Handling Benefit Enrollment and Claims EDI Data using Centerprise

One of Astera’s Centerprise connectors, EDIConnect, offers a user friendly and intuitive user interface to accurately and efficiently handle bi-directional EDI data integration. It is scalable and powerful enough to fulfill entire EDI transaction processes. In this blog we are going to focus on how to handle benefit enrollment and healthcare claims data.


EDI 834 – Benefit Enrollment and Maintenance:

The EDI 834 transaction set represents a Benefit Enrollment and Maintenance document. It is a standard format for enrolling members in healthcare benefit plans. It helps electronically exchange health plan enrollment data between employers and health insurance carriers. The Health Insurance Portability and Accountability Act (HIPAA) requires all health plans or health insurance carriers to accept 834A Version 5010 which is a standard enrollment format.

The 834 document is submitted to transfer the enrollment information typically by the employer, to healthcare payer organizations who are responsible for payment of health claims and insurance/benefits. The recipient of an 834 transaction responds with a 999 Implementation Acknowledgement. This confirms whether the file was received and provides feedback on the acceptance of the document.

 

EDI 837 – Healthcare Claim:

The EDI 837 document is required for electronic submission of healthcare claims. It has a standard format established to meet HIPAA requirement for healthcare claim information. This document is used to submit health care claim billing information from healthcare service providers to sponsors.

Healthcare providers must be compliant with version 5010 of the HIPAA EDI standards. The 837 EDI transactions may be sent either directly or indirectly via clearinghouses.

 

EDIConnect

EDIConnect offers data mapping, validation, incoming file translation and information extraction as well as outgoing file construction and acknowledgement generation. EDIConnect also provides automation, process orchestration and job scheduling for automated translation and parsing of EDI documents. It is a complete solution for accurate and efficient bi-directional EDI data integration. It offers EDI capability in an intuitive user interface with visual tools to build bi-directional integration. With built-in transaction sets for incoming file translation and ingestion, advanced data mapping, validation, and correction capabilities to better manage data ingestion, fast and easy outgoing transaction construction, acknowledgement generation, and automation, process orchestration, and scheduling, EDIConnect delivers the power and scalability to meet the most demanding EDI needs within Centerprise.

Want to know more about EDIConnect? We’re covering our top four EDIConnect features over the next several weeks. Be sure to check back for the first installment!