Companion Guides

Acronym: EDI

The health care industry has provided a method of communicating how an individual “trading partner” will implement an X12 standard; the collection of this implementation information is known as a “companion guide.” (A trading partner is a vendor with which a physician practice exchanges patient data or Protected Health Information electronically in the course of its operations.) The X12 implementation guides provide some flexibility in terms of data elements that can be used. The complexity of these transactions also sometimes requires health insurers to implement these transactions in phases as they update their internal software or business processes. Health insurers publish companion guides that provide detailed information about their specific implementation of a HIPAA standard transaction and any pertinent requirements. These guides are usually available for review on health insurers’ Web sites. Health insurers may change and modify their companion guides whenever they make a change to their implementation of a HIPAA standard transaction. For example, a health insurer might begin to use situational codes (many health insurers did not require situational codes when they first implemented HIPAA standard transactions). The materials in the implementation and health insurers’ companion guides contain important information for physician practices’ software vendors. These vendors are frequently the ones that ensure physician practices are able to send their claims and other transactions according to the X12N standards and the health insurer requirements.