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What is an 834 eligibility file?

What is an 834 eligibility file?

Simply, an EDI 834 file is a benefit enrollment and maintenance document that must abide by HIPAA 5010 standards. This file is used by a multitude of organizations, such as employers, TPAs and insurance agencies, for enrolling their members directly into a benefit plan.

What is an 834 transaction set?

The EDI 834 transaction set represents a Benefit Enrollment and Maintenance document. It is used by employers, as well as unions, government agencies or insurance agencies, to enroll members in a healthcare benefit plan.

What is a Hipaa 834 transaction?

Under HIPAA, electronic transactions are communications between two parties that relate to the provision of healthcare. HIPAA 834 is the specific format that employers must use when they electronically communicate employee health insurance benefit enrollment and maintenance data to employee health plans.

What is an 834 companion guide?

The ASC X12 834 v005010X220A1 is the established standard for the benefit enrollment and maintenance transaction. The companion guide contains assumptions, conventions, determinations or data specifications that are related for all employer groups, vendors and other submitters of the 834 transactions.

What are EDI feeds?

EDI is the electronic communication of information through a standard format, creating a paperless exchange of information. In benefits, that format is referred to as HIPAA 834. File feeds, or data feeds, are mechanisms for delivering streams of data from one database to another.

Which loop segment has the member detail in the 834 transaction?

loop 2000
The 834 transaction provides the capability to terminate a member at either the Member Detail INS level (loop 2000) or at the Health Coverage HD level (loop 2300).

What are 837 files?

An 837 file is an electronic file that contains patient claim information. This file is submitted to an insurance company or to a clearinghouse instead of printing and mailing a paper claim. • The data in an 837 file is called a Transaction Set.

What is a 277 EDI file?

The EDI 277 Health Care Claim Status Response transaction set is used by healthcare payers (insurance companies, Medicare, etc.) to report on the status of claims (837 transactions) previously submitted by providers.

Is API replacing EDI?

Although EDI has been the standard document exchange method for decades, application programming interfaces (APIs) have been growing in popularity as an alternative to EDI.

What is an API vs EDI?

Compare EDI vs API for B2B Integration. Electronic Data Interchange (EDI) plays an important role in the integration of external B2B systems and Trading Partners since decades. Application Programming Interfaces (APIs) provide selected system functions in real time, which can be accessed and used by other applications.

What is the code for the patient’s relationship to the insured?

Code indicating the relationship between two individuals or entities ALIAS: Relationship Code SEMANTIC: SBR02 specifies the relationship to the person insured.

What is EDI healthcare?

EDI is the automated transfer of data in a specific format following specific data content rules between a health care provider and Medicare, or between Medicare and another health care plan.

What are the 5 code sets approved by HIPAA?


  • International Classification of Diseases, 9th Edition, Clinical Modification (ICD-9-CM).
  • Current Procedural Terminology.
  • HCFA Common Procedure Coding System (HCPCS).
  • Code on Dental Procedures and Nomenclature.
  • National Drug Codes (NDC).

What is the difference between 837 and 835?

For an 835 file the first N3 segment is the Payor Address. For an 837 file the first N3 is the Billing Provider Address. Some segments such as the BPR segment, which specifies financial information such as the total payment amount for the file, don’t depend on where they are in the file for their meaning.

What is 837i and 837p?

The 837i is the electronic version of the paper form UB-04. 837i files are used to transmit institutional claims. Institutional claims are those submitted by hospitals and skilled nursing facilities. The 837p is the electronic version of the CMS-1500 form. 837p files are used to transmit professional claims.

What is a 999 EDI file?

The EDI 999 transaction set is an Implementation Acknowledgement document, developed specifically to replace the 997 Functional Acknowledgement document for use in healthcare. Both the 997 and 999 are used to confirm that a file was received.

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