What do the EDI rules require?
The EDI rules require the electronic transfer of information in a standard format between covered entities. The EDI rules cover a variety of electronic transactions, including enrollment, submission of premium payments, claims, and coordination of benefits. The EDI rules also include standard diagnostic and procedural code sets and identifiers to be used in the standard transactions. Employers most likely to be affected by the EDI rules are those that self-administer health benefits or maintain on-site clinics or pharmacies. Other employers will probably be able to rely on their vendors to develop the required standard electronic formats.
