Transcript EDI SYSTEM TRANSLATOR

EDI SYSTEM
TRANSLATOR
For
Health Care
Providers
BY: HOA DIEP
What the heck is EDI?
EDI stands for Electronic Data Interchange
 It is a form of sending and receiving
documents between companies but in this
case the health care industry.
 Replaces old methods of sending and
receiving documents.

What is wrong with the old ways
of sending and receiving
documents?

More importantly, what are the old ways?
In the Olden Days

Documents were sent and
received through mail, fax,
or couriers.
This

As can
you take
can see, this
method of sending and
minutes,
receiving
hours,
anddocuments are
very inefficient.
even
days.
What does EDI have to do with
health care?
An average of 26 cents of each health
care dollars was spent on administrative
overheads.
In 1996 Congress passed a law called
The Health Insurance Portability and
Accountability Act. (HIPAA)
What does EDI have to do with
health care? (cont.)
It’s aim was to reduce administrative costs
and burden by requiring the use of
standardized, electronic transmission of
administrative and financial data.
 This is where EDI comes in. It is chosen to
be use as the standard for sending and
receiving health care related documents.

Technology
Visual Basic .Net
 ADO .Net
 Microsoft SQL Server 2000

What is a Transaction set?



Each EDI transaction set represents a
document.
A Transaction Set can be a medical
claim, or orders for car parts, or even
names and addresses.
Each industry has its own set of
documents which it frequently use.
Transaction Set Structure
What a simple transaction set looks
like.
ISA*00*
*00*
*ZZ*SUBMITTER ID *ZZ*RECEIVER ID
*021002*2116*U*00401*001070000*0*P*|~GS*HS*SUBMITTER ID*RECEIVER
ID*20021002*1316*1070000*X*004010X092A1~ST*270*0001~BHT*0022*13**20021215*1316~HL*1**20*1~NM1*PR*
2*BENEFITS INCORPORATED*****PI*00432678~HL*2*1*21*1~NM1*1P*2*GREENVALLEY FAMILY
PRACTICE*****SV*235894789~REF*0B*3249965-2322*MI~N3*6343 GREENVALLEY ROAD~N4*DRAGON
CITY*MI*48302~PER*IC*PATIENT ELIGIBILITY INQUIRY DEPARTMENT, ATTENTION LISA
SMITH*TE*8231538595*FX*8236547890*EM*[email protected]~PRV*PC*ZZ*364S00000X~HL*3*2*22
*1~NM1*IL*1*JONES*JIMMY****MI*900642345~REF*EJ*34323DAJ~REF*EA*3490903DAVIS~REF*A6*9065832~REF*18*00890~REF*IG*34989812-232~N3*345 NORTH TIMBER
ROAD~N4*CORYDON*WA*98072~PRV*PE*EI*546213098~DMG*D8*19690710*M~DTP*472*D8*20021031~EQ*1~III*BF*30
0~REF*9F*2349-2322~HL*4*3*23*0~NM1*03*1*HUGHES*SALLY*L~DMG*D8*19850711*F~N3*HC 04 BOX 477528~
N4*CAGUAS*PR*00726~DMG*D8*19550215*F~REF*SY*583742013~DTP*102*D8*20020114~DTP*307*RD8*2002103020021105~EQ**AD|D1110*DEP*C1~III*ZZ*11~III*BK*300~III*BF*486~REF*G1*13579~DTP*435*RD8*2002110120021115~EQ*98**DEP*C1~REF*9F*13579~DTP*472*D8*20021217~HL*5*2*22*0~NM1*IL*1*MCDONALD*SUSAN****MI
*869323456~DMG*D8*19640607*F~N3*2561 NORLAND
AVE~N4*CAGUAS*FL*00726~DTP*472*D8*20021130~EQ*7~HL*6*2*22*0~NM1*IL*1*RODGERSON*JOHN****MI*1234067
89~DMG*D8*19451010*M~N3*2561 COUNTRY CLUB WAY~N4*WHITTIER*CA*91764~
DTP*472*D8*20021201~EQ*3~SE*51*0001~GE*1*1070000~IEA*1*001070000~
So, what does my EDI System do?
Parse various transaction sets.
 Extract name and address information
based on configurable rules.
 Insert extracted information into the
database where users can access and
process.

RULES?
The rules are constructed base on the
specific transaction sets.
 The rules are stored in the database
where it can be access and managed.

DEMO TIME!