Next Version 7030™
EDI Standard Under Discussion
EDI Standard Under Discussion
The American National Standards Institute (ANSI) is proposing the next version of HIPAA electronic data interchange (EDI) standards (7030™).
An ANSI committee called X12 develops and maintains EDI standards and XML schemas for uniform use in the healthcare industry. X12 is soliciting public comments about the new standards. The next comment period opens Sept. 1, 2017, and covers patient eligibility, benefit inquiry and information response.
Frequently Asked Questions
Who is Affected?
While there is no immediate operational impact to ABILITY payers, providers and ABILITY Strategic Partners, the final creation and implementation of 7030 will affect every entity in healthcare that processes EDI transactions. These stakeholders are encouraged by industry leadership to make their opinions and ideas known during the comment periods.
How Will ABILITY Help?
As an organization that processes more than a billion EDI transactions annually, ABILITY is fully engaged and participating in the public comment periods to contribute to a smooth transition. As regulations unfold, ABILITY will provide information via this web page to customers and ABILITY Strategic Partners on what the changes mean and how ABILITY will support them from a technical standpoint. Bookmark this page and return when you want learn the latest regarding this emerging EDI standard.
What Do I Need to Do Right Now?
Consider participating in the upcoming comment period. The next period has to do with patient eligibility, benefit inquiries and information response, and will run from Sept. 1 through Nov. 30. The topics are below. The technical reports that are associated with HIPAA-covered transactions have an asterisk:
●007030X332 Healthcare Eligibility/Benefit Inquiry and Information Response (270/271)*
●007030X327 Healthcare Services Review Inquiry and Response (278)
●007030X328 Healthcare Services Review – Notification and Acknowledgment (278)
●007030X342 Healthcare Services Request for Review and Response (278)*
What Happens After That?
The subsequent comment period will cover the following topics. The dates for the following have not yet been scheduled:
●Application Reporting for Insurance (824)
●Healthcare Claim Request for Additional Information (277RFI)
●Additional Information to Support a Healthcare Claim or Encounter (275)
●Additional Information to Support a Healthcare Services Review (275)
What Has Already Been Discussed?
Topics already addressed in public comments in 2016-2017 include:
●Payroll Deducted and Other Group Premium Payment for Insurance Products (820)*
●Health Insurance Exchange Related Payments (820)
●Benefit Enrollment and Maintenance (834)*
●Health Insurance Exchange: Enrollment (834)
●Healthcare Claim Status Request and Response (276/277)*
●Healthcare Claim Acknowledgment (277CA)
●Healthcare Claim Pending Status Information (277P)
●Implementation Acknowledgment for Healthcare Insurance (999)
●Healthcare Claim Payment/Advice (835)*
●Healthcare Claim: Professional (837P)*
●Healthcare Claim: Institutional (837I)*
●Healthcare Claim: Dental (837D)*
●Healthcare Service: Data Reporting (837R)