Electronic data interchange in healthcare is a secure electronic medium of communicating data between healthcare organizations, payers, and patients using specific messaging standards and formats. Healthcare EDI software accelerates all the workflows that happen amongst organizations involved in healthcare by enabling a fast, paperless mode of information exchange. The concept of an electronic data interchange solution is decades old but faces problems due to hundreds of messaging standards. There was conversion, interoperability, high IT overhead, and data security problems. The current version of the EDI solution standardized messaging to enable seamless information exchange.
It is an understatement to say that healthcare in the United States is complicated. When a patient walks into a hospital for treatment, there is access to EHR, prescription of tests, submissions of claims, and so on. All of these activities entail the exchange of medical information between concerned entities. OSP can build electronic data exchange platforms to accelerate all the workflows in healthcare by enabling rapid data exchange between providers and payers.
The safety and integrity of patients’ health information are important not only from a clinical standpoint but also from a legal one. Loss or misuse of data can result in serious legal consequences like fines and imprisonment. In light of this, the EDI tools for healthcare that we can develop to ensure that the information exchanged between stakeholders is safe. This safety is achieved through established protocols and standards that facilitate privacy and integrity.
Using an electronic data interchange solution in healthcare eliminates the need for physical documentation to be stored, transported, handled, filed, or retrieved. By minimizing the need for managing physical papers, a healthcare organization greatly accelerates the speed of operations while also minimizing human errors. By avoiding the need for physical document management, an EDI solution reduces the operating overhead and, ultimately, the cost of care.
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EDI stands for Electronic Data Interchange. It is the inter-organization communication of operational data in a standardized format. EDI works in the following way –
Electronic Data Interchange in healthcare is the secure, electronic means of exchanging data between organizations involved in the healthcare industry using established formats and standards. Those organizations include providers, payers, patients, and clearinghouses.
EDI services consist of all the processes involved in developing and implementing an EDI software or infrastructure for organizations in healthcare. The services in EDI involve everything from requirements assessment, to the design of a software platform, to its implementation and the integration of existing systems.
EDI (Electronic Data Interchange) is the digital exchange of business information and documents in electronic format between organizations involved in mutual trade. In the context of healthcare, it is a means of exchanging medically relevant information amongst providers, payers, patients, and clearinghouses.
Benefits of EDI include –
EDI stands for electronic data interchange. As the name suggests, it is the electronic exchange of business information among organizations involved in mutual business deals. It offers a safe medium of exchanging vital operational data without compromising security or integrity of the information.
EDI enables providers to transmit the billing information to payers rapidly and securely. It accelerates the submission of claims as well as the process of tracking them and later, processing the EOB (Explanation of Benefits) received from payers. As a result, the use of EDI software reduces the turnaround times associated with revenue cycles for providers.
1. Standard Document Format – It is the accepted format of the way documents are prepared to be sent over to the recipient.
2. Translator and Mapper – The mapper translates the data structures of a proprietary file into a format that is compatible by the recipient’s system. An EDI translator converts data from a large number of formats into a standardized structure that complies with EDI standards.
3. Communication Software – This is the software platform that is used to transmit the data from one organization to the other in the standardized format.
4. Communication Network – These are private networks for the interchange of information over the EDI. These networks offer an environment for senders and recipients to connect for exchanging data.
1. Healthcare Claim Transaction Set (837) – For providers and patients to submit healthcare claim information and receive the same.
2. Healthcare claim payment/advice transaction set (835) – For payers to reimburse providers and send EOB.
3. Retail pharmacy claim transaction – For medical personnel and regulators to submit retail pharmacy claims.
4. Benefits enrollment and maintenance set (834) – Used by employers, unions, government agencies, payers, and healthcare organizations paying the claims.
5. Payroll deducted and other group premium payment for insurance products (820) – This is used for premium payments for insurance health plans.
6. Healthcare eligibility/benefit inquiry (270) – Used by medical organizations to send enquiries about benefits and patient eligibility to payer organizations.
7. Healthcare eligibility/benefit response (271) – This is used to respond to enquiries about benefits and patient eligibility
8. Healthcare claim status request (276) – Used to request the status of claims already sent to payers.
9. Healthcare claim status notification (277) – Used by payers to report on the status of claims to providers.
10. Healthcare service review Information (278) – Hospitals use to request an authorization for medical procedures from payers.
Healthcare Electronic Data Interchange (EDI) is a means of exchanging medical data among different organizations electronically. The ability to exchange data instantaneously through digital means accelerates all the workflows and processes significantly. Most of all, it eliminates the need to handle physical paperwork and documentation, thereby reducing the operational overhead involved and maximizing data security. Since the data is exchanged digitally, there is minimal chances of its confidentiality or integrity being compromised.
Finally, the replacement of paper-based workflows with digital ones reduces the carbon footprint of the whole industry, as the use of paper is minimized.
EDI in healthcare allows the computer systems of organizations to exchange medical data digitally. The steps involved in implementing an EDI are –
1. Finalize The Organizational Structure
A robust organizational structure makes it easy to follow protocols while operating the EDI.
It highlights the priorities for EDI deployment and helps establish operational applications for the system.
3. Develop the EDI
The assessment provides insight into the specifications needed for the EDI system.
4. Select an EDI Network Provider
The selection of an EDI network provider should be done based on the operational requirements, instead of existing technical capabilities. If need be, the required technology components need to be implemented.
5. Integrate the EDI
This is perhaps the most important aspect of implementing an EDI. It needs to be integrated with other applications to facilitate data transfer.
6. Integrate Data of Businesses
It is necessary to identify the varying formats of data used by cooperating businesses before the EDI is implemented. This ensure that different systems can share data seamlessly.
7. Map the Data
Mapping the data shows how the data being actually transacted relates to the data on the systems. It is necessary for utilizing the data that has been transmitted or received.
8. Conducting Tests
Once the EDI system is ready and the data mapped, it is time to test the whole system to know if everything is working as desired. It highlights potential problems and enables the management to take appropriate measures.
9. Deploy the EDI
Following the successful testing, it is time to deploy the EDI among all the organizations that will be communicating.