ServiceXG Basics

Find Electronic Data Interchange (EDI) claim data

There might be times when you need to look at the original data that came in on an electronic claim. For example:

• A provider inquires about a payment made on an EDI claim. In researching the issue, you look at the original payment information as well as any notes related to claim payments on the EDI claim.
• A member disagrees with some information on an EDI claim. In looking into the issue, you check the original information on the EDI claim.
• To ensure data mapping rules are correct, you load some test claims and view how the data displays in the EDI claim.

The View EDI Data option allows you to view both original Electronic Data Interchange (EDI) information and repriced EDI information.

EDI A secure and standardized exchange of electronic healthcare data. For example, it enables healthcare providers to send claim status requests and receive information. is a process that allows information to be received electronically from a third party for claims submission. In this case, the provider submits claims from a computer in their office to a network or clearinghouse. The claims are then submitted electronically to the appropriate payors.

1. Search for and open the claim.

2. Select View EDI Data from the Claim menu, located in the session pane.

   

   • The information displayed on the EDI subtab corresponds to the original EDI received from the trading partner An entity which sends and/or receives electronic health care transactions (i.e.: provider, billing group, billing service, clearinghouse or payer.).

3. Click the Repriced EDIsubtab to view the repriced data.

   

   • The data has the same functional characteristics as the data on the EDI subtab. If no data exists for EDI data or Repriced EDI, the fields are blank.

   • You can only edit these fields if you have the appropriate role-based security authorization.

For detailed information see EDI Data in the Claims User Manual on MYbasys.

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