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X12 EDI Frequently Asked Questions


 Electronic Data Interchange (EDI) is used across economic sectors and key business functions to support standardized electronic communications. Today, more than 300,000 organizations use the 300+ EDI defined transaction sets to conduct business. In healthcare, X12 EDI standards have been adopted with the aim of improving the efficiency and effectiveness of the healthcare system.


What are the HIPAA X12 Transaction Sets?

The key X12 EDI transaction sets specified by HIPAA include:

EDI 837 Health Care Claim and Maintenance
EDI 835 Health Care Claim Payment/Advice
EDI 834 Benefit Enrollment and Maintenance
EDI 820 Payroll Deducted and other group Premium Payment for Insurance Products
EDI 270 Health Care Eligibility/Benefit Inquiry
EDI 271 Health Care Eligibility/Benefit Response
EDI 276 Health Care Claim Status Request
EDI 277 Health Care Claim Status Notification
EDI 278 Health Care Service Review Information
EDI 999 Functional Acknowledgement

EDI X12 Transactions in PilotFish Integration Engine

X12 EDI Transaction Format Builder in PilotFish eiConsole


What X12 EDI Supply Chain Transactions are used in Healthcare?

Common Types of X12 EDI Supply Chain Transactions include:

EDI 180 Return Notification and Authorization
EDI 810 Invoice
EDI 820 Payment Order and Remittance Advice
EDI 832 Price/Sales Catalog
EDI 846 Inventory Inquiry and Advice
EDI 850 Purchase Order
EDI 855 Purchase Order Acknowledgment
EDI 860 Purchase Order Change
EDI 864 Text Message
EDI 997 Functional Acknowledgment

EDI X12 810 transaction example in PilotFish Data Mapper

Example of EDI 810 Transaction in PilotFish Data Mapper


What is EDI Parsing?

EDI parsing is the process of matching the incoming data with a defined schema to identify, flag and/or fix data transformation issues. EDI parsing errors include data type mismatches, invalid records, incorrect values, incorrect segment and element usages, etc. While X12 EDI formats are based on the published standards – in the real world, deviations and differences between X12 EDI transactions are the norm. 

EDI Parsing 837 XML Data Transformation

X12 EDI Parsing Example in PilotFish eiConsole


What is EDI Mapping?

EDI mapping is the process through which EDI data is translated and transformed into a format more easily used or required by a trading partner or both. Data mapping is the capability to map source data fields to related target data fields in converting EDI to other formats such as XML, Excel, databases, JSON or other EDI formats. 

EDI Mapping with PilotFish

3-Pane EDI Data Mapping Example in PilotFish eiConsole


What is EDI?

Electronic data interchange (EDI) is the structured exchange of business documents between organizations by electronic means based on widely accepted and agreed to standards. EDI standards govern electronic data exchange in finance, government, healthcare, insurance, retail, transportation and more.

What does EDI stand for?

EDI is an abbreviation and shorthand for Electronic Data Interchange, a structured way to transmit data between computer systems using established message formats and standards. The businesses or organizations exchanging data are called trading partners in EDI terminology.

What is the X12 Format?

X12 is a standard for Electronic Data Interchange (EDI) developed and maintained by the American National Standards Institute (ANSI) Accredited Standards Committee (ASC). The X12 standard governs the exchange of business documents (e.g., purchase orders, invoices, healthcare claims, etc.) in standard electronic formats between trading partners – for example, EDI 837 Health Care Claim Transaction Set. PilotFish provides broad support for all X12 standards and HIPAA transactions.

What is X12 EDI?

X12 EDI is a data format based on ASC X12 standards developed by the American National Standards Institute (ANSI) Accredited Standards Committee (ASC). It is used to electronically exchange business documents in specified formats between two or more trading partners. X12 EDI releases are known by a version number. Learn more about PilotFish’s Interface Engine with exclusive X12 EDI tools to process all your transactions.

What is an EDI Transaction?

An EDI transaction set or EDI transaction is a group of one or more data segments representing a business document exchanged between trading partners to carry out financial or administrative activities – e.g., EDI 820 Payment/Remittance, EDI 999 Acknowledgment, EDI 834 Benefit Enrollment/Maintenance. The standard prescribes the formats, character sets and data elements used. View the format & description of the most common X12 EDI transactions.

What is Healthcare EDI?

Most commonly, healthcare EDI refers to the HIPAA (Health Insurance Portability and Accountability Act) rules requirement that any health plan, healthcare clearinghouse and healthcare provider transmit claims and other patient-identifiable health information in specific X12 EDI healthcare transaction sets. HIPAA EDI transactions include claims, encounters, eligibility, claim status inquiries, remittance advice and benefit enrollment.

What is HIPAA EDI?

In the electronic exchange of financial and administrative healthcare transactions, the Health Insurance Portability and Accountability Act (HIPAA) requires all health plans, healthcare clearinghouses and healthcare providers to use HIPAA X12 EDI transaction sets for claims submission, enrollment/disenrollment, eligibility, payment to provider, claims status, certification/ authorization and premium payment to health insurance plan.

What are Healthcare EDI Transactions?

In EDI, a single business document is called a “transaction set” or “message.” HIPAA requires all health plans, healthcare clearinghouses and healthcare providers to use HIPAA X12 EDI transaction sets for structured message exchange. Electronic transactions covered include healthcare claims, claims status and remittance advices, eligibility verifications and responses, referrals and authorizations, and coordination of benefits.

What is EDI Capable?

EDI capable is the ability to send and receive electronic business documents in a specific format based on established standards. It also refers to having in place an EDI solution that can streamline business workflows and onboard partners quickly. EDI capable can further encompass strategy and solutions that deliver efficiencies and high productivity. Learn more about PilotFish’s EDI Capable Integration Engine with built-in X12 EDI tools.


For more information, please call us at 813 864 8662 or click the link below to email us.

X12, chartered by the American National Standards Institute for more than 35 years, develops and maintains EDI standards and XML schemas.


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