Chapter 1. Purpose and Business Information

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1.1 Implementation Purpose and Scope

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For the health care industry to achieve the potential administrative cost savings with Electronic Data Interchange (EDI), standards have been developed to facilitate consistent implementation by all organizations. To facilitate a smooth transition into the EDI environment, uniform implementation is critical.

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The purpose of this implementation guide is to define the transaction set used to report Health Insurance Exchange-related remittance information. The entities involved in this exchange include issuers, Health Insurance Exchanges, and governmental agencies responsible for making payments to issuers. This transaction does not support the transmission of data and payment packaged together through the banking system. The payment will always be transmitted to the banking system separately while the remittance information will be transmitted directly to the issuer.

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