What is an 834 companion guide?
This companion guide contains detailed information about how the Federally facilitated Exchanges (FFE) will use the ASC X12 Benefit Enrollment and Maintenance (834) transaction, based on the 005010X220 Implementation Guide and its associated 005010X220A1 addenda. 1.2. Companion Guides.
What is an 834 transaction set?
The EDI 834 transaction set represents a Benefit Enrollment and Maintenance document. It is used by employers, as well as unions, government agencies or insurance agencies, to enroll members in a healthcare benefit plan.
What is an 834 file in healthcare?
Simply, an EDI 834 file is a benefit enrollment and maintenance document that must abide by HIPAA 5010 standards. This file is used by a multitude of organizations, such as employers, TPAs and insurance agencies, for enrolling their members directly into a benefit plan.
What is an EDI 837?
EDI 837 is the format established to meet HIPAA requirements for the electronic submission of healthcare claim information. It’s the electronic equivalent of the CMS-1500. The information in the EDI 837 file typically includes: A description of the patient. The patient’s condition related to the provided treatment.
What is a 278?
The EDI 278 transaction set is called Health Care Services Review Information. A healthcare provider, such as a hospital, will send a 278 transaction to request an authorization from a payer, such as an insurance company.
What is a Hipaa 834?
The HIPAA 834 file format is used for communications between employee benefit plans and insurance plans. These benefit plans include dental, vision, disability, and medical plans. Insurance carriers use the HIPAA 834 format to communicate with employers about health insurance benefit enrollment and maintenance data.
What is an X12 834?
The 834 EDI document type is an electronic version of a paper Benefit Enrollment and Maintenance. Standard EDI formats include X12, ANSI, EDIFACT and its subsets. The 834 EDI document type is used to establish communication between the sponsor of an insurance product and the payer.
What is a HIPAA 834 transaction?
Under HIPAA, electronic transactions are communications between two parties that relate to the provision of healthcare. HIPAA 834 is the specific format that employers must use when they electronically communicate employee health insurance benefit enrollment and maintenance data to employee health plans.
What are EDI feeds?
What is EDI? EDI is the electronic communication of information through a standard format, creating a paperless exchange of information. In benefits, that format is referred to as HIPAA 834. File feeds, or data feeds, are mechanisms for delivering streams of data from one database to another.
What is a 277 in EDI?
The Claim Status Response (277) transaction is used to respond to a request inquiry about the status of a claim after it has been sent to a payer, whether submitted on paper or electronically. Once we return an acknowledgment that a claim has been accepted, it should be available for query as a claim status search.
What is 837i and 837p?
The 837i is the electronic version of the paper form UB-04. 837i files are used to transmit institutional claims. Institutional claims are those submitted by hospitals and skilled nursing facilities. The 837p is the electronic version of the CMS-1500 form. 837p files are used to transmit professional claims.
Which 834 uses are included in this companion guide?
Other 834 uses detailed in this companion guide include cancellations, terminations, reinstatements and changes to existing health coverage enrollments. Figure 1 outlines the high level steps and interactions between the FFE, Hub, and QHP Issuers.
What is the ASC X12 Benefit Enrollment and maintenance (834) transaction number?
Standard Companion Guide Transaction Information Instructions related to the ASC X12 Benefit Enrollment and Maintenance (834) transaction, based on the 005010X220 Implementation Guide and its associated 005010X220A1 addenda for the Federally facilitated Exchange (FFE) Companion Guide Version Number: 1.5 March 22, 2013
How do I interpret a 834 code?
Codes should be interpreted with the LA Description as shown bolded below the 834 code set definition. 834 Code Description LA Code 7 Not Provided 9 (UNKOWN) A4Asian or Pacific Islander
What is an 834 effectuation confirmation transaction?
This effectuation confirmation transaction will contain information assigned by the QHP Issuer and be stored within the FFE data store. Other 834 uses detailed in this companion guide include cancellations, terminations, reinstatements and changes to existing health coverage enrollments.