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Upcoming Instructor-Led HIPAA EDI Class Date & Time as on June 12, 2025

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About HIPAA EDI training

What is HIPAA EDI Training?
Attend the best HIPAA EDI online and classroom courses from the top-class training institutes in USA. The classes are delivered by experienced trainers who have several years of Health Care EDI experience at insurance companies, hospitals, clearinghouses and other health care organizations. The various HIPAA EDI course modules cover all the nine Healthcare EDI transactions. Whether you are a beginner or a seasoned professional, you will immensely gain from this HIPAA EDI training course. You will gain knowledge about the Healthcare fundamentals, all nine Health Care EDI transactions and all the related elements. Hands-on mapping exercises are included to give more practical insights. Implementation best practices are also part of the training. HIPAA EDI training course curriculum focuses on the core aspects of HIPAA, including covered entities and business associates, transaction and data code sets, privacy and security, penalties, and recent developments. HIPAA EDI training and placement courses aim at placing the students at some of the best jobs in the industry. HIPAA EDI is a completely job-oriented training with a balanced focus on theoretical concepts and hands-on exercises. Youâ€™ll benefit from the information presented in this training course. All the scenarios, case studies, examples and best practices are from real world Health Care EDI professionals. Apart from the information, the other highlights of the HIPAA EDI includes 24/7 technical support, comprehensive study notes, guidance for certification preparation and 100% placement assistance.
What will you learn?
In the HIPAA EDI training course, students will analyze the basic concepts and components of EDI, and the relationship between the industry and EDI. You will also learn about why and where to use HIPAA EDI, how to create a paperless system, how HIPAA differ from EDI and HIPAA standards and best practices. Real-time scenarios are used to inform the students about HIPAA transactions and relation between different transactions such as 270, 271, 275, 276, 277, 278, 820, 834, 835, 837, 997 and TA1. HIPAA Mapping Guides, Communication Mechanism and Translators are other aspects covered during the training.
HIPAA EDI Course Information
Training Modes & Course Duration:
- Online (Self-paced/Live): 3-6 months
- Classroom: 6-9 months
- Bootcamp (Intensive): 6-12 weeks
Average Completion Time: 3 months
Course Fee/Price: $900 (depending on modes and providers)

HIPAA EDI Beginner Level Classes on Topics
- Introduction to HIPAA & EDI Basics
- Health Insurance Transactions Overview
- HIPAA Privacy & Security Rules
HIPAA EDI Intermediate Level Classes on Topics
- EDI X12 Transactions (837, 835, 270, 271)
- Claim Adjudication & Processing
- Compliance & Auditing Best Practices
HIPAA EDI Advanced Level Classes on Topics
- Advanced EDI Automation
- AI in Healthcare Compliance
- Real-Time Healthcare Data Exchange

HIPAA EDI Syllabus

HIPAA EDI Training Course Outline
- Introduction to HIPAA and Background
  - History and Objectives
  - Statutory and Regulatory Framework
  - Who must comply?
  - Covered entities, Business associates and Business Associate contracts
  - Breaches
  - Penalties for non-compliance
  - Other issues to consider
- Transactions and Data Code Sets
  - The covered transactions
  - The code sets
  - Compliance: Whose Issue is it?
  - Working with Payers and Clearinghouses under HIPAA
- Introduction to EDI
  - Basic ideas and definitions
  - The role of EDI
  - The role of EDI in the health care industry
  - The HIPAA implementation guides
  - How to achieve compliance
  - The place of payer requirements in the HIPAA standard
- Understanding the Security Requirements
  - History and background of security rules
  - Required implementation specifications
  - Addressable implementation specifications
  - Security administration
  - Technical standards
  - Physical safeguards
- Components of an EDI Environment and EDI Communication Methods
  - Different options such as value-added networks, Internet EDI-AS1, AS2 and FTP etc.
  - EDI enveloping
  - Setting up EDI communications with an EDI trading partner
  - Integrating EDI implementation with a companyâ€™s internal network, hardware, security and software
  - Overview of the personnel, software and hardware components of a typical EDI setup
- Business Analysis and Mapping â€“ Deciphering Health Care EDI Transactions
  - 270 â€“ Health Care Eligibility Benefit Inquiry and Response
  - 271 â€“ Health Care Eligibility Response
  - 276 â€“ Health Care Claim Status Request
  - 277 â€“ Health Care Claim Status Response
  - 278 â€“ Health Care Services Review â€“ Request for Review and Response
  - 837 â€“Health Care Claim Institutional, Dental and Professional
  - 835 â€“ Health Care Claim Payment/Advice
  - 834 â€“ Benefit Enrollment and Maintenance
  - 820 â€“ Payroll Deducted and Other Group Premium Payment for Insurance Products
  - CAQH â€“ Core Operating Rules
Who should attend HIPAA EDI Training?
This seminar is designed for healthcare consultants, business and office managers, hospital administrators, health care providers, medical records directors, billing managers, nurses, compliance officers, physicians and attorneys.
Pre-requisites for HIPAA EDI Training
Knowledge of the business processes in the healthcare industry especially claims flow process.
Related Training
- Security Plus
- Healthcare System Analyst

FAQ's on HIPAA EDI training & certification

1. What is EDI and HIPAA?
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.
2. What is a 997?
The 997 is a HIPAA-defined transaction that indicates acknowledgement of receipt and status of each segment in an EDI transaction.
3. What are the major issues focused in HIPAA?
- 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
4. What are the five components of Administrative Simplification?
- Privacy
- Electronic Transactions
- Code Sets
- Security
- Unique Identifiers
5. To Whom Does the Privacy Rule Apply and Whom Will It Affect?
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.
6. Briefly describe EDI transaction codes 837, 835, 276 and 277
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.

HIPAA EDI Certifications

Electronic Data Interchange (EDI) certifications for the Health Insurance Portability and Accountability Act (HIPAA) are essential for people who work with sensitive health information and electronic transactions in the United States. Even though HIPAA itself does not offer certifications, several reputable organizations do. These organizations offer training and certification programs related to HIPAA that can help you learn the skills and knowledge you need. Here are some standard certifications to think about:

Certified HIPAA Privacy Security Expert (CHPSE): The HIPAA Academy is responsible for awarding this certification. It is for people who work with protected health information (PHI) and ensures privacy and security rules are followed.
Certified HIPAA Professional (CHP): This certification, also offered by the HIPAA Academy, is for healthcare professionals and consultants who want to understand the HIPAA Privacy and Security Rules fully.
Certified HIPAA Privacy Associate (CHPA): This certification, offered by the HIPAA Certification Institute, is for new professionals who want to learn the basics of HIPAA's privacy rules.
Certified HIPAA Privacy Expert (CHPE): This certification is given by the HIPAA Certification Institute to people in charge of putting HIPAA privacy compliance into action and keeping it up to date.
Certified HIPAA Security Expert (CHSE): The HIPAA Certification Institute also offers this certification. IT professionals and security officers who work with electronic PHI and want to know more about HIPAA security regulations should get this certification.
Certified in Healthcare Compliance (CHC): The Health Care Compliance Association (HCCA) gives the CHC certification to people who work in HIPAA privacy and security and other areas of healthcare compliance.
Certified Information Privacy Professional/United States (CIPP/US): This certification is given by the International Association of Privacy Professionals (IAPP) and covers privacy laws in the United States, such as HIPAA.

Consider getting one or more certifications and working in the healthcare or IT fields to improve your chances of getting a job at a top company. Remember that job requirements can differ, so look at job postings to determine which certifications are most important for your desired job.