EDI (electronic data interchange) is a secure way for healthcare and associated
organizations to exchange data securely. Not only is it convenient, but also
ensures complete security and compliance with existing regulations. Before the
implementation of a uniform EDI, healthcare providers across the country used
various different information standards and data formats to exchange
information. Needless to point out, this posed a highly fragmented workflow
that was also prone to errors. Mistakes in turn led to rework, which at larger
hospitals invariably resulted in lower efficiency.
Healthcare
EDI platforms help clinical staff to send and receive information without
having to worry about data formats. Doing so speeds up the communication
between healthcare organizations, which in turn improves the productivity of
all the activities.
HIPAA
Compliance
The
Health Insurance Portability and Accountability Act of 1996 stipulated that
patients’ medical data must be protected and outlines guidelines that all
relevant organizations are required to follow. This rule invariably involves
following certain data formats for processing medical information. Moreover, it
also requires hospitals, insurance payers, testing labs, and radiology centers
to use encryption for managing patient data. Before HIPAA, organizations used
proprietary codes for data interchange. But as mentioned above, pre-processing
that data made the process cumbersome and expensive and the codes would vary
among organizations.
But edi
solution streamlined the process for exchanging data
electronically and ensured security, speed, and reliability. As there is a
digital interface with automation, there is bound to be limited human
intervention. Consequently, the probability of malicious activity, unauthorized
workflow, data leakage, and fraud is lowered significantly.
Since
there are virtually no errors in billing or financial data, insurance payers
use EDI billing software to process claims. EDI in medical billing is known to
help insurance companies function better and reduce the chances of
problems.
Let’s look at some EDI transaction sets -
EDI Benefit Enrollment and Maintenance Set
(834)
This
transaction set is applicable for use by unions, associations, and government
agencies to enroll people into health plans with payers.
EDI
Health Care Claim Status Notification (277)
This
particular transaction set can be used by an insurance company or a legally
permitted party to communicate the status of a healthcare claim or clinical
visit to a physician or other authorized persons. Moreover, the 277 set is also
used by the same entities to request further information on a said claim in
order to help the procedure along. But it is to be noted that it can’t be used
for posting about account payments.
EDI Functional Acknowledgement Transaction Set
(997)
This is
a particular transaction set that is used to outline the results of the
syntactical analysis of documents that are electronically coded. The results
are indicated by a set of acknowledgments whose control structures are defined
using this transaction set. The documents that are encoded are bunched into
certain functional groups that are used to outline the transactions for
interchanging business data.
edi
software solutions have become an integral part of the current
medical industry. As the model of reimbursements moves towards a value-based
system, we can expect newer innovations in solutions for EDI transactions in
healthcare.
Comments
Post a Comment