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Healthcare EDI Services

From patient records to medication information and insurance claims, the healthcare industry is inundated with vast amounts of data. Processing this information is a monumental task for healthcare professionals, especially since it comes from a range of sources and in different formats.

Optimize the transmission of vital documents among patient care partners with innovative healthcare-specific, HIPPA-compliant EDI solutions from Effective Data. We are EDI consulting and data integration specialists dedicated to providing a flexible, secure environment for quickly building connected healthcare ecosystems geared for multi-party collaboration and modern channels of patient collaboration.

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Healthcare EDI Benefits

Using EDI for healthcare transactions improves productivity by enabling high-level accuracy, efficiency, and speed. EDI doesn’t just benefit healthcare professionals and institutions, though. One crucial result of HIPAA was the right given to patients to access their healthcare information.

Effective Data offers a cloud-based EDI service called ED Connect, which gives hospitals and healthcare organizations a simple way to automate their entire supply chain and improve operational efficiencies while lowering costs. It provides a flexible, secure environment for quickly building connected healthcare ecosystems geared for multi-party collaboration and new patient collaboration channels.

With ED Connect, your healthcare operation can obtain:

  • HIPAA Level 7 compliance
  • Standardization
  • Higher productivity
  • Greater security
  • Improved accuracy
  • Heightened efficiency
  • Lower costs

Management of data such as patient history records, emergency services reports, and medication information is of critical importance to healthcare professionals. Key applications of healthcare EDI systems include the management of medical and dental patient databases, insurance reimbursements, clinical trials, and regulatory data.

Effective Data specializes in helping any healthcare industry businesses automate and improve processes as well as become compliant with trading partner and regulatory requirements. Our products and services make it easy and affordable to collaborate, transfer data, and integrate internal business processes.

  • Cloud EDI
  • On-premise EDI
  • Off-premise EDI
  • Hosted EDI
  • HIPAA Level 7 integration
  • VAN services
  • Strategy consulting
  • EDI assessment
  • Process automation
  • Full service, one-on-one support

EDI Documents & Transactions for Healthcare

Healthcare institutions must communicate regularly with an array of partners, from internal databases and insurance companies to outside specialists and service providers. Eliminate these tedious and error-prone processes with automated communication from Effective Data.

We support all major EDI communications methods and have extensive knowledge of industry trends and requirements. When partnering with us, EDI documents are readily available, easy to process, and hassle-free to manage. Common EDI transactions that healthcare industry professionals use daily include:

  • EDI 270 & 271: Healthcare Eligibility & Benefit Response - The EDI 270 is sent by healthcare service providers to insurance agencies or government entities, including Medicare and Medicaid.
  • EDI 276: Healthcare Claim Status Request - The EDI 276 is used by healthcare providers to verify the status of a claim submitted previously to a payer, such as an insurance company, or other agency like Medicare or Medicaid, etc.
  • EDI 277: Healthcare Claim Status Response – EDI 277 is typically used by healthcare payers to respond to a claim status request (276) sent from the provider.
  • EDI 278: Healthcare Service Review – EDI 278 is a transaction to check the status of previous submittals or transactions for a given patient.
  • EDI 820: Payment Order or Remittance Advice - The EDI 820 is used to transfer payment data between businesses or to confirm payment details and advise the seller of any adjustments to the payment amount.
  • EDI 834: Benefit Enrollment & Maintenance - The EDI 834 transaction is used by government agencies, employers, and health plans to enroll and maintain membership in a healthcare benefit plan. 
  • EDI 835: Healthcare claim payment/Advice - The EDI 835 is the electronic submission format used by healthcare insurance plans to make payments or to provide an Explanation of Benefits. 
  • EDI 837: Healthcare Claim - The EDI 837 is the electronic submission format of health care claim information that is structured to meet HIPAA requirements.
  • EDI 997: Functional Acknowledgment Transaction Set – The EDI 997 is a confirmation to acknowledge that another EDI transaction or group of transactions was received from the sender.


Improve patient care by maximizing security and productivity with HIPPA-compliant, healthcare-driven EDI services from Effective Data. We’re on your side. Contact us for more information.

We owe a debt of gratitude to Effective Data. They took a last-minute call before the weekend and a few days later, our EDI software was upgraded and ready for our go-live date. They were knowledgeable, thorough and timely. Effective Data will get our business from now on. T.D., EDI Coordinator, Leading National Pharmaceutical Supplier

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