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Each electronic claim file is subjected to various edits to before being submitted. These edits validate that the file conforms to the EDI 837 file format and that the file would not be rejected by the state. After each EDI submission, an acknowledgment receipt is sent to the submitter confirming a successful submission or a list of failed submissions.
Electronic claims processing software used in preparing the claim information should include fairly complex business rules, and must reflect a good understanding of the most recent HIPAA rules. In addition to conforming to HIPAA rules, the electronic claims processing software must also adhere to several privacy and security rules. Moreover, since HIPAA rules may change, the software should have the ability to easily update itself.