Electronic Data Interchange In Healthcare

EDI in Healthcare

The healthcare industry has undergone drastic changes like most industries, becoming more digitized specifically in how data is processed. In the healthcare industry, an enormous amount of extremely sensitive data such as patient medical records, health insurance reimbursements, and healthcare claims is being exchanged between providers, payers, and intermediaries such as clearinghouses, repricing solution providers, and vendors every day. How data is shared between trading partners shifted from manual to digital processes as a result of the regulations introduced by the Healthcare Insurance Portability and Accountability Act (HIPAA) and the Patient Protection and Affordable Care Act (ACA). With these regulations, healthcare data is transmitted securely in standardized formats with increased information accuracy.

Before HIPAA, data management was manual, mostly paper-based, making it difficult to protect and secure sensitive information. Today, information is exchanged electronically between trading partners via Electronic Data Interchange (EDI), a structured mechanism helping improve processes with less human interaction. For healthcare organizations, it is critical for their EDI systems to be compliant with HIPAA regulations and ANSI standards. Using the EDI HIPAA standard transaction sets such as 834; EDI Benefit Enrollment and Maintenance Set, 837; EDI Health Care Claim Transaction Set, EDI 835; Health Care Claim Payment Transaction Set, 276; EDI Health Care Claim Status Request, 270; EDI Health Care Benefit Inquiry, healthcare providers and payers can take advantage of improved productivity and processing, significant cost savings, optimized processes and increased security.

Where is the Healthcare EDI market heading?

Standardization, cost and time savings, security, and more efficient processes can be mentioned as the major advantages EDI provides. Substantial growth is expected in the EDI market according to analysts. Research conducted by Grand View Research, Inc. predicted the Global Healthcare Electronic Data Interchange Market to reach USD 5.9 billion by 2025. The growing number of end-users such as healthcare providers, payers, medical device companies are expected to increase the demand for EDI solutions. North America has dominated the share in the healthcare EDI market so far due to the higher adoption of innovative technology solutions and the increasing mandatory regulations.

The Common Problem Of Most Data Management (EDI) Systems

Considering the regulations and digital innovations, it’s almost accurate to say nearly all healthcare organizations have a data management system in place. While some factors such as level of compliance, ease of integration are usually considered during the planning and selection phases, most organizations ignore the critical factor which is data, itself. Having instant access to the location of the error within a file intuitively and efficiently is the missing piece with most of the systems. A common scenario includes an analyst trying to access a specific transaction to easily read the fields and pinpoint the problem to respond to the patient’s needs quickly. With most systems, this action requires the involvement of the technical teams for further investigation and determination of the cause.

Resolving one of the biggest challenges is simplified with VLink's SimplyEDI.

With SimplyEDI’s intuitive EDI parsing, editing, and validation features, business users can eliminate the downtime and interruption caused by inefficient EDI processes. Want to learn more? Contact us at [email protected] or simply send me a message!