EDI Files

Electronic Data Interchange (EDI) is a method of transmitting business information between two computers. This information is used to determine how a claim should be formatted and sent to the payer. In other words, EDI is the DNA of a claim.

The EDI information can be found in multiple places in Avea. Additionally, a user can manually import or export EDI information from Avea, depending on their specific needs. 

Outgoing EDI Information

When a claim is submitted, Avea sends an EDI file to the clearinghouse for review. Once the clearinghouse completes its review process, the file is forwarded to an intermediary for additional review before being sent to the payer. 

In the Record Center

All claims submitted (or marked as submitted) can be found in the Record Center under Insurance Claims. When one or more claims are submitted at the same time, the system will group the claims into a batch and assign them a control (internal claim) number. Let's review how to locate and download the batch EDI information.

• 1. Navigate to the Record Center > Insurance Claims > Batches.
     
     
  2. Select the Control Number of the desired batch.
     
  3. Select Download Batch Claims Institutional EDI File to download the EDI for Institutional Claims.
     
  4. Select Download Batch Claims Professional EDI File to download the EDI for Professional Claims.
  5. Select Bulk Download Claim EDI Files to download all EDI files within the batch.
     

In the Claim Instance

The individual EDI of a claim can be located within the instance of the claim. Let's review our to locate and download the individual EDI information.

• 1. Navigate to the Work Claim screen.
     
  2. Next, select Instances.
     
  3. Select the Control (Claim) Number to open the details.
      
  4. Select Recreate & Download Claim Transaction EDI to complete the process.
       

Incoming EDI Information 

After the payer receives the claim and adjudicates it, they send the EOB (Explanation of Benefits), also known as a Remit or 835 file, using the same process. When the clearinghouse receives the EOB, the EDI from that file is ported into Avea. Avea reads the information in the EDI file and uses it to apply the payment to the claim. Let's review where this information can be found and how it can be used.

In the Record Center

Payments received for a claim, regardless of the delivery method, can always be found in the Record Center under the Insurance Payment section. Let's review how to locate and download payment-related EDI files. 

• 1. Navigate to Record Center > Insurance Payments >Payment Collections.
     
  2. Select the Check Number to open the collection.
      
  3. In the collection window, select EOBs EDI to complete the download process.
     

Uploading EDI information

Users who post payments manually will now be able to upload EDI information directly into Avea. Managing Organization Users as well as Organization Users will require special permission to edit and import insurance payment information. Click here for additional information. 

• 1. Navigate to the Work Center > Insurance Payments.
     
  2. Select Enter Payment Collections.
     
  3. Next, select Import EDI.
      
  4. Select the Practice.
     
     
  5. In File, select Upload to import the file.
     
  6. Finally, select Import to complete the process. 

Note: If a payment cannot be matched when importing the EDI information, the system will route the payment to the Review Payments section for manual matching.