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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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