EDI Resource Center
Health Insurance Portability and Accountability ACT (HIPAA)
The Health Insurance Portability and Accountability ACT (HIPAA), passed in 1996 in the U.S., requires millions of healthcare entities who electronically transmit data to use EDI in a standard HIPAA format.
HIPAA EDI is a set of data transmission specifications strictly governing how to electronically transmit sensitive data from one computer to another. It defines the different types of covered transactions and stipulates the exact format for each transaction record.
Its intent is to reduce the hundreds of healthcare data formats previously in use to just one, universally implemented healthcare data standard. This uniformity greatly increases the portability and accessibility of health-related information and slashes administrative costs associated with managing a previously clunky process.
Industries Using HIPAA
- Healthcare
- Health Insurance
Types of HIPAA Transactions
HIPAA EDI governs a nearly every type of electronic data transaction, including:
- Healthcare claims
- Claims status
- Remittance Advice (RA)
- Eligibility verifications and responses
- Referrals and authorizations
- Coordination of benefits (COB)
- And many more
Age
- Standards were set for the transfer of healthcare data in 1991
- In 1996, the U.S. Federal HIPAA law mandated standard data transactions in healthcare
- In 2001, doctors, hospital, health plans and clearinghouses began implementing EDI
- In 2003, all medical parties were required to fully implement EDI
Governing Body
- U.S. Federal Law mandates the use of HIPAA EDI in healthcare
- The American National Standards Institute (ANSI) governs X12, the adopted standard format for HIPAA EDI transactions