Electronic Data Interchange (EDI)
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Empire offers a range of electronic connectivity services to suit the various technology needs of our providers. The information on these web pages is provided as a courtesy to you. While we try to keep the information as accurate as possible, we disclaim any implied warranty or representation about the accuracy, completeness, or appropriateness of the information for a particular purpose. Persons accessing this information assume full responsibility for the use of the information and agree that Empire is not responsible or liable for any claim, loss or damage arising from the use of or reliance upon the information contained on these web pages or inability to access this site.
The information is designed for educational purposes only and is not legal advice and should not be used as a substitute for legal or other professional advice. Each person should consult with counsel, as appropriate, concerning the applicability of this information to the particulars of their situation.
What is EDI?
Electronic Data Interchange (EDI) is the computer-to-computer transfer of business-to-business document transactions and information between trading partners. Many healthcare partners, payors, vendors and fiscal intermediaries choose EDI as a fast, inexpensive, and safe method for automating the business processes that take place.
Are there standards for exchanging information in healthcare EDI?
The constituencies involved in health care, including healthcare partner organizations, payors, benefit plan sponsors, financial institutions and others have jointly developed and approved specific transaction sets, or standards, for use in sending and receiving healthcare information and transactions electronically. These EDI transaction sets and their associated approved American National Standards Institute (ANSI) ASC X12 transaction set numbers are listed below.
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Transaction Name
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ASC X12 Transaction
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Reference
Implementation Guide (IG)
Washington Publishing Co.
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Health Care Claim (Institutional, Professional)
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837I, 837P
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www.wpc-edi.com/hipaa
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Health Care Claim Payment / Advice (ERA)
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835
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www.wpc-edi.com/hipaa
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Health Care Eligibility
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270/271
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www.wpc-edi.com/hipaa
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Health Care Claim Status
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276/277
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www.wpc-edi.com/hipaa
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Health Care Prior Authorization
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278
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www.wpc-edi.com/hipaa
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What are the benefits derived from using these standards?
 | Keeping healthcare affordable to the end consumer. |
| Improving accuracy of information exchanged between healthcare participants, improving the quality of healthcare delivery and its supporting processes. |
| Making enhanced information available to all healthcare participants as appropriate. This access ensures fast, reliable, accurate, secure and detailed information on patients and healthcare partner plans. |
EDI Services is committed to delivering the value that EDI brings to all healthcare participants.
For any questions, contact our EDI Representatives:
Monday through Friday, 8:00am – 4:30pm
Phone: 1-866-889-7322
Email address: EDIHelpdesk-NE@wellpoint.com
For more information click on the links below:
National Government Services (NGS) – for Medicare Part A & Part B trading partners
Empire BlueCross BlueShield Commercial Business – for trading partners enrolled to exchange electronic transactions via the Empire NY Gateway
Trading Partner Enrollment Form – Required for enrolling in any supported EDI transaction
Trading Partner Agreement – Required to be signed/acknowledged before exchanging any supported EDI transaction
Approved Clearinghouse & Vendor Listing – Required for choosing approved clearinghouse organizations that have successfully tested electronic transactions via the Empire NY Gateway
Web-Based Claims Submission & Electronic Options – We are partnering with MD On-Line, Inc., a leading national clearinghouse, to offer professional providers the ability to exchange secure HIPAA-compliant transactions with Empire BlueCross BlueShield through a web-based suite of services – at no charge. The only requirement for professional providers is a personal computer with Internet access. Take advantage of the free online service and reduce administrative expenses.
Physician Online Services – Option for exchanging electronic transactions – member search, claims submission, payment, and Precertification.
HIPAA – Latest HIPAA News and Resources
NPI FAQs – Latest NPI News
EDI Communications – Latest EDI Publications
Latest News - Alerts, reminders, important EDI announcements
EDI Seminars - Schedule of Provider Outreach Seminars and Events
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