When it comes to interviews for EDI 837 positions, there are a few key questions that you can expect to be asked. Here are a few of the most common questions to help you prepare for your interview:
1. What experience do you have with EDI 837?
2. What are your thoughts on the current state of EDI 837?
3. How do you think the industry will evolve over the next few years?
4. What challenges do you see in the industry?
5. What are your thoughts on the future of EDI 837?
By preparing for these questions, you’ll be in a great position to impress your interviewer and land the job. Best of luck!
EDI BASICS for how to read healthcare 837 claim and 835 remittance files
Which software programming languages are you familiar with?
Highlights areas of expertise.
How do you go about training end-users on a system you deployed?
Demonstrates the candidates training and communication skills.
Interview Questions for EDI Analysts:
Tests the candidates knowledge of system design.
“I had a child when I was sixteen. I was expelled from high school for my numerous absences. My family and community pretty much wrote me off. However, I quickly secured employment at a sporting goods store. A tax company hired me as a receptionist soon after, and they gave me enough responsibilities that I was able to learn how to file taxes. Eventually I learned enough to become an associate. Then I received a job offer from a smaller company, where I was given control over all of the books, including accounts payable and receivable, despite the pay cut. Although it paid less, I decided to take the chance because I really wanted the experience. And I’m so happy I did because the controller of that company left six months later, and I was given that position. They informed me that since I lack a college degree, they could not formally refer to me as the controller. After having a child at sixteen, I made it all the way to controller of a company without even having a college degree, so I completed my degree five months ago just to make it official. Can you believe that? To be honest, I’ve been waiting to share that tale for so long that I spoke with a customer service agent last week to share it. She was nice about it and pretended to care. ”.
Stanton: My mental space to direct and sculpt my artistic vision has been reduced. But its added a lot, too. Every night I used to go on these four-mile walks to try to figure out what I was going to do next, but that’s not really happening anymore. I have time to do what needs to be done.
Stanton: You know what’s interesting, though? I think it resonated more during the [President Barack] Obama administration than during the [President Donald] Trump administration because everyone who’s really [been following] this project is so fixated on Trump at the moment, and they follow him all day long. In my opinion, now is not the best time for human-interest content because Trump is dominating the thoughts of progressive liberals.
I came to the realization that the photograph was merely a pretext to engage in conversation with these people, and that the discussions were both more fascinating and significant to me, the interviewee, and the audience as a whole than the photographs themselves. The editorial, the story, or the photo are not what makes it in the end. That street interaction, in my opinion, is where the work’s true heart and power lie.
Stanton: Some people are reluctant to share their stories, so you won’t find those on the blog. But I believe that for many people, having an interview is “honoring.” You believe you have something to say and that your experience is interesting. Frequently, when someone stops them, they become irritated and engage in conflict. People enjoy believing they have a worthwhile story to share. It makes you feel important when someone is extremely interested in your story.
Slideshows for you (
- Electronic Data Interchange and Standards
- What is the 837?
- Software requirements
- Implementation Guides
- Establish relationship with payer
- Electronic Data Interchange and Standards
- What is the 837?
- Software requirements
- Implementation Guides
- Establish relationship with payer
- Electronic Data Interchange
- Computer-to-computer exchange of business data between trading partners
- In EDI, information is organized according to specified format set by both parties
- For the most part, all information contained in EDI transaction set is same as information on conventionally printed document
- EDI reduces costs, improves accuracy, and increases productivity
- Lessens time and costs associated with receiving, processing, and storing documents
- Eliminates inefficiencies
- Streamlines tasks
- Developed and maintained by Accredited Standards Committee (ASC) X12
- ASC X12 chartered in 1979 by American National Standards Institute (ANSI) to develop uniform standards for inter-industry electronic exchange of business transactions
- ACS X12 Insurance Subcommittee (X12N) developed Implementation Guides originally published in May 2000
- Implementation Guides adopted by DHHS Secretary for use under HIPAA
- In October 2002, additional guidance was developed
- Addenda to X12N Implementation Guides were adopted for use under HIPAA
- Electronic Data Interchange and Standards
- What is the 837?
- Software requirements
- Implementation Guides
- Establish relationship with payer
- 837 format replaces current electronic export modes in RPMS 3P
- Full name: Health Claims & Equivalent Encounter Information
- Definition of 837 from 837 Implementation Guide:
- “ A standardized format designed to expedite the goal of achieving a totally electronic data interchange health encounter/claims processing and payment environment.”
- Current HIPAA compliant version
- ANSII Standard X12N 837 Version 4010 with Addenda (004010X096A1)
- 837 – Institutional
- Called 837I; replaces UB-92
- 837 – Professional
- Called 837P; replaces HCFA-1500
- 837 – Dental
- Called 837D; replaces ADA forms
- 837 – Coordination of Benefits
- Called 837 – COB
- Used for sending claims to secondary payers
- Coordination of benefits also called cross-over
- Process of determining respective responsibilities of two or more health plans that have some financial responsibility for a medical claim
- Electronic Data Interchange and Standards
- What is the 837?
- Software requirements
- Implementation Guides
- Establish relationship with payer
- GIS v3.01, p2 & p5 (Optional)
- 3 rd Party Billing, v2.5, p6
- Tested and certified by many different payers
- AUT Patch v98.1, p13
- For more information and most current releases, contact ITSC Help Desk
- http://www.ihs.gov/GeneralWeb/HelpCenter/Helpdesk/index.cfm
- Electronic Data Interchange and Standards
- What is the 837?
- Software requirements
- Implementation Guides
- Establish relationship with payer
- Main support tool for interpreting electronic transactions like the 837
- ACS X12 Insurance Subcommittee (X12N) developed Implementation Guides for standards for health care electronic transactions
- X12N HIPAA Implementation Guides and Addenda should be your primary reference documents
- Implementation Guides and Addenda are critical tools
- You need to have hard copies of them
- Each Guide is about 800 pages long so print Guides and Addenda double-sided
- Get them and keep them where you use them
- Publishes X12N Implementation Guides and Addenda adopted for use under HIPAA
- Free to download:
- All Implementation Guides (May 2000)
- All corresponding Addenda (October 2002)
- Can purchase:
- Book or CD
- Version that integrates Addenda into Implementation Guide
- www.wpc-edi.com
- Click on Products/Publications/PDF Download (Free)
- Or call 1-800-972-4334
- Three 837 Implementation Guides and Addenda
- 837: HIPAA Claim: Dental
- 837: HIPAA Claim: Institutional
- 837: HIPAA Claim: Professional
- Implementation Guide contains key terms
- Testing coordination staff must understand terms
- Software developers may use terms
- To assist sites
- To work with payers
- Data element
- Data segment
- Control segment
- Delimiter
- Loop
- Transaction set
- Header and Trailer
- Data element corresponds to a data field in data processing terminology
- Data element is smallest named item in ASC X12 standard
ISA * 00* ……….* 01 * SECRET…. * ZZ * SUBMITTERS.ID.. * ZZ * RECEIVERS.ID… * 930602 * 1253 * U * 00401 * 000000905 * 1 * T * :~ Data elements
- Mandatory data element
- Data is required to be populated or entire batch will not pass initial submission
- Situational data element
- Dependant upon facility
- Can be populated if data element applies
- Data segment corresponds to a record in data processing terminology
- Data segment contains related data elements
- Sequence of data elements within one segment is specified by ASC X12 standard
- All of this is a data segment:
ISA * 00* ……….* 01 * SECRET…. * ZZ * SUBMITTERS.ID.. * ZZ * RECEIVERS.ID… * 930602 * 1253 * U * 00401 * 000000905 * 1 * T * :~
- Control segment has the same structure as data segment
- Uses
- To transfer control information (e.g., start, stop) rather than application information
- To group data elements
- Delimiter is character used to:
- Separate two data elements
- Terminate a segment
- Delimiters are integral part of data
ISA * 00* ……….* 01 * SECRET…. * ZZ * SUBMITTERS.ID.. * ZZ * RECEIVERS.ID… * 930602 * 1253 * U * 00401 * 000000905 * 1 * T * :~ Delimiters
- Loop is group of related data segments
- Loops are specified by each Implementation Guide
- Importance of loops
- Some segments repeat
- Example: address line
- Loop identifies which address it is
- Example: Billing Office, subscriber, payer
- Transaction set contains data segments
- Transaction set is a grouping of data records
- For instance, a group of benefit enrollments sent from sponsor to payer is considered a transaction set
- Sequence of data segments within one transaction set is specified by ASC X12 standard
- Header is the start segment for transaction set or functional group or interchange
- Trailer is the end segment for transaction set or functional group or interchange
- For example, a transaction set has:
- A transaction set header control segment
- One or more data segments
- A transaction set trailer control segment
- Electronic Data Interchange and Standards
- What is the 837?
- Software requirements
- Implementation Guides
- Establish relationship with payer
- Open communication channels
- Identify person you will be working with
- Establish relationship with that person
- Determine that health plan/payer is ready for HIPAA compliance
- If so, determine what their expectations are of your facility
- How will claims be submitted? By website or messaging?
- Is there a minimum number of claims to be included in each batch?
- How will site receive confirmation reports that batch has been accepted by payer?
- In what format will Error Reports be provided?
- What is process for correcting and resubmitting batch files?
- What information will payer need from site to ensure resubmitted batch is not a duplicate batch?
- Will software be certified or will payer require each site to test individually?
- Will payer allow parallel testing or will they require a “hard switch”?
- Will payer continue to support software or systems provided by payer to conduct transactions?
- Does payer have a Companion Guide that must be reviewed by facility and OIT?
- Does payer have a Trading Partner Agreement that must be submitted?
- Is there an EDI (Electronic Data Interchange) form that must be submitted?
- Payer’s operating guide to electronic transactions
- Specifies how HIPAA compliance testing and certification are to be accomplished
- Transmission methods
- Volume
- Timelines
- Specifies payer’s coding and transaction requirements that are not specifically determined by HIPAA
- Payer may not require data elements for all fields
- Payer may include data elements that are specific to payer , e.g., local codes
- Agreements that formalize relationships with entities or persons with whom you will be doing HIPPA compliance testing and production
- Trading Partner Agreement (TPA) is established with external entity or payer (e.g., Trailblazers) with whom you will be doing business
- Business Associate Agreement (BAA) is established with person or organization that performs function or activity on behalf of covered entity but is not part of entity’s workforce (e.g., need an example ).
- Assures you are a priority to do HIPAA testing
- May provide access to payer’s online systems
- Means you get paid at higher rate because you are a contract provider
- What does payer cover?
- Which procedures are billable or not?
- Who is covered, who is not?
- Is preauthorization required? For what?
- Agreement requires signatures
- Allow enough time to get all the signatures
- Don’t complete this agreement until you are ready to begin testing
- Payer will stipulate effective date and you must begin testing within six months of that date
- To complete the TPA, you must obtain trading partner ID number from payer
- Obtain and install required software patches
- Obtain all 837 Implementation Guides and Addenda
- Contact health plan/payer
- Obtain and review Companion Guide
- Complete and submit Trading Partner Agreement
EDI Interview Questions for freshers experienced :-
1. What is EDI? It is the electronic exchange of business documents in a standard format from computer to computer. * An electronic method of communication between businesses that replaces phone, fax, and paper-based transactions
2. How does EDI Work? Purchase Ordering Example
3. What are the advantages of EDI? They include: strengthening business relationships; reducing/eliminating manual data handling, errors, and rework; automating routine transactions; improving productivity and business controls; lowering costs; shortening transaction processing cycles; improving data accuracy; lowering inventory levels; improving in-stock positions; lowering freight costs; providing quick response capability; and improving business controls.
4. What are EDI Drivers?
5. What is IDES? International Demonstration and Education System. A sample application provided for faster learning and implementation.
6. What is the most common EDI cycle?
7. Why move to EDI?
8. What is necessary for EDISS enrollment? EDISS requires providers to set up an online profile in EDISS ‘Connect’ before enrollment can begin. Creating a profile in Connect gives EDISS all the data required to finish setup in our system. During online registration, all demographic, facility, line of business, electronic transaction, and submission method data is immediately captured.
9. The EDISS phone lines are open for production file submissions 24 hours a day, 7 days a week, with the exception of Sundays from 6:00 a.m. m. to 12:00 p. m. (CT) when the lines are unavailable for scheduled maintenance.
10. A companion guide is used in conjunction with the HIPAA Implementation Guide; what is it and where can I get one? It provides information on how a particular payer interprets the data elements and what they need to process claims. Visit the MassHealth Provider Library under the link for MassHealth Regulations and Other Publications to find MassHealth Companion Guides.
11. Contact MassHealth MassHealth Customer Service to arrange the necessary setup for receiving the 835 transaction if you’re wondering how to go about doing it. There are specific sets of information needed to finish the registration process depending on whether you are a provider using a clearinghouse or billing agent, a provider submitting your own claims, or an organization overseeing multiple providers.
12. A 997 is a HIPAA-defined transaction that reveals the status of each EDI transaction segment and acknowledges its receipt.
13. The different standards for EDI transactions are ANSI ASC X12 for the US and EDIFACT and Tradecom for the UK.
14. What types of integration tools are available for EDI transactions? GENTRAN, GIS(4 0,4. 1,4. 2) Gentran Integration suite, sterling Integrator(5. 0,5. 1,5. 2).
15. What is an EDI Translator? An EDI translator is necessary for the bookstore system to have a consistent EDI interface. To and from the bookstore system’s trading partners, the EDI translator normalizes the EDI documents. Many independent businesses offer EDI translators, offering updated dictionaries along with the translator software as new revisions to the standards become available.
16. How is EDI Started? Usually Reactive or Proactive.
REACTIVE:
PROACTIVE:
17. Check the VBKT Table for duplicate orders that have been submitted or created, and send them to work flow if necessary.
18. If you’re looking for a program that triggers a DOC file, look at the IDOC_input_Material Code01 function.
19. It is difficult to say precisely what user exit to use without knowing the type of document you are sending (E1EDK03 occurs in a variety of DOC file types). To find a user exit that will do the job, look in the function module that generates and sends the IDOC file.
Outbound purchase order documents use function module IDOC_OUTPUT_ORDERS. You would probably use customer function EXIT_SAPLEINM_002. To code the user exit, you should first create a project for enhancement MM06E001 in CMOD.
(declare w_eledkO3, w_first, and w_somedate in the function group top include) CASE int_edidd-segnam is an example of your code. WHEN ‘E1EDKO1’. w_first = ‘X’. “flag first segment WHEN ‘E1EDKA1’. * insert E1EDKO3 segment before the first E1EDKA1 segment. if w_first = ‘X’. w_first = “. clear w_E 1EDKO3. W_E1EDKO3-IDDAT = “022”. W_E1EDKO3-DATUM = w_sornedate. MOVE W_E 1EDKO3 TO int_edidd-sdata. MOVE ‘E1EDKO3’ to int_edidd-segnam. APPEND int_edidd. ENDCASE.
20. Goods Movement With EDI Fields VLIEF_AVIS and VBELP_AVIS must be filled out in order for the correct shipping notification (ASN) to be pulled. You must not enter the purchase order number or the item number in this field. The “correct” ASN is not pulled by the IDOC, which is a technical interface. It must possess all required information in order to retrieve the proper ASN. It will always select the first item if this is not the case.
21. You can find out what the functional requirements are for mapping IDOCs to EDT by looking at a document from SAP titled “analysis of the compatibility of edifact messages in SIMPL-EDI with the IDOC interface.”
22. Data Extraction From EDI 830 The IDOC type for the message type DELFOR in ED1830 is DELFOR 01
23. The message type NEU is automatically created when the purchase order system is created or modified. When we configure the EDT, occasionally the E1EDKA1 segment shows the name of the plant and not the customer address. I want to perform a debugging. Output determination in purchase orders is carried out as a separate background process, not in the dialog process, so where should I place the breakpoint? NEU must be repeated in ME22N output, but you must set the timing to one and send with a recurring job. Set a breakpoint in IDOC_OUTPUT_ORDERS, then navigate to SE38 and run program RSNASTOO with the following parameters: application: EF object key: [your po number] output type: NEU transmission medium: 6 (for edi) or A (for ALE). Once you have finished this, your breakpoint will stop, allowing you to carry out a debugging operation.
24. Change the IDOC being generated from the purchase order to an inbound IDOC instead of the customary outbound IDOC for Intercompany ALE/E DI within the Same Client. In the partner profile, assign a new process code. The IDOC is created and the inbound process to create the sales order is started when you save the purchase order. The purchase order and sales order will be ready for you in one step.
25. message context properties in orchestration? Yes it’s possible. To do so reference to Microsoft. BizTalk. Edi. BaseArtifacts. dll should be added.
FAQ
What is EDI interview questions?
What data is necessary before a system for electronic data interchange (EDI) can be built? Which software programming languages are you familiar with? . What methods do you employ to guarantee that an EDI system is precise, effective, and user-friendly? How do you go about deploying a system and training end users?
What is a 837 in EDI?
An 837 file is a digital document that contains data on patient claims. Instead of printing and mailing a paper claim, this file is sent to an insurance company or a clearinghouse. • A transaction set is the name given to the data in an 837 file.
How do I read an 837 EDI file?
This is in reference to how the 837 EDI file that was sent to them was coded. Overview of How to Read an EDI (837) FileGo to Filing > CMS-1500 Locate the electronic claim you wish to view, then choose the icon. Click View EDI File.
What is a 837 response?
Information about medical claims is submitted electronically using the 837-transaction set. When submitting medical claims to payers in an electronic format, healthcare service providers must adhere to HIPAA EDI standards.
