The healthcare industry is one of the most highly regulated and data-intensive sectors, where the accuracy and speed of data exchange can have a significant impact on patient care, billing, and reimbursement. To address these challenges, the healthcare industry has adopted Electronic Data Interchange (EDI) transactions as a standard way of exchanging healthcare-related information electronically between healthcare providers, payers, and other stakeholders. EDI transactions in the healthcare industry include transactions related to patient registration, eligibility verification, claims submission, remittance advice, and more. The use of EDI transactions in healthcare has helped improve the efficiency and accuracy of data exchange, reduce costs, and minimize errors. With the increasing demand for healthcare services and the growing complexity of healthcare regulations, the adoption of EDI transactions has become essential for healthcare organizations to improve patient care and financial outcomes while meeting regulatory compliance requirements.
Adeptia also offers an EDI solution for healthcare that comprises the following EDI Transactions:
834 (Benefit Enrollment & Maintenance)
This Transaction is used to transmit benefit enrollment information between a benefits provider (such as an insurance company) and an employer. The 834 transaction provides details of employee benefit enrollments and changes, including information on health insurance, dental insurance, vision insurance, life insurance, and other benefits.
EDI 834 5010 Outbound Transaction details |
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Name | Benefit Enrollment & Maintenance EDI 834 5010 Outbound From XML |
Description | Outbound transaction to send Benefit Enrollment & Maintenance EDI 834 5010 from the received canonical XML file. |
Type | EDI Outbound |
Network | Health Care |
Partner Name | Health Care Partner |
Project | EDI Health Care |
EDI Standard | X12 |
EDI Standard Version | 5010X220A1 |
Transaction Set | 834 |
Source and Target | SFTP, Adeptia hosted FTP server |
Source File Name | EDI_Outbound_834_5010_SourceFile.xml |
Output File Name Pattern | BenefitEnrollmentMaintenance_EDI_834_5010_XML_output_month-dd-yyyy_hh:mm:ss.SSS.edi For example, BenefitEnrollmentMaintenance_EDI_834_5010_XML_output_Dec-23-2022_20:46:56.096.edi |
Trigger Type | File Exist |
Action Type | Create File |
837 (Claims)
This Transaction is used to submit healthcare claims for reimbursement from healthcare providers to payers, such as insurance companies or government healthcare programs. The 837 Professional transaction is used for submitting claims for medical services provided by healthcare professionals and institutional healthcare providers.
EDI 837 5010 Outbound Transaction details |
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Name | Claims EDI 837 5010 Outbound from XML |
Description | Outbound Transaction to send claims EDI 837 5010 from the received canonical XML file. |
Type | EDI Outbound |
Network | Health Care |
Partner Name | Health Care Partner |
Project | EDI Health Care |
EDI Standard | X12 |
EDI Standard Version | 5010X222A1 |
Transaction Set | 837 |
Source and Target | SFTP, Adeptia hosted FTP server |
Source File Name | EDI_Outbound_837_5010_SourceFile.xml |
Output File Name Pattern | Claims_EDI_837_5010_Output.edi For example, Claims_EDI_837_5010_Output.edi.edi |
Trigger Type | File Exist |
Action Type | Create File |
EDI 837 5010 Inbound Transaction details |
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Name | Claims EDI 837 5010 Inbound to Json |
Description | Inbound Transaction to receive Claims EDI 837 5010 and generate canonical JSON file. |
Type | EDI Inbound |
Network | Health Care |
Partner Name | Health Care Partner |
Project | EDI Health Care |
EDI Standard | X12 |
EDI Standard Version | 5010X222A1 |
Transaction Set | 837 |
Source and Target | SFTP, Adeptia hosted FTP server |
Source File Name | EDI_Inbound_837_5010_SourceFile.txt |
Output File Name Pattern | Claims_EDI_837_5010_JSON_Output_month-dd-yyyy_hh:mm:ss.SSS.json For example, Claims_EDI_837_5010_JSON_Output_Aug-16-2021_13:23:55.056.json |
Trigger Type | File Exist |
Action Type | Create File |
999 (Functional Acknowledgement)
This Transaction is used to send the response by acknowledging the receipt and validity of the transaction, and providing information on any errors or issues that were encountered during processing. It contains information such as the sender and receiver of the original transaction, the date and time the transaction was received, and a status code indicating whether the transaction was accepted or rejected.
ACK EDI 999 5010 Outbound Transaction details |
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Name | Health Care ACK EDI 999 5010 Outbound |
Description | EDI Acknowledgement 997 (ACK) 5010 version to be used for all Inbound EDI 5010 transactions for Manufacturing Trading Partner. When you want to send an acknowledgment against an Inbound EDI Transaction, you need to use Health Care ACK EDI 999 5010 Outbound Transaction. |
Type | EDI Outbound |
Network | Health Care |
Partner Name | Health Care Partner |
Project | EDI Health Care |
EDI Standard | X12 |
EDI Standard Version | 5010X231A1 |
Transaction Set | 999 |
Target | SFTP, Adeptia hosted FTP server |
Source File Name | TBD. Is this parameter valid here? |
Target File Name Pattern | edi_ack_999_5010_healthcare_yyyymmdd_HHmmss.SSS.txt For example, edi_ack_999_5010_healthcare_20220316_223646.036.txt |
Action Type | Create File |
Details | ACK EDI 999 5010 Inbound Transaction details |
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Name | Health Care ACK EDI 999 5010 Inbound |
Description | EDI Acknowledgement 999 (ACK) 5010 version to be used for all Outbound EDI 5010 transactions for Health Care Trading Partner. When you want to receive an acknowledgment against an Outbound EDI Transaction, you need to use Health Care ACK EDI 999 5010 Inbound Transaction. |
Type | EDI Inbound |
Network | Health Care |
Partner Name | Health Care Partner |
Project | EDI Health Care |
EDI Standard | X12 |
EDI Standard Version | 5010X231A1 |
Transaction Set | 999 |
Source | SFTP, Adeptia hosted FTP server |
Source File Name | TBD. Is this parameter valid here? |
Trigger Type | File Exist |
