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HIPAA EDI

TRANSACTION SETS

  • 270/271 - Eligibility
  • 275 - Additional Information to Support Claims/Encounters
  • 276/277 - Claim Status
  • 278 - Prior Authorization
  • 820 - Premium Payments
  • 834 - Benefit Enrollment and Maintenance
  • 835 - Claim Payment and Remittance Advice
  • 837 - Claims (Dental, Professional, and Institutional)
  • Implementation of X12 5010
  • National Required Transactions

MEDICAL CODES

PROVIDER

  • FL Medicaid NPI Requirements [PDF 24KB]
    No embedded intelligence
  • 10+3 position numeric, one digit checksum
    Sub-ID may appear on health card & direct EDI
    No embedded intelligence