The Health Insurance Portability and Accountability Act (HIPAA) was enacted by the U.S. Congress in 1996. A key component of HIPAA is the establishment of national standards for electronic health care transactions and national identifiers for providers, health insurance plans and employers. The HIPAA Electronic Data Interchange (EDI) transaction sets are based on the X12 standard and the preferred message type utilized by VBA is described below:
Benefit Enrollment and Maintenance (834): The 834 is a standard file format used to transfer enrollment information from the sponsor of the insurance coverage, benefits or policy to a payor. It is used by employers to provide enrollment data including subscriber and dependent information, employer information and healthcare provider information to health insurers.
Health Care Claim Professional (837): The 837 is the format established to meet HIPAA requirements for the electronic submission of healthcare claim information.
Health Care Claim Payment/Advice (835): The 835 is the electronic transaction that provides claim payment information. These files are used by practices, facilities and billing companies to auto-post claim payments into their systems.