Claims

The Health Insurance Portability and Accountability Act (HIPAA) requires that health insurance payers in the United States, comply with the EDI standards for health care as established by the Secretary of Health and Human Services. The ANSI X12N 837 implementation guides have been established as the standard for compliance for claim transactions.

The implementation guides for the 837 professional and institutional are available electronically at http://www.wpc-edi.com/hipaa/HIPAA_40.asp.

The NCPDP Telecommunication Standard Version 5.1 and Batch Standard Version 1.0 guides have been named for pharmacy claims.

Remittance

Electronic Remittance Advice (ERA) is an electronic version of your Explanation of Benefits and allows you to automatically post your accounts.

The implementation guide for the 835 is available at http://www.wpc-edi.com/hipaa/HIPAA_40.asp.