EDI Reference Guide

Table of Contents What is Electronic Data Interchange (EDI)? 2 Example of EDI: 2 How does using EDI facilitate electronic transactions in healthcare? 3 Example of the Benefits of EDI: 3 How has HIPAA changed how healthcare information is transmitted in EDI? 4 Example of HIPPA/EDI: 4 What is the relationship between Electronic Health Records, reimbursement, HIPAA, and EDI transactions? 5 Example of HIPPA/EDI Claim Transaction 5 References 6

What is Electronic Data Interchange (EDI)?

Electronic Data Interchange is a way to transmit data between different computer systems. EDI is the standard designated by HIPAA to exchange patient data.

EDI systems effectively eliminates the need to print, file, store, post and retrieve paper documents which is more cost efficient in the doctor’s office. The goals for the future is to completely get rid of paper records. This will then have everyone working with the same systems so that all of our information is processed and read easily. This will help us provide better and quicker care for our patients.

Some doctors that have been using the EDI system, often find it more difficult to use then paper, but converting to the system means that it will pay dividends in the end.

Example of EDI:

(Kavidayal, 2015)

How does using EDI facilitate electronic transactions in healthcare?

· Manual data entry and processing is reduced

· Improved data quality

· Elimination of contrasting forms and codes

· Improved cash flow

· Improved accuracy of information

· Fewer rejections of claims

· Cost savings (paper, postage, labor)

· Less billing errors

· Improved accuracy, reliability and usefulness of shared information

· Improved patient service

· Prevents errors that could lead to allegations of fraud and abuse

· Minimizes the risk of penalties

· Staff stress is reduced

Example of the Benefits of EDI:

(Admin, 2015)

How has HIPAA changed how healthcare information is transmitted in EDI?

First let’s explain HIPPA. The Health Insurance Portability and Accountability Act (HIPPA) was enacted in 1996. An important feature of HIPAA is the national standards for electronic health care transactions. These standards are meant to improve the efficiency of the healthcare system in the U.S. By doing this we are boosting the widespread use of the EDI system here in the U.S.

“Standards for Electronic Transactions (EDI) and Code Sets The HIPAA transactions standards clearly set forth a special role for healthcare clearinghouses to provide services to translate electronic data that is not in the HIPAA-dictated format into standardized data that complies with the HIPAA-dictated formats (referred to as the X12 format). National Information Services (NIS) has provided customers with this “translation” service as part of our electronic claims service before the compliance date of October 16, 2002. Stringent testing and evaluation of electronic claims transmissions by Claredi resulted in full certification that all claims transactions and protocols were compliant with all electronic transaction and code set requirements mandated by HIPAA” (HIPPA, 2009).

Now I know you’re thinking, “that is great to know but what are the code sets?” Code sets are medical codes that have been approved by HIPPA. Examples of codes sets are, ICD-9-CM, National Drug codes, the common coding system for healthcare, current dental terminology, and so forth and so on.