HIPAA X12 EDI Training Bundle: The detailed course agenda

Learn about Health Care EDI Environment and dive into deep mapping. Register for a training bundle.

HIPAA EDI 101 – Introduction To The Health Care EDI Environment 

  • Introduction to the Health Care EDI Environment 
  • Health Care EDI Defined
  • Benefits of Health Care EDI
  • X12 Standards
  • X12N Workgroups
  • WEDI – Workgroup for Electronic Data Interchange
  • Software & Infrastructure for EDI (What’s a Translator & Mapper)
  • EDI Connectivity (e.g. SFTP, HTTPS, Web Services)

HIPAA EDI 110 – EDI Enveloping & TR3 Viewing

  • EDI Enveloping & TR3 Viewing 
  • EDI Enveloping ISA-GS-ST-SE
  • Key terms related to the structure of EDI (e.g. qualifier, segment, terminator, delimiter)
  • Instructions on using the TR3 manual to look at transactions, segments and data elements, situational rules and loops.
  • LOOP IDs – Deep Dive (HL,NM1,CLM,etc)
  • Instructions on viewing EDI Implementation Guides and Mapping Specs
  • Health Industry Related Code Sets – Clinical and Non-Clinical

HIPAA EDI 201 – Deciphering HIPAA EDI Transactions – Enrollment & Eligibility

  • Deciphering 834 Benefit Enrollment 005010X220A1 
  • 834 Update File
  • 834 Audit File
  • 834 Exchange Enrollment 005010X307
  • 820 Premium Payment 005010X218
  • Deciphering 270-271 Eligibility Enquiry and Response & 271 005010X279A1
  • 270 Eligibility Inquiry
  • 271 Response To Eligibility Inquiry
  • 278 Prior Authorizations and Referral Authorizations
  • CAQH Requirements – Real Time & Batch

HIPAA EDI 210 – Deciphering EDI Transactions – 837 Claims 

  • 837 Professional Claim 005010X222A1 
  • 837 Institutional Claim 005010X223A2
  • 837 Dental Claim 005010X223A2
  • HIPAA EDI 215 – Deciphering EDI Transactions – 835 Health Care Claim Payment/Advice and Acknowledgements
  • 277CA Claim Acknowledgment 005010X214
  • 276-277 Claim Status Inquiry & Response 005010X212
  • TA1 Acknowledgement
  • 999 Acknowledgement 005010X231
  • Medicare MAO Acknowledgments
  • Deciphering 835 005010X221A1
  • Claim Adjustment Group Codes
  • Claim Adjustment Reason Codes
  • Line Level Balancing
  • Claim Level Balancing
  • Transaction Level Balancing
  • Provider Level Adjustments
  • 835 Matching Logic

HIPAA EDI 401: Advanced 837 Coordination of Benefits & 277/RFAI & Encounters 

Part 1: SNIP Level Validation.

Part 2: COB In this session we will cover advanced 837 topics with different situational rules. In addition, we will walk you through several scenarios of Coordination of Benefits and show you how the 837 and the 835 are linked when more than one payer is involved. 

Part 3: Encounters Transmitting 837 Outbound to CMS (Center for Medicare and Medicaid Services) is a common practice for most health plans. The Encounter Data System (EDS) Companion Guide contains information to assist Medicare Advantage Organizations (MAOs) and other entities in the submission of encounter data. This class will go through the highlights of the Encounter Companion Guide for institutional and professional claim. We will also some highlights Medicaid claim companion guides for some states. We will show examples of 837 x12 transactions encounters. Part 4: 277/FRAI This combined section will cover the 277 Request for Additional Information along with the 275 Health Care attachments.

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