Electronic Data Interchange (EDI)

In previous documents from Stratford we have used the term "Electronic Claims Submission" or "ECS".

This is being replaced "in the literature" by the more correct term: electronic data interchange. Electronic data interchange (or EDI) is the exchange of information on routine business transactions in a standardized computer format; for example, a data interchange between a Medicare Carrier and a provider. Where did we get EDI? In 1979, ANSI (American National Standards Institute) chartered a new committee, known as the accredited standards committee (ASC) X12, to develop uniform standards for electronic interchange of business transactions. The work of ASC X12 is conducted primarily by a series of subcommittees and task groups whose major function is the development of new, and the maintenance of existing, EDI standards. ASC X12 has more than 600 voluntary members. The reason this is (or will be) very important to almost everyone who is in the healthcare industry is:

The Center for Medicare and Medicaid Services - CMS has adopted the American National Standards Institute, Accredited Standards Committee (ASC) X12.86 Health Care Claim (ANSI 837) as the standard format for the electronic data interchange (EDI) of Medicare claim data for Medicare services. All Medicare Intermediaries will implement this format on or before October 1, 2003.

The ANSI 837 format is the only format that is accepted by Medicare and all other payers.