What is EDI Healthcare claim transaction?

With established message formats and standards, electronic data interchange (EDI) transactions safely transfer data within healthcare organizations, insurers, and patients. The EDI system decreases data exchange and interpretation costs, addresses conversion issues and enhances healthcare interoperability. All EDI transactions in the healthcare industry must adhere to common standards in order for health plans, clearinghouses, and healthcare providers to exchange medical records electronically in a HIPAA-compliant fashion. Electronic health records are secure and accurate thanks to EDI solutions. Everyone involved in the integration of medical EDI must adhere to accurate data specifications. For instance, if the information is sent to a computer that will receive it, the programmed for electronic data interchange converts it into a language that is not human. Every documentation set used by electronic data solutions has a standard code given to it. 

• Providers and patients can access and electronic data exchange through activities involving healthcare claims.
• Healthcare professionals and regulatory bodies can submit retail pharmacy claims through this transaction. Additionally, this EDI software solution sends payers information regarding medical billing payments and claims for retail pharmacy services.
• In order to pay healthcare providers, insurers use the healthcare claim payment/advice transaction.
• Benefits enrolling and maintenance – Unions, governmental organizations, insurance companies, associations, or healthcare organizations paying claims use this healthcare EDI software.
• This EDI transaction in healthcare makes premium payments for insurance products through payroll deduction and other group premium payments. In order to communicate with financial organization, healthcare providers use electronic data interchange.
• Healthcare organizations can transmit enquiries about subscriber eligibility and healthcare benefits to financial institutions and governments with the use of the electronic data interchange system.
• Responding to enquiries concerning a subscriber’s or dependent’s eligibility for healthcare benefits and other requests for information is the main goal of this electronic data interchange solution.
• Status of healthcare claims: With the use of this EDI service, healthcare providers can inquire about or confirm the standing of claims they have already submitted to payers like insurance companies.