The learner will: Define the purpose and function of ANSI X12 standards in healthcare data exchange. Explain how 837, 835, and 270/271 transaction sets are used in claims, remittance, and eligibility verification. Demonstrate how to navigate and use EDI software tools to track claim transmissions and acknowledgments. Evaluate common EDI error codes, transmission failures, and corresponding correction steps. Analyze remittance advice data (835/ERA) to identify payer performance and reimbursement patterns. Develop a concise training module or workflow guide outlining EDI transaction processes and compliance requirements.

Before starting this unit, learners should have: Basic understanding of claim submission workflows and clearinghouse functions. Familiarity with payer data exchange requirements and billing software systems. Completion of Unit 4.1: Claims Submission and Clearinghouse Functions or equivalent EDI-related experience.

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This unit is ideal for professionals seeking to develop or advance skills in healthcare data exchange, automation, and compliance. It is especially beneficial for: EDI Analysts and Data Exchange Coordinators – managing transaction files and troubleshooting submission issues. Billing and Claims Specialists – working with electronic claim formats and payer remittance data. Revenue Cycle Managers – overseeing system interoperability and EDI compliance. Healthcare IT and Systems Analysts – integrating EDI tools with billing or EHR systems. Students and Entry-Level Professionals – building foundational knowledge in healthcare data standardization and automated claim processes.