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The X12 834 EDI Enrollment Implementation Format is a standard file format in the United States for electronically exchanging health plan enrollment data between employers and health insurance carriers.
Healthcare Provider Information 275 Patient Information 276 Health Care Claim Status Request 277 Health Care Information Status Notification 278 Health Care Services Review Information 362 Cargo Insurance Advice of Shipment 500 Medical Event Reporting 834 Benefit Enrollment and Maintenance 835 Health Care Claim Payment/Advice 837 Health Care Claim
The Accredited Standards Committee X12 (also known as ASC X12) is a standards organization.Chartered by the American National Standards Institute (ANSI) in 1979, [2] it develops and maintains the X12 Electronic data interchange (EDI) and Context Inspired Component Architecture (CICA) standards along with XML schemas which drive business processes globally.
In July 1992, WEDI published a report that outlined the steps necessary to make electronic data interchange (EDI) a routine business practice for the health care industry by 1996. The Workgroup envisioned the entire health care industry transacting business electronically, under a nationwide set of coding and format standards for all transactions.
Electronic data interchange (EDI) is the concept of businesses electronically communicating information that was traditionally communicated on paper, such as purchase orders, advance ship notices, and invoices. Technical standards for EDI exist to facilitate parties transacting such instruments without having to make special arrangements.
An explanation of benefits (commonly referred to as an EOB form) is a statement sent by a health insurance company to covered individuals explaining what medical treatments and/or services were paid for on their behalf. [1] The EOB is commonly attached to a check or statement of electronic payment. An EOB typically describes:
EDI Health Care Service Review Information (278) is a transaction set that can be used to transmit health care service information, such as subscriber, patient, demographic, diagnosis or treatment data for the purpose of the request for review, certification, notification or reporting the outcome of a health care services review.
XML/EDIFACT is an Electronic Data Interchange (EDI) format used in Business-to-business transactions. It allows EDIFACT message types to be used by XML systems. EDIFACT is a formal machine-readable description of electronic business documents. It uses a syntax close to delimiter separated files.