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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.

 

What is an EDI file?

X12 is an ASCII standard. This means that all the content of a transmission consists of ASCII characters. ASCII or text files can be viewed and edited with a regular text editor but since EDI does not use line feeds and carriage returns to mark the end of a line, an EDI document is usually very hard to view.

A view of raw EDI data

As you can see in the previous figure, it is quite difficult to discern the individual data elements within the ASCII text file. One needs an EDI Editor to get a more meaningful representation of an EDI file. Here is how this file is displayed in the EDI Editor:

The same data viewed with HIPAA Claim Master's built-in EDI Editor