HIPAA Compliance

HIPAA Compliance At Emdeon: Overview of HIPAA Legislation HIPAA Compliance (The Health Insurance Portability and Accountability Act) of 1996 carries provisions for administrative simplification. HIPAA Compliance requires the Secretary of the Department of Health and Human Services (HHS) to adopt standards to support the electronic exchange of administrative and financial health care transactions primarily between Read More →


CMS EDI Enforcement Notes and Guidelines for Emdeon Partners CMS EDI Enforcement guidelines described below refer to payers who continue to operate under contingency plans under the Centers for Medicare and Medicaid Services (CMS). Such payers may accept CMS EDI claims transactions in a HIPAA format but may not be prepared to accept or use Read More →

EDI Acknowledgment – Emdeon  Receiver Guidance This blog post represents EDI Acknowledgment Emdeon implementation guidance for supporting claim acknowledgment transactions in response to a received 837 5010 claim file. Emdeon strongly recommends that payers return EDI Acknowledgment, claim status, and ERA transaction responses. 837 5010 Claim EDI Acknowledgment file received from Emdeon Payer generated claim acknowledgement Read More →

EDI Control Segments (Envelopes)

EDI Control Segments (Envelopes) – Emdeon 837 Claims Notes EDI Control Segments (Envelopes) notes are given in today’s post to provide the information necessary to facilitate electronic interchange of healthcare transactions with Emdeon. Emdeon partners with hundreds of practice management system vendors to bring the connectivity to the network. EDI Control Segments (Envelopes) Necessary Points Read More →

EDI Acknowledgment Emdeon

EDI Acknowledgment – Emdeon Submitter Guidance EDI Acknowledgment Emdeon implementation guidance is given below in today’s post for supporting claim acknowledgment transactions in response to a submitted 837 5010 claim file. Emdeon strongly recommends that submitters accept EDI Acknowledgment transaction responses. 837 5010 EDI Acknowledgment File received from Submitters Emdeon generated EDI acknowledgment transactions in response Read More →

EDI communication protocols

EDI Communication Protocols and File Formats Accepted Emdeon allows connections using multiple EDI communication protocols. Each of the agreed EDI communication protocols is described below. Sterling Gentran® IBM® Sterling Gentran® is a third party product providing an EDI and data translation solution that supports multiple protocols. Emdeon supports connectivity with this product through one of Read More →

Emdeon EDI connectivity

Emdeon EDI connectivity and claims processing Emdeon EDI connectivity is a result of succesfuly completed testing phase between the two parties involved. Emdeon EDI testing consists of submitting EDI claims, validating the EDI data, and certifying multiple electronic transmissions. After all setting-up and testing procedures claims processing begins. The Submitter sends a file marked as (P) for Read More →


Test EDI files  Submission and Validation Guides The process of submitting test EDI files  varies based on the selected platform and the implementation method. During EDI implementation, you will log a ticket to the ON24/7 application that includes the following information: Tracking/Reference number Number of claims submitted Time and date of submission Submitter ID Line of Business Read More →

Emdeon EDI Testing

Emdeon EDI Testing and Certification Overview Emdeon 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 Read More →

Emdeon EDI

Emdeon EDI Enrollment Process Steps Emdeon EDI Enrollment is required to set up your system with access to the payers and transactions you need. This may include both Emdeon EDI Setup and Payer Registration. After completing your Emdeon EDI Enrollment, you may continue to Payer Enrollment. Emdeon provides the payer enrollment forms and manages the Read More →