The Electronic Data Interchange (EDI) process for onboarding new trading partners to exchange Healthcare EDI files can be performed using files conforming to ANSI X12 specifications. This can be done manually with our FREE EDI Editor download or automatically using an EDI Gateway software solution. These Claim, Payment, and¬ Remittance Advice files may originate from payers, providers, clearinghouses, or third party administrators (TPAs). One prevalent hurdle in sending or receiving these HIPAA transactions is the often complex onboarding process of new EDI trading partners.
Figure¬ 1: Trading Partner Information in 837 file.
The¬ onboarding process for new trading partners requires that both the sender and receiver mutually agree on the content of the header fields. A X12 formatted file header consists of the following, shown in the first three lines of the above 837 claim file sample.
- Interchange Control Header Segment (ISA) – Indicates the start of at least one Functional Group (GS) and provides the various identifiers, separators, and options used to successfully parse the file interpret its contents. This is the only segment that has a fixed length.
- Functional Group Header (GS) – Indicates the beginning of a (functional) group of Transaction Sets (ST).
- Transaction Set Header (ST) – Indicates the start of a single transaction set, it’s type such as 837 claim or 834 enrollment and version, for example, 005010.
Focusing again on the sample claim file we can begin to extract the information needed for the successful consumption of the file. This requires picking out several values, but we can focus on a few notable values and their purpose. This process is done automatically in the T-Connect EDI Gateway solution.
EDI File Delimiters
- Element Delimiter – Specified by the fourth character in the file ‘*’ separates each individual element in the file. Taking the first line as an example, ISA01 is the element after the first asterisk ’00’, ISA16 is element after the last asterisk ‘:’.
- Component Element Separator (ISA16) – ‘:’ delimits elements that may comprise of multiple components.
- Segment Terminator – Specified by the character immediately after ISA16 shows that the character ‘~’ is used to separate each segment. The above sample shows one segment per line
EDI File Envelope Settings
- Acknowledgment Requested (ISA13) – Displayed by a ‘1’ or ‘0’ instructing the recipient if an acknowledgment (999) is or is not required.
- Interchange Usage Indicator (ISA14) – Labels the interchange as consisting of test (T) or production (P) data.
- Sender ID Qualifier (ISA05) and Receiver ID Qualifier (ISA07) – Both ‘ZZ’ in the sample designates the type of ID that it qualifies. A value of ’30’ would present a Tax ID designated by the IRS. ‘ZZ’ is used to signify that no particular authority assigned ID numbers, but they have been mutually agreed upon by the sender and receiver.
- Sender ID (ISA06) and Receiver ID (ISA08) – The actual identifiers for the sender and receiver, qualified by the ISA05 and 07 qualifiers.
Typical EDI Onboarding Scenarios
By this point, you may start to realize that EDI files are pretty complex. Even the quick look through the few data elements within the first lines of the file can seem overwhelming. Indeed, the process of setting up a trading partner within most systems is an arduous process. Typically integration platforms or gateways may require you to navigate through a maze of wizards and interfaces, each requiring intimate knowledge of EDI to understand. Doing this to onboard a few partners may not present much of an issue, multiplied by tens, or even hundreds, and the time investment without the proper EDI Gateway becomes unmanageable.
Rapid EDI Onboarding with T-Connect
An easier way to set up trading partners is by using a partner’s EDI file and extracting the necessary values to satisfy the requisite setup. The T-Connect EDI Gateway¬ operates in this manner, using any X12 EDI file to create the trading partners and agreements between the partners in seconds. The partner upload feature also takes care to re-use any existing partners if the sender or receiver partner is pre-existing.
After uploading, the trading partner can be edited if desired, but is otherwise immediately used for validating incoming files – without the need to restart services or deploy artifacts!
Caliber Health EDI Software Company
Caliber Health provides¬ EDI Gateway¬ solutions¬ can reduce your trading partner EDI onboarding woes. But that’s just a sample of what can be achieved. Our software also facilitates¬ EDI encounter management and X12 validation with 999 acknowledgements. We¬ tailor our solutions to your unique requirements and can have your team up and running in a days, not months.¬ To begin a conversation with our Caliber Health or compare EDI software¬ visit our website. Let’s¬ discuss how we can improve your EDI processing capabilities.