EDI Agreements
Are you new to EDI (Electronic Data Interchange) agreements? EDI Agreements are contracts between a medical provider and the health insurance carrier to submit claims electronically. Not all health insurance carriers require EDI agreements for claims but the main ones like Medicare, Medicaid, Blue Cross Blue Shield require EDI agreements to be completed.
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Once the EDI Agreements are setup and approved then medical claims 837P or 837I can be tested and submitted for electronic processing.
All claims submitted goes through two different departments for processing. The first is the Clearinghouse where they will acknowledge they have received the claim and the second is passing the Health Insurance Carriers EDI department. Once it passes these two levels it goes on for claim processing.
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Most clearinghouses offer 3 different options for data transfer inlcuding Patient Eligibility Verification (270/271), Medical Claims (837P, 837I and 837D) along with Electronic Remittance Advice (835) also known as Explanation of benefits or EOB's. Depending on the type of transmission your medical office is looking for you may or may not be required to complete a EDI agreement.
If you are interested in learning more about setting up Electronic Data Interchange (EDI) Agreements please visit our FREE Medical training video series.
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