HIPAA/EDI Publications

EDI Enrollment Forms:

• EDI Payer Agreement
• 835 ERA Enrollment Form

HIPAA/EDI 4010 Transactions:

• 837 Companion Document for HealthCare Claim: Institutional (ASC X12N 4010X096 & 4010X096A1)
• 837 Companion Document for HealthCare Claim: Professional (ASC X12N 4010X098 & 4010X098A1)
• 277 Companion Document for HealthCare Claim Status Response (ASC X12N 4010X093 & 4010X093A1)
• 277 Accept/Reject reason codes for HealthCare Claim Status Response transactions
• 835 HealthCare Claim Payment Reason Code Crosswalk
• 834 Companion Document for Benefit Enrollment (ASC X12N 4010X095 & 4010X095A1)
• 271 Companion Document for Eligibility Benefits (ASC X12N 4010X092 & 4010X092A1)

HIPAA/EDI 5010 Transactions:

• 5010 Migration Provider Notification
• 837 Companion Document for HealthCare Claim: Professional (ASC X12N 5010X222 & 5010X222A1)
• 837 Companion Document for HealthCare Claim: Institutional (ASC X12N 5010X223 & 5010X223A2)
• 277CA Companion Document for Healthcare Claim Acknowledgment (ASC X12N 5010X214)