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  Tuesday, April 23, 2024
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Electronic Data Interchange

Electronic Data Interchange (EDI) permits computer-to-computer exchange of formatted business transactions between business partners and makes it possible for organizations to generate, receive, and process large volumes of information swiftly with limited human intervention. It is a beneficial strategy to improve customer service, improve operational effectiveness, and save taxpayer dollars. As a computer processes the transactions in EDI, there is less chance of human error, and speed is dramatically increased as opposed to the time it takes to mail paper documents.

EDI involves reformatting a standard computer data file, as produced by an organization’s business application systems, into a structured EDI format. This format must comply with the specific industry and Georgia standards. A specialized software program, called an EDI translator, performs the transformation process from the system data file into the EDI format. Once the file has been put into a structured format, it is brought into the Georgia Medicaid Management Information System (GAMMIS) for processing.

Health Insurance Portability and Accountability Act (HIPAA) 1996 Guidelines

The Health Insurance Portability and Accountability Act (HIPAA) was enacted by Congress in 1996 and became effective July 1, 1997. The administrative simplification provisions of HIPAA required the Department of Health and Human Services (HHS) to establish national standards for electronic healthcare transactions and national identifiers for providers, health plans, and employers. It also addresses the security and privacy of health data. As the industry adopts these standards for the efficiency and effectiveness of the nation's healthcare system, it will improve the use of electronic data interchange.

The EDI Unit provides support for trading partners and providers that exchange transactions electronically. Support functions include:

  • Enrollment processing for trading partners requesting to submit transactions electronically
  • Assistance to Billing Agents, Clearinghouses and Software Vendors
  • Identifying and troubleshooting technical issues
  • Data Exchange help

Attention Payees Receiving ERAs.
Important: Providers enrolled for Electronic Remittance Advices (ERAs) must activate their Payee Provider Web Portal PINs that they received in the mail.

ERAs are generated using the PAYEE Provider ID; therefore, if you wish to delegate these 835 ERAs so that your clearinghouse/software vendor/billing agent can access these on your behalf, you must provide them access to your file downloads.

Contact your clearinghouse/software vendor/billing agent to get the email address and username that you should grant access to, then follow the instructions in the "Web Portal User Account Management Guide" found on the Provider Manuals page. Refer to section 3.2 titled, "Providers or Trading Partners Delegating Access to a Billing Agent or Trading Partner Account" for detailed instructions.

You will need to grant the "Trade Files Download" role for a user to have access to your 835 ERA file.
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