This list reflects answers to frequently asked questions regarding Electronic Data Interchange (EDI).

The EDI Department supports:

Clearinghouses or billing agents that submit ASC X12 transactions on behalf of providers through secure file transfer protocol (SFTP) or the NCTracks Provider Portal
Providers submitting ASC X12 transactions directly to NCTracks, using either purchased or proprietary software, through secure file transfer protocol (SFTP) or the NCTracks Provider Portal
Ramp Manager
Pharmacy Point of Sale (POS) Vendors
NCTracks Provider Portal (upload of ASC X12 batch files only)

The EDI Department does not support:

NCID (see https://ncid.nc.gov/login/)
NCTracks Provider Portal (unless regarding upload of ASC X12 file)
Electronic Funds Transfer (EFT) and pre-note
Claims processing/adjudication
Pharmacy Point of Sale claims adjudication
Assignment of PIN code
TSN Assignment in NCTracks Provider Portal

For assistance with these non-EDI functions (except NCID), please contact the main Call Center number at 1-800-688-6696.

  • 1. What is EDI?

    EDI stands for Electronic Data Interchange. Essentially, it’s the exchange of data between sources electronically. In healthcare, the information exchanged includes, but it not limited to: claims, requests for eligibility information, claims payment information, etc. The sources exchanging the data (also known as transactions) are referred to as Trading Partners.

  • 2. What are the X12 ASC HIPAA transactions?

    Inbound Transaction (transaction TO NCTracks)
    • 837I – 837 Institutional
    • 837P – 837 Professional
    • 837D – 837 Dental
    • 270 – Eligibility Request
    • 276 – Claims Status Request
    • 834I – Benefit Enrollment and Maintenance
    Outbound Transaction (transaction FROM NCTracks)
    • 999 Acknowledgement Report
    • 271 - Eligibility Response
    • 277 – Claims Status Response
    • 277U – Claim Status Response, Unsolicited (generated at check write to report pending claims
    • 835 - Electronic Remittance or Explanation of Benefits