EDI Management

EDI Benefits Using EDI to exchange information and other payers may benefit care providers and their billing services. The benefits to care providers:

• Sending and receiving information faster Turnaround times are typically quicker than using manual processes. For example, a payer can receive a claim the same day the care provider sends it, and an eligibility inquiry can be received and responded to in seconds.
• Identifying submission errors immediately and avoiding claim processing delays Electronic claims are automatically checked for HIPAA and payer-specific requirements at the vendor, clearinghouse and payer levels. This process decreases the reasons a claim may be rejected by the payer. This same level of automated data verification can’t be performed on paper claims.
• Lowering account receivables Electronic transactions, such as the eligibility transaction, provides the patient’s current coinsurance, deductible and benefit information when they’re in for an appointment and before the claim is submitted to the payer for processing. This allows the care provider to collect a copayment at the time of service.
• Reducing administrative expenses EDI cuts down on purchases of paper, forms, supplies and postage. It also saves time faxing, printing, sorting and stuffing envelopes.
• Exchanging information with multiple payers EDI lets you complete transactions for multiple payers at one time. Transactions can be set up to automatically generate in a practice’s daily workflow. For example, a practice management system could perform a claim status inquiry at the same time it sends eligibility inquiries to verify a member’s benefit coverage and copayment.