Transactions & Electronic Data Interchange

The Health Insurance Portability and Accountability Act of 1996 was enacted by the US Congress and signed by President Bill Clinton in 1996. Title II, known as the Administrative Simplification provisions, requires the establishment of national standards for electronic health care transactions and national identifiers for providers, health insurance plans, and employers.

The Administrative Simplification provisions also address the security and privacy of health data. The standards are meant to improve the efficiency and effectiveness of the nation's health care system by encouraging the widespread use of electronic data interchange in the U.S. health care system.

Some of the transactions and code sets that WEDI addresses include:

  • Claims ProcessingEligibility (270/271)
  • Enrollment (834)
  • Admissions
  • Acknowledgements (999)
  • Prior Authorization (278)
  • Coordination of Benefits
  • Pharmacy Order
  • Electronic Funds Transfer  & Remittance Advice (835)
  • Attachments
  • Credentialing

Corresponding workgroups and subworkgroups: Transactions & Code Sets; 835, Acknowledgements, 837, Health ID Card, EFT, Testing, Attachments, 27x

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