Healthcare Electronic Data Interchange Speeds Up Clinical Operations 

ByShawn davidson

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 solutions for EDI healthcare 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.

Solutions for EDI health 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.