EDI or Electronic Data Interchange is an organized system to transmit data between computer systems utilizing established message formats and standards. Using healthcare EDI solutions, healthcare organizations, care, providers, and patients can exchange electronic health data for more secure and efficient data processing. Healthcare providers must follow HIPAA regulations and ANSI standards for healthcare EDI transactions. According to information from the Centers for Medicare & Medicaid Services (CMS), these transactions include, Claims and encounters information, Payment and remittance advice, Eligibility, Claims status, Enrollment and dis-enrollment, Coordination of benefits, Referrals and authorizations & Premium payments.
The common bottlenecks which might slow down your business growth
Slow EDI processing resulting in penalties, huge manual workforce hours, and high RCM cost.
Lack of EDI transparency into processing, causing the inability to apply rules and manageability.
Inability to maintain HIPAA compliance and ANSI standards for EDI transactions.
Lack of compatibility between services that use different programming language and platforms.
A growing volume of healthcare data that is beyond manageable with available resources.
Inability to maintain the healthcare data security for secure EDI transaction.
Streamlining healthcare EDI for flawless and optimized data transfer
Electronic data interchange (EDI) streamlines the health claims process, helping the healthcare organization run smoothly and more profitably. Compliance with HIPAA regulations and ANSI standards is a key part of any enterprise’s EDI structure. EDI modernization has a huge impact on the speed and efficiency of claims resolution and overall workings of a clearinghouse. Healthcare EDI modernization can help in streamlining the operations by enhancing submissions onboarding, processing, and reconciliation, with an independent console for claims exception management. It improves accuracy by providing deep visibility into transactions and metadata, while allowing automatic review, flagging, and error corrections for diverse EDI formats. OSP’ custom-made healthcare EDI software can reconcile data transactions and provides real-time data on transaction status and HIPAA compliance.
Our Electronic Data Interchange solutions employ mapping to integrate clinical data to the accepted EDI standards. We utilize the Application Program Interface (API) as an alternative method for mapping. The API is more efficient than mapping as its directly connected to the business applications database and can help to avoid the need to import/export. Being one of the renowned healthcare EDI companies, OSP’ healthcare EDI solutions help to implement EDI/X12 transaction across payers, providers as well as clearing houses. Our team of expert EDI specialists can develop a full-proof system of EDI gateway that has the potential to implement 834, 837, 820, 835 successfully, 27x, 274 transactions. We help to reconcile multiple sources of Healthcare data with CMS, Medicare, state, exchanges, and providers.
Analyzing EDI records effectively assess the variances at the file and database level is the need of the hour. Many find managing bigger batches of claims data while eliminating the dependencies on the applications is highly challenging. We help with our custom-made healthcare EDI software by employing heuristic parsing algorithms to conduct the required file comparisons and automatically test the EDI files for errors. A smart reporting mechanism can be developed to mark EDI-related data comparisons and variations in the EDI file and the database. We engineer next-gen EDI in healthcare with scalability in tests to add or remove additional claims of files. The advanced tools, metrics, and techniques are specifically designed for EDI to allow stakeholders to track the statuses of projects. Our healthcare EDI solutions help in expediated test automation with positive ROI gains.
Electronic data exchange in healthcare is a long and complicated process where workflow management and security are at paramount importance. To capitalize on the transfer of health EDI data, an easy-to-use EDI reporting and analyzing feature makes a better difference. Customized dashboards and ‘Schema-on-Read’ technology’ can be leveraged to view data on demand and track EDI activities. OSP can program top-notch healthcare EDI solutions with inbound analytics and reporting module. It can provide a real-time monitoring console and reporting dashboard for more thorough compliance auditing. Comparative remittance analytics can be delivered through easy-to-understand EDI reporting formats. We strive to help you with customized reports enable you to access, analyze, and track EDI data and performance.
Visualizing the EDI integration and management is highly important to have a clear and complete picture of your organization’s electronic data interchange. We help you gain access to real-time web-based healthcare data visibility to detect errors and uncover market trends to enhance your decision making. OSP can engineer electronic data interchange software to empower the ecosystem of healthcare stakeholders by allowing them to visualize their data intuitively, supporting a high standard of self-service capability, and reducing call volume. The real-time data access enables the stakeholders with robust decision-making ability and boosts the operational workflow. With the interactive dashboard, you can track every 837 files, claim, and line item. Our custom healthcare EDI software offers flexible and advanced dashboard templates to review work in progress claims, daily rejection, examiner productivity view, denial reasons, and analysis, etc.
It is mandatory for healthcare organizations to follow HIPAA and HL78 compliance while sending or receiving X12 EDI files. The electronic exchange of valid documents between diverse healthcare partners with greater accuracy is highly essential. We can healthcare EDI software helping you to quickly establish if a message is valid or not and provides you with the correct position and reason for any errors. We engineer healthcare EDI solutions with custom validation attributes that check for mandatory items and regulatory compliance, too many or too few repetitions, data type or EDI code of a data element, and the correct length of EDI, etc. Our validation engine first assesses EDI for structural changes such as missing trailer segments or reference number matching. Then it evaluates all items in the DOM tree and executes the pre-defined validation logic for each attribute.
A Texas-based mental health center wanted to reinvent the medical billing process and enhance approval rates which were 10% against 100 claims submitted.
It was challenging to manage multiple insurance providers for a large clinic set up for a health specialty that needs flexibility in medical billing solutions, workflow automation, accurate claim scrubbing, and fill regulatory compliance gap.
The solution comes with-
OSP' healthcare EDI solutions help to strengthen, cleanse, and enrich clinical data coming from a varied number of disparate data sources and different formats. With healthcare EDI advanced document management, we strive to build a system enabling patient care coordination, clinical research, or analytics reporting. We support quality metrics and value-based healthcare system through electronic data exchange in healthcare. We customize EDI in healthcare to tackle every pattern of EDI data integration from any source.
Patient eligibility and benefit verification are one of the crucial and challenging steps in revenue cycle management. OSP' extensive and tailored EDI software solutions help you connect a group of payers to automatically evaluate a patient's insurance coverage, identify provider database discrepancies and manage patient financial responsibility, while the patient is on site. Our solution can be customized to provide real or batch-time eligibility verification. You can submit eligibility requests via API integration, file upload or direct data entry, benefit-level sorting, and get data directly from payers.
If you must look at EDI files, you will find how challenging it is to make sense of them. They are made for computers to understand in their raw format. Making changes to EDI files can solve may future problems, but even the popular EDI systems lack in this feature. Our Healthcare EDI solutions can replace the manual injections of carriage returns with automated EDI editing capability. Importing the complex raw files and displaying the data in a clear and understandable format can be made possible with EDI editor. It can format raw EDI files, and every segment can be marked for editing the data.
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