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Formularios y Recursos

EDI Transaction Resources

Electronic Data Interchange (EDI) is an industry-standard method for the exchange of healthcare data, enacted by HIPAA (Health Insurance Portability and Accountability Act), and used to support consistent and secure transactions. Presbyterian utilizes the ANSI X12 EDI standards to minimize errors and increase efficient exchange of information between healthcare entities. To support your organization in configuring each transaction set and successfully exchanging data, we have provided the following resources for download. These resources are designed to help you understand and implement the necessary EDI standards, ensuring that your data exchanges are seamless, secure, and compliant with all requirements.

Benefits of EDI

  • Exchange information with multiple payers

  • Increase productivity and lower administrative costs

  • Send and receive information faster

  • Identify submission errors immediately and avoid process delays

Benefit Enrollment and Maintenance

The EDI 834 transaction, also known as ANSI X12 EDI 834, is an electronic exchange of Benefit Enrollment and Maintenance. This standardized format is used by employers, insurance agencies, government entities, and healthcare companies to enroll individuals in healthcare benefit plans. Compliant with HIPAA standards, the EDI 834 facilitates the electronic exchange of member enrollment details, benefits, plan subscriptions, and employee demographic information.

EDI 834 Benefit Enrollment Companion Guide

Healthcare Authorization Service and Review Information

The EDI 278 transaction, also known as ANSI X12 EDI 278, is an electronic exchange of Healthcare Authorization Service and Review Information. This standardized format allows healthcare providers, hospitals, and medical facilities to transfer authorization data to healthcare insurers/payors, enabling them to review proposed healthcare services to be provided to a patient.

EDI 278 Authorization Companion Guide

EDI X12 Supported Formats

Presbyterian supports the following X12 EDI formats for file transfer. (Companion Guides coming soon)

  • 270/271 – Eligibility, Coverage or Benefit Inquiry

  • 278 / 278 Response – Health Care Authorization Service and Review Info (Download Guide)

  • 276/277 – Health Care Claim Status Request/Notification

  • 834 – Benefit Enrolment and Maintenance (Download Guide)

  • 835 – Health Care Claim Payment/Advice

  • 837 – Health Care Claim

  • 277CA – Claims Acknowledgement

  • 820 – Payment Order/Remittance Advice