EDI 274 Healthcare Provider Information

Electronic Data Interchange (EDI) is essential for efficient information exchange in healthcare. EDI-enabled medical transactions cost 7.34 times less than manual transactions, highlighting its efficiency and cost-effectiveness. The EDI 274 Healthcare Provider Information transaction set is specifically designed to facilitate the accurate transmission of healthcare provider details. By understanding EDI 274, healthcare organizations can ensure timely and accurate provider information exchange, enhancing administrative accuracy and reducing costs, improving the overall quality of patient care.

What is EDI 274 Healthcare Provider Information Transaction Set?

The EDI 274 Healthcare Provider Information transaction set is used to transmit information about healthcare providers. This includes details about the provider’s identification, demographic data, relationships to other providers, locations, and affiliations. The primary purpose of EDI 274 is to facilitate the accurate and efficient sharing of healthcare provider information among healthcare entities, including insurance companies, government agencies, and other organizations.

This transaction set is crucial in maintaining updated and accurate provider directories and credentialing processes and ensuring that providers are appropriately authorized to deliver services. EDI 274 allows organizations to streamline operations, reduce administrative burdens, and improve provider data accuracy.

EDI X12 274 Healthcare Provider Information Sample File

Let’s look at a sample file to better understand the EDI 274 transaction set. This example provides a glimpse into the structure and types of data included in the transaction set.

ISA*00*          *00*          *ZZ*SENDERID       *ZZ*RECEIVERID     *210610*1705*U*00401*000000905*0*P*:~

GS*HR*SENDERID*RECEIVERID*20210610*1705*905*X*004010X092A1~

ST*274*0001~

BHT*0010*13*10001234*20210610*1700~

HL*1**20*1~

NM1*85*2*PROVIDER NAME*****XX*1234567893~

N3*123 MAIN STREET~

N4*CITY*STATE*ZIP*COUNTRY CODE~

REF*EI*123456789~

PER*IC*CONTACT NAME*TE*PHONE NUMBER~

PRV*BI*PXC*207Q00000X~

DMG*D8*19700101*M~

HL*2*1*21*1~

NM1*1P*1*RELATED PROVIDER NAME*****XX*9876543210~

N3*456 SECOND AVENUE~

N4*CITY*STATE*ZIP*COUNTRY CODE~

PRV*AT*PXC*208D00000X~

SE*17*0001~

GE*1*905~

IEA*1*000000905~

This file demonstrates the hierarchical structure and the various segments used in the EDI 274 transaction set, including information about the provider, related entities, and their relationships.

EDI 274 Specification and File Components

The EDI 274 transaction set follows a specific structure and includes various segments and elements. Understanding these components is essential for accurate implementation and compliance. Here are some key components:

• ISA (Interchange Control Header): Identifies the sender and receiver of the EDI message and contains control information.
• GS (Functional Group Header): Groups transaction sets and provides control information.
• ST (Transaction Set Header): Indicates the start of a transaction set and assigns a control number.
• BHT (Beginning of Hierarchical Transaction): Provides transaction-specific control information.
• HL (Hierarchical Level): Represents the hierarchical structure of the transaction set.
• NM1 (Individual or Organizational Name): Contains information about individuals or organizations.
• N3 (Address Information): Provides address details.
• N4 (Geographic Location): Includes city, state, zip code, and country.
• REF (Reference Identification): Contains reference numbers.
• PER (Administrative Communications Contact): Provides contact details.
• PRV (Provider Information): Contains provider-specific information.
• DMG (Demographic Information): Provides demographic details.
• SE (Transaction Set Trailer): Indicates the end of a transaction set and provides control information.
• GE (Functional Group Trailer): Indicates the end of a functional group and provides control information.
• IEA (Interchange Control Trailer): Indicates the end of an interchange and provides control information.

Each of these segments and elements plays a critical role in ensuring the accurate and efficient transmission of healthcare provider information.

Workflow for the Exchange of EDI 274 Healthcare Provider Information

The workflow for exchanging EDI 274 healthcare provider information involves several steps to ensure accurate and secure data transmission. Here is the step-by-step process:

1. Data Collection: Healthcare organizations collect provider information from various sources, including applications, credentialing databases, and other systems.
2. Data Formatting: The collected data is formatted into the EDI 274 transaction set format, adhering to the specified structure and components.
3. EDI Translation: The formatted data is translated into the EDI X12 274 format using an EDI translator tool. This ensures the data is in the correct syntax for EDI transmission.
4. Interchange Control: The EDI message is wrapped with ISA, GS, and other control segments to ensure the message is properly identified and can be tracked throughout the transmission process.
5. Transmission: The EDI 274 transaction set is transmitted to the intended recipient via a secure communication channel, such as a Value-Added Network (VAN) or direct EDI connection.
6. Receipt and Acknowledgment: The recipient system receives the EDI 274 message and sends an acknowledgment (997 Functional Acknowledgment) to confirm successful receipt and processing.
7. Data Integration: The received provider information is integrated into the recipient’s system, updating provider directories, credentialing databases, and other relevant systems.
8. Error Handling: If any errors occur during the transmission or processing of the EDI 274 message, error messages are generated, and corrective actions are taken to resolve the issues.

Stay EDI Compliant

As the healthcare industry continues to evolve, staying compliant with EDI standards is crucial for ensuring efficient and accurate data exchange. Astera EDIConnect offers a comprehensive solution for managing EDI transactions, including the EDI 274 Healthcare Provider Information transaction set.

Astera EDIConnect provides an intuitive, user-friendly interface that simplifies creating, translating, and managing EDI transactions. With robust data mapping capabilities, this solution allows organizations to easily map their provider information to the EDI 274 format, ensuring accuracy and efficiency. Astera EDIConnect supports the creation of EDI messages conforming to ANSI X12, EDIFACT, or HL7 standards, making it a versatile and comprehensive solution for all EDI needs.

Organizations ready to streamline their healthcare provider information exchange and stay compliant with EDI standards can contact Astera today to learn more about EDIConnect and how it can transform their EDI processes. Schedule a demo to see EDIConnect in action.