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EDI SYSTEM TRANSLATOR For Health Care Providers

EDI SYSTEM TRANSLATOR For Health Care Providers. BY: HOA DIEP. What the heck is EDI?. EDI stands for Electronic Data Interchange It is a form of sending and receiving documents between companies but in this case the health care industry.

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EDI SYSTEM TRANSLATOR For Health Care Providers

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  1. EDI SYSTEMTRANSLATORForHealth CareProviders BY: HOA DIEP

  2. What the heck is EDI? • EDI stands for Electronic Data Interchange • It is a form of sending and receiving documents between companies but in this case the health care industry. • Replaces old methods of sending and receiving documents.

  3. What is wrong with the old waysof sending and receiving documents? • More importantly, what are the old ways?

  4. In the Olden Days • Documents were sent and received through mail, fax, or couriers. • As you can see, this method of sending and receiving documents are very inefficient. This can take minutes, hours, and even days.

  5. What does EDI have to do with health care? • An average of 26 cents of each health care dollars was spent on administrative overheads. • In 1996 Congress passed a law called The Health Insurance Portability and Accountability Act. (HIPAA)

  6. What does EDI have to do with health care? (cont.) • It’s aim was to reduce administrative costs and burden by requiring the use of standardized, electronic transmission of administrative and financial data. • This is where EDI comes in. It is chosen to be use as the standard for sending and receiving health care related documents.

  7. Technology • Visual Basic .Net • ADO .Net • Microsoft SQL Server 2000

  8. What is a Transaction set? • Each EDI transaction set represents a document. • A Transaction Set can be a medical claim, or orders for car parts, or even names and addresses. • Each industry has its own set of documents which it frequently use.

  9. Transaction Set Structure

  10. What a simple transaction set looks like. ISA*00* *00* *ZZ*SUBMITTER ID *ZZ*RECEIVER ID *021002*2116*U*00401*001070000*0*P*|~GS*HS*SUBMITTER ID*RECEIVER ID*20021002*1316*1070000*X*004010X092A1~ST*270*0001~BHT*0022*13**20021215*1316~HL*1**20*1~NM1*PR* 2*BENEFITS INCORPORATED*****PI*00432678~HL*2*1*21*1~NM1*1P*2*GREENVALLEY FAMILY PRACTICE*****SV*235894789~REF*0B*3249965-2322*MI~N3*6343 GREENVALLEY ROAD~N4*DRAGON CITY*MI*48302~PER*IC*PATIENT ELIGIBILITY INQUIRY DEPARTMENT, ATTENTION LISA SMITH*TE*8231538595*FX*8236547890*EM*LISA.SMITH@GREENVALLYDOCS.COM~PRV*PC*ZZ*364S00000X~HL*3*2*22 *1~NM1*IL*1*JONES*JIMMY****MI*900642345~REF*EJ*34323DAJ~REF*EA*3490903- DAVIS~REF*A6*9065832~REF*18*00890~REF*IG*34989812-232~N3*345 NORTH TIMBER ROAD~N4*CORYDON*WA*98072~PRV*PE*EI*546213098~DMG*D8*19690710*M~DTP*472*D8*20021031~EQ*1~III*BF*30 0~REF*9F*2349-2322~HL*4*3*23*0~NM1*03*1*HUGHES*SALLY*L~DMG*D8*19850711*F~N3*HC 04 BOX 477528~ N4*CAGUAS*PR*00726~DMG*D8*19550215*F~REF*SY*583742013~DTP*102*D8*20020114~DTP*307*RD8*20021030- 20021105~EQ**AD|D1110*DEP*C1~III*ZZ*11~III*BK*300~III*BF*486~REF*G1*13579~DTP*435*RD8*20021101- 20021115~EQ*98**DEP*C1~REF*9F*13579~DTP*472*D8*20021217~HL*5*2*22*0~NM1*IL*1*MCDONALD*SUSAN****MI *869323456~DMG*D8*19640607*F~N3*2561 NORLAND AVE~N4*CAGUAS*FL*00726~DTP*472*D8*20021130~EQ*7~HL*6*2*22*0~NM1*IL*1*RODGERSON*JOHN****MI*1234067 89~DMG*D8*19451010*M~N3*2561 COUNTRY CLUB WAY~N4*WHITTIER*CA*91764~ DTP*472*D8*20021201~EQ*3~SE*51*0001~GE*1*1070000~IEA*1*001070000~

  11. So, what does my EDI System do? • Parse various transaction sets. • Extract name and address information based on configurable rules. • Insert extracted information into the database where users can access and process.

  12. RULES? • The rules are constructed base on the specific transaction sets. • The rules are stored in the database where it can be access and managed.

  13. DEMO TIME!

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