AS 4937-2002

Provides guidance for the implementation of electronic messages for exchange of claim and related information using the UN/EDIFACT Standard.

This Standard covers implementation of commercial transactions between (predominantly) health care providers and payers of healthcare services for the purposes of patient claiming, eligibility checking and related commercial transactions. The Standard refers to —(a) several existing message syntaxes;(b) the United Nations Electronic Data Interchange for Administration, Commerce and Transport (UN/EDIFACT); and(c) the National Consultative Group for Private Healthcare E-Commerce (NCG) formats for hospital claiming.The NCG, in its role as the working group on Finance and Billing for the IT-014 Health Informatics Committee, recognizes the importance of standard implementations of the UN/EDIFACT syntax, which are automatically provided in the interface engines and message translators provided by the major e-Commerce software organizations. Wherever possible, standard implementations have been recommended.The NCG reviewed and interpreted data segments and data elements that are mandatory (required), optional or conditional (required, based on a condition), and relevant usage notes in the Australian health environment. The Standard provides consistent use of data definitions as well as commentary and references to the International Organization for Standardization (ISO) and the National Health Data Dictionary.This Standard focuses upon business-to-business e-Commerce transactions. Although a range of interchanges involving business-to-consumer information flows have been included in the data model for the sake of completeness, functional messages supporting business-to-consumer transactions do not form part of this Standard.This Standard does not cover transactions conveying messages to and from financial institutions for the purposes of debiting and crediting bank accounts, and messages conveying transactions to and from healthcare suppliers for the purposes of electronic procurement.

First published as AS 4937-2002.