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What is the most common EDI cycle?
Subscriber or Sponsor or Member will Enroll the individual or Group EDI 834 ( Enrollment) *With 834 transaction Subscriber information will be stored at Payers data base * Subscriber starts paying Premium payment EDI821 * Provider sends EDI270 for Eligibility Inquiry* Payer responds with Eligibility Response EDI271* Some times Provider request for prior authorization for Patient ( subscriber) EDI278* Payer responds with review response EDI278 * Provider submits the Claim to Payer EDI837 * Payer some times request Additional information EDI277 * Provider request for Claim status by sending EDI276 * Payer replies with Status Response EDI277 * Provider response with attachment EDI275/HL7 * Payer process remittance advice EDI835 *
Asked In ::
Sonu
23 Feb, 2019 5:07 AM
* Supplier transmits EDI 997 (functional acknowledgement)
* Supplier transmits EDI 856 (advance ship notice)
* Customer transmits EDI 997 (functional acknowledgement)
* Supplier transmits EDI 810 (electronic invoice)
* Customer transmits EDI 997 (functional acknowledgement)
* Customer transmits EFT (Electronic Funds Transfer) Payment.
Venkat
13 Oct, 2019 1:07 PM
Subscriber or Sponsor or Member will Enroll the individual or Group EDI 834 ( Enrollment) *With 834 transaction Subscriber information will be stored at Payers data base * Subscriber starts paying Premium payment EDI821 * Provider sends EDI270 for Eligibility Inquiry* Payer responds with Eligibility Response EDI271* Some times Provider request for prior authorization for Patient ( subscriber) EDI278* Payer responds with review response EDI278 * Provider submits the Claim to Payer EDI837 * Payer some times request Additional information EDI277 * Provider request for Claim status by sending EDI276 * Payer replies with Status Response EDI277 * Provider response with attachment EDI275/HL7 * Payer process remittance advice EDI835 *
