Emdeon EDI Testing and Certification Overview

Emdeon EDI TestingEmdeon EDI Testing consists of submitting EDI claims, validating the EDI data, and certifying multiple electronic transmissions. Emdeon EDI Certification for a new implementation requires the successful submission of 100 test EDI claims with a validation percentage that meets or exceeds 95%. Emdeon EDI Certification for a conversion project begins by submitting the same volume of test claims as a full day’s production volume in a minimum of three files. The rejection rate on the test claims in a conversion project cannot exceed the current production-level rejection rate.

Once you receive 5010 certification, you may begin submitting 5010-certified EDI transactions within the production environment.

During Emdeon EDI Testing, Emdeon gives its vendors a guided implementation process with an Implementation Analyst or a self-directed process using ON24/7, Emdeon’s customer self-service portal.

Your Implementation Analyst or Account Representative will provide you with login information and instruction to ON24/7

Every project is guided to the point that connectivity is assured and a fundamental understanding of the Emdeon process is reached, but with the release of 5010, all EDI vendors will be able to access the 5010 Conversions module of ON24/7 to test transactions independently. This functionality provides the ability to initiate a format conversion project, upload test files, engage in two-way communications with Emdeon and generate file- and claim-level reports to guide your 5010 conversion project.

Both EDI implementation approaches follow the requirements and guidelines described under the topics listed below.

  • Test Process
  • Acceptable File Formats
  • Allowable Character Set
  • Emdeon Processing Hours

Before you begin your Emdeon EDI Testing project, please discuss the options available with your Implementation Analyst or Account Representative. Once EDI connectivity is established, testing a new implementation or a format conversion is a three-step process:

  • Submission
  • Validation
  • Certification

As it was mentioned many times before, EDI in health insurance connects providers, payers and other health care partners. It allows you to send and receive vital healthcare information electronically. Information is sent from your billing or practice management system to an EDI network where it is verified for accuracy and then sent straight through to the payer’s computer systems.

We invite you to visit EDI Academy seminars and workshops where you can gain basic HIPAA EDI knowledge and get deeper understanding of mapping practice. See the schedule and learn about course agenda.

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