Digital Transformation

Health Data Interchange set can be used to transmit health care service information, such as subscriber, patient, demographic, diagnosis or treatment data for the purpose of a request for review, certification, notification or reporting the outcome of a health care services review.

Used to submit health care claim billing information, encounter information, or both, except for retail pharmacy claims (see EDI Retail Pharmacy Claim Transaction). It can be sent from providers of health care services to payers, either directly or via intermediary billers and claims clearinghouses. It can also be used to transmit health care claims and billing payment information between payers with different payment responsibilities where coordination of benefits is required or between payers and regulatory agencies to monitor the rendering, billing, and/or payment of health care services within a specific health care/insurance industry segment.

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