US · guidance
CMS Pub. 100-04, ch. 24, § 20
General EDI
EDI is the process of using nationally established standards to exchange electronic
information between business entities. These national standards are developed and
maintained by a group of standards development organizations (SDOs), such as the
Accredited Standards Committee (ASC) X12 and the National Council of Prescription
Drug Programs (NCPDP). The Department of Health and Human Services (HHS)
adopted certain electronic standards for use in health care under the Health Insurance
Portability and Accountability Act of 1996 (HIPAA). Medicare FFS is required, as are
all payers in the US, to adopt the standards specified under HIPAA. However, as part of
Medicare FFS’ EDI Acknowledgement Model, three additional ASC X12 standards will
be adopted for error handling (277CA claim acknowledgment, 999 implementation
acknowledgment, and TA1 interchange acknowledgment) that are not mandated under
HIPAA. In addition, there will be one additional standard adopted for NCPDP error
handling (transmission response) that is not mandated under HIPAA.
History
(Rev. 2803, Issued: 10-28-13, Effective: 09-17-13, Implementation: 09-17-13)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
2ca394f6f6194fdeef27760cc3c33ae30a75eba1c137c1b06146c6eb3a26760f
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