HIPAA EDI Support Service

HIPAA EDI Support Service Operation Process Common Description

HIPAA EDI Support Service serves for parties involved in EDI documents exchange process to make the operation easy and effective. Before any operation providers should obtain an account at the chosen service and make the enrollment. Usually creating a profile in EDI support service the party is given all the necessary information for setup completion in the system. Often demographic, facility, line of business, electronic transaction, and method of submission information is captured during online registration.

Provider should have a web-based application that allows to update basic facility information, add billing NPIs and lines of business, add or change vendor associations, and manage their electronic transactions online. It gives easy control/management of user profiles, helps in administrative and operational cost savings, provides real-time registration and validation of EDI status. New providers usually are only required to submit the appropriate enrollment form to register for electronic transactions. Depending on the line of business and location of practice, the forms may be different. Sometimes there are forms that service provider requires to be faxed.

Testing and Set-up

A common period for provider setups process is 7-10 business days but this term may vary. Most service providers require all direct providers to test claim submission. Testing ensures providers submit claim transactions in the HIPAA compliant format and meet the syntax and structure billing requirements defined in the correspondent implementation guide and the companion documents. If the company uses a third-party billing service or clearinghouse, that bodies should test on their behalf.

Submitting a Test File

In most cases test files are submitted over the internet through a web-based application. Directions for submitting a test file usually are included in the correspondent implementation guide and the companion documents. Providers should carefully review these instructions prior to contacting service help desk with any additional questions.

Here is a list of common actions made for testing:

  • All appropriate enrollment forms have been received by service provider
  • A submitter ID has been assigned to vendor profile
  • EDI claim indicates testing required.

After all the steps have been made the service provider reviews the test file and completes the steps to move the associated NPI into a production status. Once set up in production, your transaction is approved by the service provider in appropriate application.

If you use EDI medicare services and need basic knowledge or advanced real-world practice, you can choose HIPAA EDI trainings or online webinars at EDI Academy.

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