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EDI 835

EDI 835: Healthcare Claim Payment & Remittance

Healthcare documents often require tedious data entry that is time-consuming and results in data entry errors. To increase production time and reduce errors, businesses that work with or in the healthcare industry can use EDI systems.

The EDI 835 is the electronic submission format used by healthcare insurance plans to make payments or to provide an Explanation of Benefits. The EDI 835 is specified by HIPAA 5010 requirements.

An EDI 835 document is used alongside the EDI 837. A specific EDI 835 may not match up directly with one EDI 837 document. Multiple EDI 835 documents may be used for one EDI 837 or multiple EDI 835 documents may be used for one EDI 837.

When using EDI integration, the EDI 835 is created with zero risks of data entry error and is done in a seamless, time-efficient process. At Effective Data, we offer complete healthcare EDI services. We are dedicated to supplying a secure and flexible structure for healthcare systems to efficiently and safely share documents.

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Data for the EDI 835 can either be manually entered into an EDI standard document or pulled from data integration through your in-house EDI system.

Once the data has been entered into the EDI translator, it will begin the conversion process into an EDI 835 document. This conversion process follows specific guidelines that have been set into place by the ASC X12 and meets HIPAA-based EDI requirements.

The data includes information such as:

 

  • Charges that were paid, reduced, or denied
  • Deductible, co-pay, co-insurance
  • Bundling or Splitting of claims and line items
  • How payment was made

The EDI 835 is a critical document for healthcare providers to track what payments were received. At Effective Data, our EDI solutions provide complete security and knowledge of the EDI transmission process.

EDI 835 transactions are most commonly sent directly to the receiver where the receiver of the EDI 835 decodes the EDI into a document that can be used by the recipient. The second way of sending the EDI 835 is to send it via a secure dial-up connection to a Value-Added Network (VAN) and then is routed to the recipient.

At Effective Data, we support all major EDI communication methods while maintaining knowledge of changing industry standards and trends. We understand that the management of patient documents is of critical importance and requires absolute security.

 

We specialize in helping healthcare industry businesses securely automate and improve processes while maintaining compliance with all healthcare requirements. Our services include:

  • Cloud EDI
  • Off-premise EDI
  • On-premise EDI
  • Hosted EDI
  • EDI Assessment
  • HIPAA Level-7 Integration
  • Strategy Consulting
  • Process Automation
  • VAN Services
  • And More

We offer full-service, one-on-one support for all of your needs.

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