Pharmaceutical, Medical Supply and Healthcare EDI

EDI within the framework of the pharmaceutical and medical supply industry is very much like any retailer/supplier EDI relationship.  These medical EDI relationships include those between pharmaceutical companies, medical device companies, wholesalers, retailers, distributors, freight logistics carriers and any combination thereof.  What makes this industry unique is the use of documents such as the EDI 867 (Product Transfer and Resale Report) and that in many cases there is a middle man between the medical manufacturer and retailer adding an extra link in the supply chain.  Most of these relationships are handled via EDI, with the end customer of course, being the consumer.

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The data flow between pharmacy, medical supplies and retailers typically follow a path that starts with an EDI 850 (Purchase Order) that is sent from the retailer or distributor to the pharmaceutical, medical device company or wholesaler.  The wholesaler often will send back an EDI 855 (Purchase Order Acknowledgment).  Usually, an EDI 856 (Advance Ship Notice) is required to notify the retailer or distributor that the order has shipped. A special Pedigree ASN (known as an RxASN 856) is required to track prescription items through the entire supply chain. A UCC-128 bar coded label on each carton that corresponds with the Advance Ship Notice (ASN) will also be required.  Lastly, the wholesaler sends an EDI 810 (Invoice) to request payment. 

The EDI relationships between hospitals, providers, payers/insurers, etc. are completely different.  These relationships are more heavily regulated by HIPAA laws than that of pharmacy and medical supply.  Typical EDI transactions within these relationships include the Eligibility Inquiry (EDI 270), Eligibility Response (EDI 271), Claim (EDI 837), Claim Status Inquiry (EDI 276), Claim Status Response (EDI 277) and Benefit Enrollment (EDI 834).  Due to the sensitive nature of this data and legal liability, it's important to use an EDI provider that has experience with HIPAA documents.  

If you are looking to be EDI capable within the healthcare industry... 

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