X12N Implementation Guide

Acronym: EDI

The X12N subcommittee has documented the specific details of each HIPAA standard transaction in an implementation guide. The implementation guide is a very detailed document that defines: The electronic format of the transaction The details of the necessary data and where to place them in the electronic file The details of the various code sets that are used and how to use them The kind of electronic “envelopes” each transaction requires (these are sometimes known as the headers and control documents) References for the different code sets used in that transaction The implementation guides are complex documents. For example, the X12 837 professional version for health care claims is 768 pages in length. The primary entities that use these guides are: (1) health insurers (to program their software to process claims); (2) clearinghouses (to ensure that claims conform to the implementation guides); and (3) physician practice management software vendors (to program their software to capture information and transmit a compliant standard transaction or receive and process a standard transaction). The current version of the guides that the government has adopted is known as version 5010.