Coordination of benefits - 837. Dr. Chiang of Redix International Inc. made a presentation on the E-Commerce and HealthCare Conference to talk about the practical way of implementing the Healthcare Claims and Payment Advice. The slides of the talk can be viewed by click here . EDI Applications in the Health Care Industry - Introduction A full range of EDI transaction sets between payer, employer, and provider is being addressed by the insurance subcommittee of X12. Several transaction sets as described below are designed for use within the entire health care and general insurance marketplace.
Patient information consists of demographic, clinical, and other supporting data.
Used by a provider, recipient of health care products or services, or an authorized agent to request from a health care payer the status of a health care claim or encounter. Used to exchange health care Consumer insurance enrollment information between a health care Sponsor and a Payer organization. Used to transmit health care claims and billing payment information between payers with different payment responsibilities where coordination of benefits is required. For some healthcare transaction sets, there is an expected response and a number of possible responses. The list of possible healthcare transaction sets and their possible responses in shown in the following table.