EDI 835 Formatting 

The ANSI X9 standard for the EDI 835 file format has enabled the healthcare industry to move forward with Administrative Simplification part of the Affordable Care Act. However, as IT, programmers and HIS/PMS system vendors know, the complexity of the healthcare payment process does not always allow for “standard” EDI 835 file autoposting.

Because of these technical file differences, simply converting to electronic EDI 835 files cannot be done without strong format and posting tests along with accuracy validation. The role of this function is typically placed on a healthcare provider’s IT group, a billing company or facilities management company.

HPAC EDI 835 customization capabilities include examples like these:

  • File Structure Modifications – delimiter changes, line-breaks (carriage returns), etc.
  • File Naming Conventions –rename 835 output based on lockbox control file, image name or other customer request
  • Output Grouping – ability to output multi-payer files, single-payer-grouped files or by individual transaction
  • Payer Information – ability to ingest a clearinghouse or PM vendor Payer Table and modify 835 ISA, GS, BPR, TRN and N1 fields based on cross-walked values
  • File Content Modification – Ability to add static or variable values for non-ANSI-required fields such as REF segments, PER segments and DTM*405 segments.

Orbograph Electronic2Post (E2Post) Solution can ingest virtually any existing EDI 835 file and enhance the data for autoposting in the PMS/HIS or billing system. Additionally, E2Post can take EDI 837 claim files and append specific claim fields into the EDI 835 files for enriched posting data.

Achievements:

  •  Enhance posting data with higher quality and greater detail
  • Append patient claims information in posting file
  • Improve quality of posting
  • Improve research process with archive of transaction data and images
  • Provide full payment picture from claim creation, insurance remittance to patient payments
  • Reduce receivables and improve collection process
  • Reduce exceptions
  • Long term archive of transaction data and images integrated with remittance and claim information
  • Free software upgrades
  • Performance monitoring and trend analysis by Orbograph Client Services
  • Business Intelligence (BI) and volume tracking 

Testimonial


“The versatility of HPAC to address the varying needs in EDI processing provides the foundation for universal acceptance of electronic transactions for financial institutions, billers, clearinghouses and healthcare providers.”

-Barry Cohen
Co-President, Orbograph


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