About HIPAA EDI Editor

Navigation:  Introduction >

About HIPAA EDI Editor

Return to chapter overviewNext page

The HIPAA EDI Editor is a tool for viewing and modifying EDI files.

The HIPAA act of 1995 mandates that every medical claim that is transmitted electronically conforms to strict standards. These standards are developed by ANSI, the American National Standards Institute, under the umbrella of the X12 committee for Electronic Data Interchange (EDI). X12 contains standards for hundreds of electronic data interchanges. HIPAA EDI Editor is able to open and organize these into a more legible format than a text editor. X12 standards are continuously developing. The HIPAA compliant versions are the version 4010A1 and 5010. EDI Editor handles both.

Electronic claims were introduced in the 1990's and made mandatory by 1/1/2003. During the last decade, the adaptation of this electronic format was phenomenal. More than 90% of claims are now (as of 2012) transmitted electronically.

The HIPAA EDI Editor recognizes Interchange Control Headers, Functional Groups and Transaction Sets. The files themselves are presented in as legible a fashion as possible. Lines are split by segment separators and segment name abbreviations and element separators are highlighted for ease of reading.