EDI Health Care

EDI Health Care Electronic Transaction Options

EDI Health Care helps to minimize providers’ administrative time and effort, and to reduce paper waste in health care communities. EDI Health Care by Beacon Health Options company significantly enhanced eServices portal and electronic data interchange (EDI) capabilities for completing transactions efficiently and cost-effectively.

The intended audience for the information below is the technical department/team responsible for submitting EDI Health Care electronic claims transactions to Beacon. In addition, this EDI Health Care information should be communicated and coordinated with the provider’s billing office in order to ensure the required billing information is provided to their billing agent/submitter. Beacon is actively promoting EDI Health Care electronic communication so that all future notices and alerts can be delivered electronically.

Electronic Data Interchange (EDI)

For larger providers, EDI is Beacon’s preferred method for receiving EDI Health Care claims. Beacon accepts standard HIPAA 837 Professional and Institutional health care claims transactions and provide 835 transactions. EDI claims can be uploaded via eServices. Providers also view their EDI upload history, and receive EDI acknowledgement and submission reports, through eServices. Providers/trading partners may submit 837 claim transactions using the EDI gateway, which requires an Internet a browser that supports 128-bit encryption.

HIPAA Notes

The Health Insurance Portability and Accountability Act (HIPAA) of 1996 mandates the establishment of national standards for electronic transmission of health data and ensuring privacy protection. The Administrative Simplification provisions of HIPAA, Title II, require the Department of Health and Human Services to establish national standards for electronic healthcare transactions and national identifiers for providers, health plans and employers. It also addresses the security and privacy of health data. Adopting these standards improves the efficiency and effectiveness of the nation’s healthcare system by encouraging the widespread use of electronic data interchange in health care. Beacon Health Options (Beacon), as a covered entity and health insurance payer accepts X12 837 Professional (837P) and Institutional (837I) Health Care Claims as mandated by the administrative simplification provisions of HIPAA.

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