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May 30, 2006

HIPAA Transactions

HIPAA transactions are defined to streamline the process of a practice and its communications with the payers.

These HIPAA transactions are a set of EDI standards defined to support transactions like verification or elligibility of  patient health plans, process pre authorizations, claim submissions, claim remittance.

These transactions are organized in a sequence of activities that need to be undertaken right from the moment  the patient requests an appointment to the patient checking-in through check-out. 

The HIPAA transactions and the standards to be followed is listed in the following chart in same sequence as discussed above

Transaction Type

EDI Standard for Transaction
Eligibility Verification Request from Practice
EDI-270
Eligibility Response from Payer
EDI-271
Authorization Request
EDI-278
Authorization Response
EDI-278
Claim Submission
EDI-837
Claim Remittance
EDI-835

For more information on either implementing these transaction or buying these components refer to HIPPA Transactions.