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EDI X12 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, EDI X12 standards have been adopted with the aim of improving the efficiency and effectiveness of the healthcare system.


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 EDI X12 formats are based on the published standards – in the real world, deviations and differences between EDI X12 transactions are the norm. PilotFish EDI X12 Parser

EDI Parsing 837 XML Data Transformation

EDI X12 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. PilotFish 3-Pane EDI X12 Data Mapper

EDI Mapping with PilotFish

3-Pane EDI Data Mapping Example in PilotFish eiConsole

What are the HIPAA X12 Transaction Sets?

The key EDI X12 transaction sets specified by HIPAA include:

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

Read more about EDI X12 transaction formats and descriptions.

EDI X12 Transactions in PilotFish Integration Engine

EDI X12 Transaction Format Builder 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 EDI X12?

EDI X12 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. EDI X12 releases are known by a version number. Learn more about PilotFish’s Interface Engine with exclusive EDI X12 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 EDI X12 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 EDI X12 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 EDI X12 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 EDI X12 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 EDI X12 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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