from providers, scrubs and reformats them, and routes them…
EDI 270/271: Eligibility and Benefit Inquiry and ResponseThe EDI 270/271 pair is the X12 eligibility transaction. The 270 is the provider's inquiry asking a payer whether a pat…
EDI 276/277: Claim Status Request and ResponseThe EDI 276/277 pair is the X12 claim status transaction. The 276 is the provider's inquiry asking a payer for the stat…
EDI 277CA: Claim AcknowledgmentThe EDI 277CA (Claim Acknowledgment) is the X12 transaction a payer returns after an 837 to report whether each claim p…
EDI 278: Health Care Services Review (Authorization/Referral)The EDI 278 is the X12 Health Care Services Review transaction used to request and receive prior authorizations and ref…
EDI 835: Health Care Claim Payment/Advice (ERA)The EDI 835 is the X12 Health Care Claim Payment/Advice transaction — the electronic remittance advice (ERA) a payer se…
EDI 837I: Institutional Health Care ClaimThe EDI 837I is the X12 Health Care Claim transaction for institutional providers — hospitals, skilled nursing faciliti…
EDI 837P: Professional Health Care ClaimThe EDI 837P is the X12 Health Care Claim transaction for professional (physician and non-institutional) services — the…
EDI 999: Implementation AcknowledgmentThe EDI 999 (Implementation Acknowledgment) is the X12 transaction that reports whether a submitted functional group pa…
Payer ID: The Electronic Routing Number for ClaimsA payer ID is the electronic identifier that tells a clearinghouse which insurance company a claim should be routed to.…
TA1 Acknowledgment: Interchange-Level EDI ReceiptThe TA1 is the X12 interchange acknowledgment — the first response after transmitting an EDI file. It reports whether t…
X12 Standard: The EDI Format Behind Health Care TransactionsX12 is the ANSI-accredited EDI standard that defines the format of electronic health-care transactions. HIPAA adopted s…
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