Emdeon EDI connectivity and claims processing
Emdeon EDI connectivity is a result of succesfuly completed testing phase between the two parties involved. Emdeon EDI testing consists of submitting EDI claims, validating the EDI data, and certifying multiple electronic transmissions. After all setting-up and testing procedures claims processing begins. The Submitter sends a file marked as (P) for Production or (T) for Test as indicated using a P or T in segment in ISA15. The file is validated for required elements and syntax. The results of the validation are posted to the Submitter’s mailbox for the Submitter to retrieve as desired.
If Emdeon EDI connectivity works properly and the file passes validation, it continues to Transaction Processing. The results are available in statuses generated through the clearinghouse. At this point, Test transactions and rejected production claims end their EDI workflow. Accepted production claims continue to the Payer.
The Payer returns an acknowledgement at the point that they receive the processed 837 claim files. During the Payer’s processing, most payers will return a claim status message. Once the claim has been adjudicated at the Payer, an 835 response is returned to Emdeon. After Emdeon processing completes, Emdeon logs the Acknowledgements and sends all Payer responses to the Submitter’s mailbox.
Retransmission Procedures
Emdeon does not routinely perform retransmissions. When there is a problem with the file submitted to Emdeon, it is the responsibility of the Trading Partner to resubmit.
As it was mentioned earlier, Emdeon Clearinghouse EDI program connects providers, payers and other health care partners using computers and communications networks or modems and ordinary phone lines. It allows you to send and receive vital healthcare information electronically. Information is sent from your billing or practice management system to an Emdeon Clearinghouse EDI network where it is verified for accuracy and then sent straight through to the payer’s computer systems. Read more about Emdeon EDI program.