EDI solution for healthcare

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:

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

EDI 834 5010 Outbound Transaction details
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

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

EDI 837 5010 Outbound Transaction details
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

EDI 837 5010 Inbound Transaction details
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

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

ACK EDI 999 5010 Outbound Transaction details
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
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

Details	ACK EDI 999 5010 Inbound Transaction details
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
Trigger Type	File Exist

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EDI solution for healthcare

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