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HEALTHCARE EDI
X12 BASICS
By Sushmita Kumari
Topics
 What is EDI?
 What is X12 ?
 Transaction set
 Loop and Data segment
 Data Elements
 Sample of X12
EDI Introduction
EDI stands for Electronic Data Interchange which allow businesses to interchange data using a
standardized format rather than paper.
• These standards are defined by HIPAA for the healthcare market
• These are widely acceptable standards
EDI
What is X12?
American National Standard Institute chartered (ANSI) as Accredited Standard Committee
(ASC) to develop the standards which are uniform across the businesses for electronic data
interchange.
X12
Transaction Set /Loop /Segment
• Transaction set is considered as the functional grouping of data
Invoice
Transaction
Loop
Data
Segment
Data
Element
Data
Element
Loop
Data
Segment
Data
Element
Data
Element
Claim
Transaction
Loop
Data
Segment
Data
Element
Data
Element
Loop
Data
Segment
Data
Element
Data
Element
837 transaction Example
Sample data
ISA*00* *00* *ZZ*99999999999 *ZZ*888888888888 *111219*1340*
^*00501*000001377*0*T*>
GS*HC*99900999999*888888888888*20111219*1340*1377*X*005010X222
ST*837*0001*005010X222
BHT*0019*00*565743*20110523*154959*CH
NM1*41*2*SAMPLE INC*****46*496103
PER*IC*EDI DEPT*EM*CONTACTUS@ABC.COM*TE*3305551212
NM1*40*2*PPO BLUE*****46*54771
HL*1**20*1
PRV*BI*PXC*333600000X
NM1*85*2*EDI SPECIALTY SAMPLE*****XX*123456789
N3*1212 DEPOT DRIVE
N4*CHICAGO*IL*606930159
REF*EI*300123456
HL*2*1*22*1
SBR*P********BL

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Healthcare HIPAA Edi x12 basics 1

  • 2. Topics  What is EDI?  What is X12 ?  Transaction set  Loop and Data segment  Data Elements  Sample of X12
  • 3. EDI Introduction EDI stands for Electronic Data Interchange which allow businesses to interchange data using a standardized format rather than paper. • These standards are defined by HIPAA for the healthcare market • These are widely acceptable standards EDI
  • 4. What is X12? American National Standard Institute chartered (ANSI) as Accredited Standard Committee (ASC) to develop the standards which are uniform across the businesses for electronic data interchange. X12
  • 5. Transaction Set /Loop /Segment • Transaction set is considered as the functional grouping of data Invoice Transaction Loop Data Segment Data Element Data Element Loop Data Segment Data Element Data Element Claim Transaction Loop Data Segment Data Element Data Element Loop Data Segment Data Element Data Element
  • 7. Sample data ISA*00* *00* *ZZ*99999999999 *ZZ*888888888888 *111219*1340* ^*00501*000001377*0*T*> GS*HC*99900999999*888888888888*20111219*1340*1377*X*005010X222 ST*837*0001*005010X222 BHT*0019*00*565743*20110523*154959*CH NM1*41*2*SAMPLE INC*****46*496103 PER*IC*EDI DEPT*EM*CONTACTUS@ABC.COM*TE*3305551212 NM1*40*2*PPO BLUE*****46*54771 HL*1**20*1 PRV*BI*PXC*333600000X NM1*85*2*EDI SPECIALTY SAMPLE*****XX*123456789 N3*1212 DEPOT DRIVE N4*CHICAGO*IL*606930159 REF*EI*300123456 HL*2*1*22*1 SBR*P********BL