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Healthcare/Pharma

 

EDI Solutions for Healthcare Industry
 

 

EDI is prevalent  throughout the healthcare industry. The use of Edi can however be classified into 2 specific areas.

  • Healthcare Supply and Replenishment Transactions
  • Health Insurance Information Exchange (HIPAA)

 

In Healthcare supply the transactions are similar to the transactions in Retail EDI

 

Type of Transaction

ANSI X12

UN/EDIFACT

Invoice

810

INVOIC

Purchase order

850

ORDERS

Purchase order acknowledgment

855

ORDRSP

Purchase order change acknowledgment/request

865

Ship notice/manifest

856

DESADV despatch advice

PRODEX product exchange reconciliation

Purchase order change request

860

ORDCHG

 

With HIPAA some of the EDI transactions include

Transaction

Description

Versions

270/271

Eligibility/Benefit Inquiry & Information response

004010X92 & 004010X92A1

276/277

Health Care Claim Status Request and Notification

004010X93 & 004010X93A1

278

Health Care Services Review Information Request and Response

004010X94 & 004010X94A1

820

Payroll Deducted and Other Group Premium Payment for Insurance Products

004010X61 & 004010X61A1

834

Benefit Enrollment and maintenance

004010X95 & 004010X95A1

835

Health Care Claim Payment/Advice

004010X91 & 004010X91A1

837

Health Care Claim – Institutional

004010X96 & 004010X96A1

837

Health Care Claim – Dental

004010X97 & 004010X97A1

837

Health Care Claim - Professional

004010X98 & 004010X98A1

 
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