Electronic Data Interchange (EDI) companion guides can vary significantly from health plan to health plan, making it challenging for delegates and provider practices to reference the information needed to submit encounter data. This lack of consistency hinders the timeliness and accuracy of submitted encounters. IHA’s EDI companion guide assessment tool informs companion guide development, helping to align structure and contents to create industry-wide consistency. By increasing alignment in their companion guides, health plans will ultimately helps providers more easily navigate encounter data submissions across their health plan contracts.
IHA in partnership with the Health Industry Collaboration Effort (HICE) Encounters Standardization Team
Why use it
Electronic interchange of data is essential for health plans and providers looking to improve the completeness and timeliness of their encounter data and claims submissions. To aid in this, health plans create and maintain companion guides for providers to use in tandem with HIPAA ASC X12 Implementation Guides. The EDGE EDI assessment tool will help health plans evaluate their existing companion guides or aid in the development of a new companion guide. The tool includes questions to assess whether your guide contains the proper information as well as instructions and tips on what to look for when assessing each component. To learn more about this issue, read the Recommended Actions for Aligning EDI Companion Guides Memo.
Who it’s for
This resource is intended for all health plans that provide Electronic Data Interchange companion guides, or other versions of provider manuals.
Health plans can use the EDGE EDI Companion Guide Assessment Tool to assess your companion guide structure and content to ensure it aligns with the industry. The assessment tool includes the following resources and key features:
- CAQH CORE Master Companion Guide Template
- X12 Intellectual Property Use Policy
- Assessment questions related to implementation and set up as well as a transaction-specific details