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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 Process

3-Pane EDI Data Mapping Example in PilotFish eiConsole

How are EDI X12 Files Validated?

Several parts of an EDI message can have problems that corrupt or invalidate the message contents. The EDI specification includes SNIP Types (also known as SNIP Levels) that define checks to make sure a given EDI message passes specific criteria for being well-formed. PilotFish provides SNIP Types 1, 2 and 3 validation out of the box along with an additional EDI validation processor that can provide a preliminary overall sanity check.

What Application Software Converts XML to EDI and EDI to XML?

PilotFish eiConsole’s graphical drag & drop Data Mapper component. The Data Mapper is a graphical editor used to generate the XSLT transformations that transform the data format to any other data format. PilotFish provides a unique, robust triple-pane paradigm that supports mappings of any length and any complexity. Mapping remains graphically functional throughout.

How Do You Build EDI 270 Transactions?

In the PilotFish Data Mapper, EDI messages can be graphically constructed into specific XML representations that the EDI Transformation Module can then convert into properly structured EDI messages.

How Do You Ingest X12 Files and Export Them to a Flat File?

PilotFish software supports an array of EDI ingestion methods including AS2, (S)FTP and local files. From there, the EDI messages can be parsed into a common format that can be converted to an XML or flat file format.

What Tool Parses EDI 837 and EDI 835 Data to an SQL Database?

Pilotfish’s eiConsole Interface Engine can configure interfaces to parse EDI 835 and EDI 837 messages and transform them into SQL inserts. Read more about X12 EDI Parsing.

EDI 837 Transaction Loaded Into Healthcare Data Mapping Software

EDI 837 Mapping in PilotFish Interface Engine

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.

What Software Handles Both Batch and Real Time X12 EDI Transaction Processing?

PilotFish can be configured to handle both batch and real time processing of X12 EDI over a multitude of different protocols.

Does PilotFish support single sign on (SSO)?

Typically single sign on is outside the scope of what our software does and is the responsibility of the IT infrastructure / security team. However, PilotFish can communicate complex web API calls with our API XL features. So, if something uses SSO (usually something with tokens) we can likely communicate with it. If a user wanted to create some web app using PilotFish we could probably build out an SSO authentication scheme, specifically, that would be via a route configuration.


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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