Ohio Department of Aging
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The following are key terms users will encounter while processing EDI transactions within the Ohio Department of Aging's computer system.
Trading Partner -- An external entity with whom business is conducted. Providers wishing to become a Trading Partner with the Ohio Department of Aging must complete and return a Trading Partner Profile and a Trading Partner Agreement.
Trading Partner Profile - A document that is submitted during the assessment period. Information requested on the form includes contact information, networking preferences, and enveloping identifiers.
Trading Partner Agreement - A legal document which stipulates the terms and conditions that trading partners agree to before exchanging electronic documents. VAN (Value Added Network) - A VAN is a vendor that stores and forwards EDI documents from/to trading partners. Some VANS also offer EDI translation services too.
Translation Software -- This is software used to translate (convert) proprietary files into EDI transactions (i.e., 837) and EDI transactions (i.e., 277 & 835) into proprietary files. Providers can purchase their own software or contract with a VAN/Clearinghouse who will do the translations for them.
OIT/ESS/ECC (Office of Information Technology/Enterprise Shared Services/Electronic Commerce Center) - This is a state facility that Ohio Department of Aging has contracted with to provide EDI translation services. This facility takes EDI transactions and translates them into proprietary text files for use in ODA's computer system. This facility also receives proprietary text files from ODA and translates them into EDI transactions for providers.
Electronic Transmission Medium - These were originally a value-added network (VAN), magnetic tapes and disks, but are increasingly the open, public Internet.
837 Health Care Claim-Professional - This is the ASC X12 EDI document providers must use to submit their billing information to the PAA for processing and payment.
277 Claim Acknowledgement - This EDI transaction is generated by PIMS when errors are detected in the content of an 837 transaction. Information which has been rejected is not loaded into the Department of Aging's PIMS system. Rejected data must be corrected and resubmitted.
997 Functional Acknowledgement - This EDI transaction is generated by the EDI translator to report the status of syntax checking the EDI documents received from a provider. It notifies the provider on whether their EDI transaction was accepted or rejected. If rejected, detail information on the error is returned. If accepted, the document is translated into a text file and sent to ODA for processing.
835 Claim Payment/Advice - This is the electronic remittance advice that is sent back to the provider once the PAA adjudicates the claims in PIMS.
Passport Administrative Agency (PAA) - Organization contracted by the Ohio Department of Aging to administer services for Ohio's PASSPORT Medicaid waiver program. In Ohio, there are 13 PAAs.
Ohio Department of Aging (ODA) - The state regulating agency who administers the PASSPORT program.
Submitter - Entity who initially formats the claim data into the ASC X12N EDI transaction and begins the transmission chain. The submitter could be a billing service, an automated clearinghouse, or another entity that formats the claims into the 837.
X12 - An ANSI-accredited group that defines EDI standards for many American industries, including health care insurance.
National Patient ID - A system for uniquely identifying all recipients of health care services.
National Payer ID - A system for uniquely identifying all organizations that pay for health care services.
National Provider ID - A system for uniquely identifying all providers of health care services, supplies, and equipment.
Clearinghouse - A public or private entity that processes, facilitates or converts non-EDI files into EDI format and/or EDI-formats into non-EDI formats.
Billing Provider - Original entity who submitted the electronic claim. Although the billing provider may be a health care provider, a billing service, or some other representative of the provider, ODA requires billing provider to be a PASSPORT provider.
Pay-to Provider - Entity that receives the claim payment and is only used if different from the billing provider.
Rendering Provider - In health care, the entity preparing the claim is not always the entity that performed the service. Rendering provider identifies the entity performing the service.
Receiver - Entity that receives the claim transmission which may be the payer or an entity acting on behalf of many payers.
Ohio Department of Aging