HIPAA and EDI

Electronic data interchange (EDI) transactions have been in use for decades in the financial and retail industries, but the healthcare industry had been slow to adopt any standards that would broadly enable the transmission of healthcare information until it was mandated by the Administrative Simplifications provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA Title II). Title II requires that the Department of Health and Human Services (HHS) create standards for the use and dissemination of healthcare data.

EDI X12 Data Format

The EDI X12 data format is the current standard used by the healthcare industry in the United States. There are multiple versions (releases) of this standard, and each release contains a set of message types that “define” the electronic version of a paper-based document, such as an invoice, a purchase order, or a healthcare claim. Each message type has a specific number assigned to it instead of a name. For example, an invoice is an 810, a purchase order is an 850, and a healthcare claim is an 837.