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According to the HIPAA EDI rule, a "transaction" is the exchange of information
between two parties to carry out financial or administrative activities related
to health care.
HIPAA identifies certain transactions for which there is a mandatory "standard"
format and data content, which cannot be changed or altered by covered entities
when conducting any of those transactions.
The Department of Health and Human Services has adopted "Implementation Guides"
that outline each of the transaction standards. These Guides can be found on
the Washington Publishing Company website at
http://www.wpc-edi.com/hipaa/HIPAA_40.asp
The HIPAA EDI transaction standards are referred to by both a name and a
numerical identifier. For example the transaction that is used to support the
electronic payment of premiums is often referred to as the 820 transaction
standard.
The HIPAA EDI transaction standards that impact Unum's covered products are as
follows:
| 834 |
Enrollment / Disenrollment |
820 |
Premium Payment |
| 270 |
Eligibility Inquiry
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271 |
Eligibility Response |
| 837 |
Claim Encounter |
837COB |
Coordination of Benefits |
| 276
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Claim Status Inquiry |
277 |
Claim Status Response |
| 835 |
Remittance Advice EOB |
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Please click this link for more information on the HIPAA EDI
transaction standards that impacts Unum's covered products.
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