EDI 834 Enrollment

EDI 834 Enrollment And Maintenance File (Caliber Health) EDI 834 is the Benefit Enrollment transaction type found in the X12 transaction set directory. It is used by government agencies, employers, and health plans to enroll and maintain membership in a healthcare benefit plan and can be processed utilizing Healthcare EDI software. The EDI 834 spec is Read More →

EDI 834 Exercise

EDI 834 Exercise: Check Your HIPAA Mapping Skills EDI 834 transaction set (Benefit Enrollment and Maintenance Transaction) has been specified by HIPAA 5010 standards for the electronic exchange of member enrollment information, including benefits, plan subscription and employee demographic information. It is used to establish communication between the sponsor of the insurance product and the payer. Also in EDI Read More →

EDI 271 Mapping

EDI 271 Mapping Exercise: Check Your EDI Skills EDI 271 Mapping Exercise is an easy way to check your EDI knowledge and practical skills. The 271 transaction is the EDI function that responds eligibility and benefit information of the patient. It is set to receive care, from the Insurance Company to the Provider of Service. Read More →

EDI Claims Reporting

EDI Claims Reporting Requirements (Iowa DWC) The DWC will work with the DWC Vendor to provide initial and ongoing training and guidance to trading partners who need assistance regarding the proper reporting of claim information via EDI. It is imperative that trading partners become familiar with the Iowa EDI Claims Release 3.1 Event Table to Read More →

EDI Partnership

Iowa DWC EDI Partnership Basic Requirements Iowa DWC EDI Partnership program includes a Request for Proposal (RFP) process to contract for a Vendor (DWC Vendor) to facilitate EDI Claims filing for Iowa’s workers’ compensation carriers and self-insured employers and/or their claims administrators. In the context of EDI, claims administrators, carriers, self-insured employers, and/or their contracted vendors Read More →

EDI Claims Reporting

Evolution of the EDI Claims Reporting Standards In the 1970s, various state legislatures began questioning how their workers’ compensation systems were working compared to other state systems, and in the 1980s the International Association of Industrial Accident Boards and Commissions (IAIABC) created a Statistics Committee, whose task it was to identify, compare, and standardize injury Read More →

Iowa DWC EDI Claims

Iowa DWC EDI Claims Release Iowa DWC (Iowa Division of Workers’ Compensation) EDI Claims system is used for receiving claims submissions via Electronic Data Interchange. This solution provides a means for the State of Iowa to manage its Workers’ Compensation Act required reporting efficiently and accurately. EDI Claims for First Report of Injury (FROI) and EDI Read More →

EDI FAQs

Louisianna Workforce Commission EDI FAQs EDI is used in nearly all the major industries such as insurance, automotive, retail, and finance sectors. EDI is regarded as the standard for the electronic exchange of documents from one company to another. Find below Frequently Asked Questions for LWC trading partners. How do I decide which submission method to Read More →

LWC EDI

LWC EDI FAQs (Louisiana Workforce Commission) LWC EDI serves for the exchange of business documents, such as First Reports Of Injury (FROIs) and Subsequent Reports Of Injury (SROIs), between trading partners in a common format directly from one computer to another. Find below Frequently Asked Questions for LWC trading partners. Who typically uses EDI? EDI Read More →

EDI 837

Health Net EDI 837 Professional and Institutional Submissions Mapping Guides Health Net requires at least one ST and one SE record per Submitter ID within a submission. This means that Health Net requires one ST and one SE for each unique occurrence of the 1000A NM109 Submitter ID field. Health Net does not want any additional ST/SE Read More →