HIPAA Electronic Data Interchange (EDI) Rule (The American Speech-Language-Hearing Association)
HIPAA Electronic Data Interchange Rule is very technical and based on the X12N EDI data transmission protocol standard. Although rare allowances are made, the rule requires that any covered entity who electronically transmits data must use this, and only this format in doing so. The EDI rule is a set of data transmission specifications that strictly govern the way data is electronically transferred from one computer to another. The rule specifically defines the different types of transactions that are covered under HIPAA and stipulates the exact format for each transaction record. Electronic transactions such as health care claims, claims status and remittance advices (RA), eligibility verifications and responses, referrals and authorizations, and coordination of benefits (COB) among others are included in the rule. Its intent is to reduce the hundreds of health care data formats to just one that is universally implemented throughout the health care industry. The objective is to greatly increase the portability and accessibility of this information and to decrease the administrative overhead associated with the management of the process.
Will there is a need to hire a consultant to comply with the EDI Rule?
Although it does not necessarily require the use of a consultant, the electronic data interchange (EDI) standards of HIPAA do necessitate a relatively sophisticated understanding of data transmission protocols. Key determinants of whether a consultant is needed to achieve compliance with the EDI standards are:
- Whether the provider will submit claims directly to the third party payer or electronically through an intermediary, and
- The technical sophistication of the organization’s information technology (IT) resources.
The HIPAA rules clearly expect that the response to the EDI rule will be based on the needs and resources of the provider. As long as all electronic transmissions are EDI compliant, the method of response is left up to their discretion.
To learn more about HIPAA EDI compliance and become a certified EDI Professional please visit our course schedule page.