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Technical Discussion :: EDI

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What is the most common EDI cycle?

Answer:

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 * 

 

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