What are Healthcare EDI and its Types?


The health sector comprises of a wide assortment of different elements and procedures. Data is something we rarely discuss, yet it is unquestionably an essential component of practice management. A consistent system is required to process the large quantity of medical informatics.


Using established message formats and standards, electronic data exchange (EDI) transactions safely transport data between hospital systems, insurers, and patients. The EDI system decreases data exchange and interpretation costs, addresses conversion problems, and enhances healthcare interoperability. All EDI transactions in the healthcare industry must adhere to common standards in order for health plans, clearinghouses, and healthcare professionals to exchange medical records electronically in a HIPAA-compliant method. Electronic health records are secure and accurate thanks to EDI solutions. All parties concerned in the implementation of medical EDI must adhere to precise data specifications. For instance, if the information is sent to a computer that will receive it, the programmed for electronic data interchange converts it into a language that is not human. Every documentation set used by electronic data solutions has a standard code ascribed to it.

Healthcare EDI types:

Ten different types of HIPAA-compliant electronic data exchange software are used by healthcare organisations:


  • Providers and patients can access and exchange data through transactions involving healthcare claims.
  • Healthcare practitioners and regulatory bodies can submit retail pharmacy claims through this transaction. Also, this EDI software system sends payers information regarding medical billing payments and claims for retail pharmacy services.
  • In order to pay healthcare providers, insurers use the healthcare claim payment/advice transaction.
  • Benefits enrolment and maintenance - Unions, governmental organisations, insurance companies, associations, or healthcare organisations paying claims use this edi tools for healthcare.
  • An EDI transaction in healthcare makes premium payments for insurance products through payroll deduction and other group premium payments. In order to communicate with financial entities, healthcare providers use electronic data exchange.
  • Healthcare businesses can transmit enquiries about subscriber eligibility and healthcare benefits to financial institutions and governmental organisations with the use of the electronic data interchange system.
  • Responding to enquiries concerning a subscriber's or dependent's eligibility for healthcare benefits and other requests for information is the main goal of this electronic data interchange solution.
  • Healthcare claim status- This EDI healthcare lets healthcare providers to seek or verify the status of healthcare already filed to a payer, such as an insurance company.