HIPAA EDI Classroom Training and Certification Classes

EDI stands for Electronic data interchange. It is used to transfer the medical related data in the form of electronic data transfer.

HIPAA stands for Health Insurance Portability and Accountability. It is a set of rules or protocols set for the privacy of the individuals.

The 997 is a HIPAA-defined transaction that indicates acknowledgement of receipt and status of each segment in an EDI transaction.

• Limitations on exclusions for pre-existing conditions
• Availability of health insurance coverage for small employers
• Right of individuals to apply for health coverage when they lose their existing coverage
• Strengthening of laws related to federal health care fraud and abuse

• Privacy
• Electronic Transactions
• Code Sets
• Security
• Unique Identifiers

These rules apply to "covered entities" as defined by HIPAA and the HHS. Covered entities include health plans, health care clearinghouses, such as billing services and community health information systems, and health care providers that transmit health care data in a way that is regulated by HIPAA.

837 - Healthcare Claim. It can be used to submit health care claim billing information, encounter information, or both, except for retail pharmacy claims

835 - Payment & Remittance. It can be used to make a payment, send an Explanation of Benefits (EOB) remittance advice, or make a payment and send an EOB remittance advice only from a health insurer to a health care provider either directly or via a financial institution.

277 - Status Response. This transaction set can be used by a health care payer or authorized agent to notify a provider, recipient or authorized agent regarding the status of a health care claim or encounter, or to request additional information from the provider regarding a health care claim or encounter.

276 - Status Inquiry. This transaction set can be used by a provider, recipient of health care products or services or their authorized agent to request the status of a health care claim.