Electronic Data Interchange (EDI)

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) requires that Medicaid and all other health insurance payers in the United States comply with the Electronic Data Interchange (EDI) standards for health care as established by the Secretary of Health and Human Services. Electronic Data Interchange (EDI) is a set of standards for structuring information to be electronically exchanged between and within businesses, organizations, government entities and other groups. These transactions are electronic exchanges relating the shift of information between two parties for precise purpose.

INTRODUCTION:

Electronic Data Interchange (EDI) is a set of standards for structuring information to be electronically exchanged between and within businesses, organizations, government entities and other groups. There are variety of network for each industry where EDI is used. These networks are used to exchange information that would traditionally be exchanged between two parties. Another term is electronic commence which is widely used to describe the paperless exchange of information or data. EDI allows transactions to be exchanged between computer from one organization to computer of another organization. EDI helps the paperless industry to be more organized by mandating the industry standards like HIPAA in healthcare. 

What is HIPAA EDI?

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) requires that Medicaid and all other health insurance payers in the United States comply with the Electronic Data Interchange (EDI) standards for health care as established by the Secretary of Health and Human Services.

Objective:
  1. Understand and justify the role of the EDI resource in the healthcare IT domain
  2. Describe the EDI transactions use in healthcare and IT stakeholders
  3. Understand the healthcare (Payer and Provider) data submission process
  4. Understand the importance of EDI exchange and data handling
  5. Understand and use the basic principles and rules of EDI transactions
  6. Understand and use basic loop and data segments with corresponding values
  7. Understand the HIPAA documentation
  8. EDI mapping functional and non-functional requirements
  9. Understand and gain hands on experience about the basic competencies required to work as a BA in the healthcare IT sector
  10. Learn how the healthcare market place or exchange work
  11. Learn about EDI data analyst role
  12. Be aware of employers need when applying for any EDI job
  13. Understand how to find best suited position of Healthcare Business Analyst
KEY FEATURES
  1. 20+ Hrs of High Quality e-Learning Content
  2. Transaction covered – 834/837/276/277/275/278/835 etc
  3. Health Care (HIPAA) EDI Training Fundamentals
  4. Heatlhcare care Exchange (HIX)
  5. Heatlcare Market Place
  6. Self-Paced High quality e-Learning content
  7. 24/7 on demand Support
  8. Real time projects
ELIGIBILITY

Anyone having a general understanding of computer with good communication skills can opt for Business Analysis course. This course is suitable for:

  1. Students with a Bachelor or Master’s degree in any stream.
  2. Self-taught IT Business Analysts and Quality Assurance wanting to fill in the gaps and put all the pieces together
  3. Technical people who are interested in expanding their role into Healthcare IT.
  4. Executives and Managers want to get into Healthcare Industry
  5. People who want to start their career in IT / EDI
  6. Need to have Healthcare EDI domain knowledge to complete your job
  7. The course is also suited to anyone embarking on a career within IT or project management who requires an understanding of the Healthcare IT domain as Business Analyst role and the need for robust requirements.

CURRICULUM

 

Healthcare Fundamentals
  1. Introduction to Healthcare IT
  2. Branching Of Healthcare
  3. Framework of Healthcare Branches
  4. Healthcare Statistics
  5. Major developments in Healthcare
Office & Patient Management
  1. Information Exchange
  2. Medical Record
  3. Managing New Patients
  4. Managing Established Patients
  5. Clean Claim
3. CMS 1500
  1. When To Use
  2. How To Use
  3. Sample CMS 1500 Form
  4. Patient Information
4. Uniform billing
  1. When To Use
  2. How To Use
  3. Sample UB 04 Form
  4. Inpatient Information
  5. Outpatient Information
5. Coding overview
  1. CPT Coding
  2. Modifiers
  3. Unlisted Codes
  4. HCPC National Level II Codes
  5. CPT Coding with Manual
6. Overview of ICD codes
  1. ICD History
  2. Why ICD codes?
  3. ICD Codes – What does it tell us?
  4. Use of ICD codes
  5. Anatomy and Terminology for Coders
  6. Advanced Anatomy and Terminology for Coders
  7. Coding for the Non-Coder
7. ICD 9 Vs ICD 10 History
  1. Why ICD-10 over ICD-9
  2. ICD-9 Vs. ICD-10
  3. ICD-10 CM Diagnosis Code – Overview
  4. ICD-10 PCS Procedure Code – Overview
8. ICD-10 codes
  1. Preparation Analyzer
  2. Anatomy and Terminology Essentials from an ICD-10-CM Perspective
  3. Anatomy and Terminology Essentials from an ICD-10-PCS Perspective
  4. General Equivalence Mappings (GEMs)
  5. ICD 10 Implementation phases
  6. ICD-10 Release Timeliness
  7. ICD-10 Impact to Payer
9. Overview Of Electronic Data Interchange
  1. History Of EDI
  2. EDI X12 Transaction Sets
  3. EDI HL7
10. What goes inside EDI TRANSACTIONS / MAPPING?
  1. 270 – Health Care Eligibility Benefit Inquiry and Response
  2. 271 – Health Care Eligibility Response
  3. 276 – Health Care Claim Status Request
  4. 277 – Health Care Claim Status Response
  5. 278 – Health Care Services Review – Request for Review and Response
  6. 837 – Health Care Claim Institutional, Dental, Professional
  7. 835 – Health Care Claim Payment / Advice
  8. 834 – Benefit Enrollment and Maintenance
  9. 820 – Payroll Deducted and Other Group Premium Payment for Insurance Products
11. Health Insurance Exchange?
  1. Introduction of HIX
  2. Introduction to HUB
  3. State Exchange Overview
  4. 1095 Tax Form and its usage
  5. 8962 Form & usage
12. Case Study

 

13. Resume & Interview Guideline
What will you learn?
You will also learn about why and where to use HIPAA EDI, how to use a paperless system, how HIPAA play a role in EDI and HIPAA standards and best practices. Real-time documents used to teach the students about HIPAA transactions and relation between different transactions such as 270, 271, 275, 276, 277, 278, 820, 834, 835, 837, 999 and HL7. HIPAA Mapping Guides, companion vs implementation guide, HIX and Market place covered during the training.
What is transaction?
Transactions are electronic exchanges relating the shift of information between two parties for precise purposes. Loop is the highest level in the transaction set and data element is the lowest level.
What are the HIPAA transactions?
These are the EDI transactions in healthcare: * Benefit Enrollment & Maintenance (834) * Claim/Encounter (837) * Payment & Remittance Advice (835) * Premium Billing (811) * Premium Payment (820) * Eligibility Inquiry & Response (270/271) * Claim Status Inquiry & Response (276/277) * Patient Information (275) * Health Care Service Review (278)
What is the prerequisite for EDI training?
Knowledge of Healthcare business domain and the terminology.
Why EDI understanding is important?
Understanding loop, segment and the data element is essential for the Business analyst, QA and system analyst because you may be required to investigate or analyze the data and find the root cause In that case if you do not know how the data structure is and how to read it? It will be difficult for you.
What is 834?
* The EDI 834 transaction set represents a Benefit Enrollment and Maintenance document. It is used by employers, as well as unions, government agencies or insurance agencies, to enroll members in a healthcare benefit plan.
What is 999?
The EDI 837 transaction set is the format established to meet HIPAA requirements for the electronic submission of healthcare claim information. The claim information included amounts to the following, for a single care encounter between patient and provider.
What is 837?
The EDI 837 transaction set is the format established to meet HIPAA requirements for the electronic submission of healthcare claim information. The claim information included amounts to the following, for a single care encounter between patient and provider. This is the transition of CMS-1500 paper claim form fields to the ANSI -837 Professional format electronic data elements. What are the types of 837? There are three types on 837 file: *837 I-Used for institutional claims. *837 P=Used for professional claims and *837 D- Used for dental claims submission process.
What is 835?
The 835 is used primarily by Healthcare insurance plans to make payments to healthcare providers, to provide Explanations of Benefits (EOBs), or both. When a healthcare service provider submits an 837 Health Care Claim, the insurance plan uses the 835 to detail the payment to that claim.
What is 811 transactions?
The EDI 811 transaction set is a Consolidated Service Invoice/Statement. This transaction is used in place of the paper invoice or statement for very complex and structured billing applications.
What is 820?
In healthcare, the 820 is similar to the EDI 835 transaction set. The 820 is specifically for plan sponsors – that is, companies providing healthcare benefits to their employees – to transmit information on premium payments to the health plans.
What is 270 & 271?
The EDI 270 Health Care Eligibility/Benefit Inquiry transaction set is used to request information from a healthcare insurance plan about a policy’s coverage's, typically in relation to a particular plan subscriber. The 271 is the Health Care Eligibility/Benefit Response and is used to transmit the information requested in a 270.
Explain 276 & 277 !
Similar to 270 and 271 , these transaction are also used as a request and response. The EDI 276 transaction set is a Health Care Claim Status Inquiry. It is used by healthcare providers to verify the status of a claim submitted previously to a payer, such as an insurance company, HMO, government agency like Medicare or Medicaid, etc.

This course is designed for clearing interview for the Healthcare EDI positions. At the end of the course there will be a quiz and project assignments once you complete them you will be awarded with Elearningline Course Completion certificate.

Aaryan Kapur

The EDI course is nicely designed for all. I liked the study material. They are easy to understand and very well organised. I did not face any issue during my course with study material. Also my instructor Sushmita was a big help throughout. She is knowledgeable and has immense skill on EDI. Thanks E-Learning Line for this course.

Anoushka Kajaria

I have taken EDI course with e-Learning Line. It was instructor led online course that I opted for and I must say my instructor was excellent. She has immense knowledge of the course and she has a huge help for me throughout the class. I am very lucky to be a part of e-Learning Line education. I would definitely like to take up other course under e-Learning Line.

Prakash Jain

Trainer brings a lot of excitement to her class and teaching, even for us who have no IT background. EDI class by trainer is a well thought through program. She poses distinct teaching skills and is ever ready to answer each and every question in her class. Her major concern has always been for students to grasp the principles and concepts of the course and topics rather than just answering her questions.

Vinay Iyer

I am currently doing EDI Class from e-Learning Line. My Instructor is an expert in the relevant field. She teaches perfectly and keeps helping all of the candidates nicely. Especially the projects and case studies were very apt and related to real life. She shares a lot of her experiences with us so that we can apply them to the real time projects.

Kriti Gupta

I am currently enrolled in the EDI Analyst. The instructor has been great from day one. She brings a lot of excitement to her class and teaching. She is having in depth knowledge of EDI and the best part of her is she has skills to transfer her knowledge to the entire batch.

 

  Self Paced Learning

 149.00

 Contact Us

 848-200-0448
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 Course Features

20+ Hrs e-Learning Content
20+ Hrs of High Quality e-Learning Content
Transaction – 834/837/276/277/275/278/835
Transaction covered – 834/837/276/277/275/278/835 etc
Heatlhcare care Exchange (HIX)
Knowledge of Heatlhcare care Exchange (HIX)
HIPAA EDI Training
Health Care (HIPAA) EDI Training
Real time projects
Real time projects

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