HIPAA EDI, or Health Insurance Portability and Accountability Act Electronic Data Interchange, refers to the standardized electronic exchange of healthcare-related data between entities, ensuring secure and efficient communication in compliance with HIPAA regulations. HIPAA EDI standards define specific transaction sets that facilitate the electronic exchange of information, such as:
- Claims (837): Used by healthcare providers to submit billing claims to insurers.
- Eligibility Inquiry and Response (270/271): Allows providers to check patient insurance eligibility and benefits.
- Claim Status Inquiry and Response (276/277): Helps providers obtain the status of submitted claims.
- Payment and Remittance Advice (835): Enables insurers to inform providers about claim payments.
- Referral Authorization (278): Used to request and authorize referrals.
By adhering to these standards, healthcare organizations streamline their administrative processes, reduce paperwork, and enhance data accuracy. Compliance with HIPAA EDI requirements ensures the security and confidentiality of sensitive healthcare information during electronic transactions, improving overall efficiency and data integrity in the healthcare industry.
