EDI integration
EDI Integration for Healthcare & Payers
Claims, eligibility and payments — without the flat-file pain. BharathiExchange validates, translates and routes administrative transactions between providers, payers, TPAs and national claims exchanges, and links every claim to the clinical evidence behind it.
Supported transaction sets · ASC X12 005010
| Set | Purpose | Direction |
|---|---|---|
| 270 / 271 | Eligibility & benefits inquiry / response | Provider ⇄ Payer |
| 276 / 277 | Claim status inquiry / response | Provider ⇄ Payer |
| 278 | Prior authorisation & referral | Provider ⇄ Payer |
| 837 P / I / D | Professional, institutional & dental claims | Provider → Payer |
| 835 | Remittance advice & payment | Payer → Provider |
| 834 | Benefit enrolment & maintenance | Sponsor → Payer |
| 820 | Premium payment | Sponsor → Payer |
| 999 / TA1 | Implementation & interchange acknowledgements | Both |
| NCPDP D.0 | Pharmacy claims & eligibility | Pharmacy → PBM |
| FHIR Claim | National claims exchanges (e.g. India NHCX) | Provider ⇄ Payer |
Lifecycle of a claim
271 response caches benefits at registration.
278 with clinical attachments pulled from the HIE record.
AI pre-checks codes and edits; 837 goes out, 999 comes back.
277 status updates stream into the provider's work queue.
835 auto-posts payments and flags denials with reason codes.
Gateway capabilities
Built for every trading partner
Configuration, not custom code, for each new payer or provider connection.
SNIP levels 1–7
Syntax through code-set and trading-partner rules, with plain-language error messages instead of raw 999 segments.
Trading-partner management
Companion guides, envelopes, IDs and schedules configured per payer — no custom code per connection.
AS2, SFTP, REST
Batch and real-time channels with retries, acknowledgements and full message lineage.
X12 ⇄ FHIR mapping
Claims and remittances surface as FHIR Claim, ClaimResponse and ExplanationOfBenefit for analytics and patient apps.
Denial prevention
AI scores each claim for likely denial reasons before submission. See AI Solutions.
Actuarial feeds
Claims and payments flow straight into reserving and pricing models. See Actuarial.
FAQ · EDI integration
Claims and administrative transactions.
5 common questions.
Which EDI standards are supported?
ASC X12 005010 transaction sets — 270/271, 276/277, 278, 834, 835, 837P/I/D, 820 and 999/TA1 — plus NCPDP D.0 for pharmacy and FHIR-based claim bundles for national claims exchanges.
Can we connect to payers that don't use X12?
Yes. The gateway handles FHIR claims, payer-specific JSON or XML formats and flat files, and maps them to a common internal claim model.
How are EDI errors handled?
Files are validated against SNIP levels 1–7 before submission. Rejections and 999 errors are turned into plain-language messages and routed to the right billing work queue.
How long does onboarding a new trading partner take?
Most partners are configuration rather than code: envelopes, IDs, companion-guide rules and transport. Timelines depend mainly on the partner's own testing cycle.
Can clinical documents be attached to claims?
Yes. Because EDI sits on top of the HIE, supporting evidence such as discharge summaries or lab reports can be pulled from the record and attached to a prior authorisation or claim.
Modernise your claims flow
See eligibility, prior authorisation and claims running end to end on BharathiExchange.