Final answer:
Claims data must be converted into a standardized format like ASC X12 for EDI submission, with the EDI 837 transaction set being common in healthcare. HIPAA standards must be followed to ensure data security and privacy.
Step-by-step explanation:
To submit claims data through EDI (electronic data interchange), claims data must be converted into a standardized format that meets specific requirements for data integrity and confidentiality. This process often involves translating the data into a format such as ASC X12, which is a widely recognized standard for the formatting and transmission of electronic documents in healthcare and other industries.In healthcare, for instance, the EDI 837 transaction set is commonly used for the electronic submission of healthcare claim information. This ensures that all the necessary information is included and formatted properly for processing by payers, such as insurance companies.
Additionally, to maintain the security and privacy of personal health information, the Health Insurance Portability and Accountability Act (HIPAA) standards must be adhered to when transmitting health care data electronically.To submit claims data through EDI (electronic data interchange), claims data must be converted into a standardized format. This format is known as the X12 format, which is used for transmitting healthcare claims electronically. EDI claims data is typically sent as an electronic file that contains specific data elements organized in a specific order.For example, in the X12 format, each claim is represented by a series of segments. These segments contain information such as the patient's name, date of service, procedure codes, and billing amounts. The data elements within each segment are separated by delimiters, such as commas or pipesOnce the claims data has been converted into the X12 format, it can be securely transmitted between healthcare providers, payers, and clearinghouses using EDI standards and protocols. This allows for efficient and accurate processing of healthcare claims.