EDI SYSTEMS

What is HIPAA?

The Health Insurance Portability and Accountability Act (HIPAA) is a U.S. federal law enacted in 1996 to enhance the efficiency and security of healthcare systems. HIPAA mandates national standards for the protection of patient data and governs the secure handling of electronic healthcare transactions.

Healthcare organizations must adhere to HIPAA Privacy, Security, and Transaction rules when transmitting health information electronically.

HIPAA Administrative Simplification

The Administrative Simplification provisions of HIPAA require healthcare providers, health plans, and clearinghouses to use standardized EDI formats for electronic transactions. These standards are governed by the ASC X12 and NCPDP data formats.

Benefits of Administrative Simplification include:

Standardized Data

Ensure consistent and standardized EDI formats across all trading partners

Faster Claims

Accelerate reimbursement timelines with efficient processing.

Smart Process

Reduce paperwork and cut down on administrative expenses.

Secure Data

Ensure data privacy and security during healthcare exchanges.

EDI Systems Solutions provides a broad range of quality HIPAA EDI solutions designed to enable companies to communicate business data electronically.

All of our HIPAA EDI products and services provide extremely reliable and affordable methods of connecting to trading partners, transforming data, and integrating into existing business processes.

The Administrative Simplification provision of HIPAA requires the utilization of EDI as the standard for the exchange of health care related messages. This provides a common standard for documents that all parties involved in the health care process may follow.

HIPAA EDI Standards Covered

270/271: Eligibility Verification

Check patient insurance eligibility in real-time.

837: Claims Submission

Submit healthcare claims electronically in standard formats.

276/277: Claim Status Inquiry

Monitor the claim status of submitted claims.

835: Remittance Advice

Receive electronic explanation of payment from payers.

834: Enrollment/Disenrollment

Manage health plan enrollments electronically.

820: Premium Payments

Submit electronic premium payments to health plans.

HIPAA Mapping & Expertise

EDI Systems has the infrastructure and expertise to fulfill your HIPAA EDI requirements. With over 8 years of experience in:

EDI mapping and translation
System integration (e.g., claims management)
HIPAA and guide compliance
Secure message exchange

HIPAA Compliance & EDI

Key Compliance Features

Data encryption in transit and at rest
Role-based access control
Audit logging of transactions
Security Rule adherence
Patch and update management

Who Must Comply?

Hospitals and Clinics
Physicians and Specialists
Health Insurers
Medical Billing Services
Clearinghouses
Healthcare Software Vendors

Reach out to learn more about our comprehensive HIPAA EDI solutions tailored for your business.

HIPAA 5010

HIPAA Overview