AHCCCS EDI Communication Start Basic Requirements AHCCCS (Arizona Health Care Cost Containment System) EDI Communication should start from agreeing all questions related to submission of electronic transactions and data with EDI Customer Support. Information required for initial inquiry Customer Name Organization Name Customer Email Address Customer Telephone Number Health Plan ID, Provider ID and/or NPI, Submitter Read More →


HIPAA EDI 835 (Electronic Remittance Advice (ERA)) Mapping Test Do you feel comfortable with EDI 835 Electronic Remittance Advice (ERA)) Mapping? When someone sounds out EDI terms ISA, GS, ST, DTM, NM1, is it clear for you what this person means? We have prepared HIPAA EDI 835 Mapping Exercise  to check the level of your Health Care Read More →


HIPAA 837 Professional Quiz Scenario HIPAA 837 Professional Quiz will help to check you HIPAA EDI knowledge. Learn the following example: Patient Daisy Duck was referred to Dr. Ben Kildare by her doctor, Dr. Marcus Welby, MD. She saw Dr. Kildare, a skin specialist, on Nov. 16, 2015. She paid her co-pay of $10, at the Read More →


HIPAA EDI Quiz: Test your EDI knowledge on practical examples Do you feel comfortable with terms like Submitter, Receiver, Billing Provider or Payer for the Claim? When someone sounds out EDI terms ISA, GS, ST, DTM, NM1, is it clear for you what this person means? Do you agree that Diagnosis Code numbers are not Read More →

AHCCCS EDI Transactions

AHCCCS EDI Transactions (Control Segments/Envelopes) AHCCCS EDI transactions transmitted during a session or as a batch are identified by an interchange header segment (ISA) and trailer segment (IEA) which forms the envelope enclosing the transmission. Each ISA marks the beginning of the transmission and provides sender and receiver identification.  Only one set of ISA/IEA is accepted by Read More →

AHCCCS EDI Transmission

AHCCCS EDI Transmission Administrative Procedures AHCCCS EDI transmission procedures require that each trading partner must establish an SFTP/EFT user account in order to exchange electronic data with AHCCCS. To setup an SFTP/EFT user account, the Electronic Data Exchange Request and External User Affirmation Statement forms must be completed for each individual user accessing SFTP/EFT. It is Read More →


AHCCCS EDI Testing Procedures AHCCCS EDI trading partners are responsible for ensuring that their transactions are compliant with HIPAA mandates based on the types of testing described below. AHCCCS encourages providers and other entities to use either a third party tool or AHCCCS’ Community Manager tool to certify that the entity can produce and accept HIPAA Read More →

EDI Medical Bills

EDI Medical Bills Acceptance And Rejection by Florida Division of Workers’ Compensation EDI Medical Bills may have the following statuses: Acceptance, Acceptance with Error, Rejection, Not Processed, Withdrawal, Correction, Replacement. When submitting corrections for rejections, replacements (amended/readjusted/data cleanup), or withdrawals, use the same Control Number that was used in the original submission of the medical bill. Submitted Read More →

Medical EDI

Medical EDI Implementation Guide (Electronic Medical Report Submission) Medical EDI is the electronic submission of medical bills by all healthcare providers. The Medical EDI Team assists electronic medical submitters with the management of electronic medical filings. To allow comparison benchmarking among the insurance industry, the team generates monthly report cards that denote the primary reasons for Read More →

837 Healthcare Claim

837 Healthcare Claim Implementation Guides 837 healthcare claim can be compared to an invoice in the merchandising world. However, it is much more complicated than that and some consider it to be the most complicated EDI transaction set. The purpose of this transaction is to submit healthcare billing information from providers of healthcare services to payers, either directly or Read More →