Home Encounter Data Improvement Resources Standardizing 837 EDI companion guides

Standardizing 837 EDI companion guides

August 2023

Companion guides (CGs) are provided to delegates to support the timely and accurate exchange of encounter data between trading partners, such as delegates and health plans. The guides contain specific information required to successfully exchange data, but can vary significantly from health plan to health plan. This variation makes it challenging for delegates to reference information needed to submit encounters and hinders the timeliness and accuracy of submitted encounters. The recommended actions within this document are intended to support alignment across health plan electronic data interchange (EDI) CGs.

Author

IHA in partnership with the Health Industry Collaboration Effort (HICE) Encounters Standardization Team

Why use it

IHA’s recommended actions for aligning EDI companion guides memo sets health plans up for success when creating or updating their EDI companion guides. By following a set format, structure, and content, health plans can ensure their companion guides will be consistent with other versions in the industry and will allow their contracted provider groups to consistently find the information they need. After reviewing the recommendations, health plan representatives should download the accompanying EDGE EDI Companion Guide Assessment Tool for hands-on guidance in this area.

Who it’s for

This resource is intended for all health plans that provide companion guides, or other versions of provider manuals.

Key take-aways

The following recommendations are meant to provide consistency and structure to health plan Electronic Data Interchange (EDI) companion guides.

  • Companion guide owners should adopt the CAQH CORE Master Companion Guide Template, which was created by the industry for HIPAA compliant transactions.
  • Companion guide owners should evaluate their companion guides to comply with the X12 Intellectual Property Use policies.
  • Companion guide owners should use the EDGE Companion Guide Assessment Tool and make corrections based on findings.

Have edits or additions for this resource? Please let us know.

IHA’s Resource Hub is made possible through a grant from Health Net, LLC’s Encounter Data Improvement Program.

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