Medical industry EDI overview

Challenges facing the healthcare industry

Under the pressure of changing regulatory challenges and rising costs , It is essential that medical organizations maintain the highest level of efficiency . Managing medical payments is an important process , It will put great pressure on their management , And affect efficiency 、 Compliance and care costs . Any discrepancy in the submission of a claim may result in the rejection of the claim and subsequent paperwork . The payer and the clearing house must use effective means to achieve smooth claims processing . Electronic data interchange (EDI) It is an electronic remedy for the challenge of medical payment .

However , In the medical field EDI It has its own complexity .EDI The most important aspect in medical treatment is management standards . These are very important for medical claims . Every EDI Transactions need a standardized format , To ensure fast data transmission and interpretation . Besides ,EDI The transaction must comply with HIPAA And other regulatory requirements ANSI standard .

adopt EDI Submit supporting documents and claim information , Faster identification of submission errors and claims processing , So as to improve the return on investment .

The medical industry EDI background

Electronic data interchange （EDI） yes 1960 Developed by the transportation industry in the s , Used to initiate accurate digital communication between customers and suppliers . After the transportation industry , Many other industries have also adopted EDI. All major industries require the use of EDI And comply with EDI Compliance .

The medical industry processes a lot of data every year ： Patient medical records 、 Drug data 、 Emergency service records and insurance claims, etc . Imagine , For every patient , Hospitals produce a lot of paperwork . Medical forms containing sensitive information will be transferred from one department to another or even several departments , Sometimes it will be transferred to an external company , For example, insurance providers , Thus errors and medical accidents may occur .

To protect and guarantee the security of medical information , Working group on electronic data interchange （WEDI） On 1991 Founded in , And included in 1996 Health insurance circulation and Liability Act of (HIPAA) statute .WEDI The introduction of 400 Great success in multiple paper medical forms and elimination of multiple formats .

EDI working principle

First , EDI medical transactions are not just email or something like that .EDI It involves the electronic data transmission between computer system and application program . Of course , These systems and applications vary depending on end users and delivery methods . These include ：

P2P EDI（ Point to point EDI）

Point to point EDI, Also known as direct connection EDI, It has historically been regarded as VAN substitute , It establishes a single secure transmission channel between two trading partners .

VAN EDI（ Value added network EDI）

many EDI Still pass VAN Conduct . flexible 、 The growth of low-cost methods , Such as Web EDI Or through AS2 Of EDI, Has begun to change the way businesses respond to VAN The choice of . but VAN Providers can also provide value-added services , adopt VAN The enduring appeal of EDI is based on VAN Value added services .

cloud EDI etc.

cloud EDI It's a convenience 、 Off site 、 Pay as you use solutions , It's cost-effective , Can improve operational efficiency , Enhance end-to-end visibility and facilitate more efficient collaboration . Simply speaking , cloud EDI There is less to build and manage , So that you can quickly join new trading partners , And can effectively help EDI Enterprises with limited expertise , Simplify the supply chain and EDI management .

The medical industry EDI Standard message

The medical industry uses standard messages , It is generally used X12 standard , Include ：

EDI Medical claims transaction set （837） EDI Medical claim payment / Suggested transaction set （835） EDI Benefit registration and maintenance set （834） EDI Health care qualification / Benefit query （270） EDI Medical related qualifications , Contracting scope or benefit response information （271） EDI Medical claim status request （276） EDI Health care provider information （274） EDI Healthcare information status notification （277） EDI Healthcare service review information （278） EDI Medical incident report （500）

In the medical industry EDI And data integration advantages

In today's digital business world , Most require the use of EDI Carry on the key B2B Trading companies are actually doing this . however , Those who make the most of EDI Companies with integrated advantages , Those companies that truly reap the rewards of automation by improving the visibility of business partner transactions and eliminating manual processes . From saving millions of dollars to increasing speed 、 Accuracy and efficiency ,EDI Still a very useful tool .

Standardization ：

standardized EDI Message can eliminate the confusion and complexity caused by file format , All recipients receive messages in a clear and consistent format , Consistent formats do not take time to decode other message formats .

Efficiency and cost savings :

EDI Message consistency leads to improved efficiency , Efficient processes save time ; Automatic data transmission is more efficient , There is no need for human participation , And automatic data transmission allows the party who needs data to receive and take action faster , Efficiency and higher accuracy save more costs for medical organizations ; Besides EDI and MFT Eliminates the time and effort required to support paper processes .

accuracy ：

Human error is sometimes inevitable , This can lead to costly mistakes , Automatic data entry greatly reduces the possibility of errors .

Security ：

EDI The format prevents unauthorized parties from accessing the patient's personal information in a readable manner ; And through medical treatment EDI Trade and MFT Improve safety , Reduce violation HIPAA The risk of ; be based on EDI Communication protects patients from violations and protects the organization from financial penalties and reputation risks .

choice EDI Things to consider before

Medical systems have many defined data formats and processes that have been used for many years , Adopt unity 、 Standard format , Make information easier to share , Make it easy for every authorized person to access data and reduce the administrative burden .

according to MarketsandMarkets The data of , To 2022 year , Medical care EDI The market value is expected to reach 37.7 Billion dollars . This growth means an increase in the amount of data , The growth of data volume needs technical support . Now it is time to adopt EDI The best time , Don't fall behind in a really important competition .

If you have any questions or suggestions , Please feel free to contact us . We look forward to your quick talk and demonstration with us , To learn how to put EDI Apply to your healthcare business .

Learn more about EDI knowledge , You can refer to ：EDI white paper

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