
Boosting Healthcare Industry With EDI Technology

Since the COVID-19 pandemic outbreak in 2019, digitalization has become one of the biggest global trends. Many businesses considered it as an opportunity to continue their work in the remote mode. Others were looking for a way to streamline their operations. But all of it resulted in significant growth of data transfer globally.
According to Statista, the total amount of data created, captured, copied, and consumed globally, reached 97 zettabytes in 2022 and will almost double in 2025.
How can we make all that data work efficiently? Out of a variety of software solutions, each business chooses a product according to its specific needs. But for productive cooperation, all those applications should be aligned and appropriately integrated. And this is where EDI comes in.
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EDI (Electronic Data Interchange) technology streamlines business operations by allowing companies to exchange documents digitally in a standardized format.
From faster document transmission and transformation to automated workflows, EDI integration has the potential to reduce costs and errors, creating smoother relationships with partners and customers. An example of its application in order processing. Buyers submit orders for products that suppliers invoice before both parties exchanges actual receipts.
An efficient electronic data interchange between businesses enables this optimized interaction.
As mentioned before, each company chooses software for its specific needs. One company can have a particular ERP while its counterparty may use another. As they constantly exchange data, it needs to convert to be read and stored in both systems.
It will take heaps of time to convert all data manually, which is why the need for automation arises. In general, the process looks like this:
The healthcare industry is one of the most heavily regulated ones.
Medical servers store large volumes of confidential and sensitive data. Aside from diagnoses and health records, it includes billing and financial details. This data must be secure yet easily converted to keep the flow going. And, of course, all transactions should be HIPAA-compliant.
Here are some standard medical EDI transactions:
EDI 834 for employers, government agencies, and insurers to enroll members in a healthcare benefit plan.
EDI 820, commonly used by healthcare providers to remit premium payments for insurance products, effortlessly facilitates transactions between financial institutions and consumers.
EDI 270 offers healthcare providers a vital tool to easily access crucial information from financial and government organizations, providing quick insight into patient benefits eligibility.
EDI 278 sends essential details like the patient’s diagnosis, treatment data, and personal information from healthcare providers to payers during payment authorization.
EDI 837 is an essential data format for healthcare providers with payers. It facilitates a seamless exchange of healthcare claim billing, encounter info, or both. It may be direct transmission from providers to insurers or via third-party billers and clearinghouses. In any case, it helps ensure that payments come on time. It doesn’t apply to retail pharmacy claims.
With this kind of EDI, healthcare providers can easily and securely transmit retail pharmacy claims directly to payers, ensuring speedy reimbursement.
Healthcare organizations must have a ten-digit national provider identifier (NIP) and follow HIPAA Privacy Rule, HIPAA Security Rule, and HIPAA Enforcement Rule to align with HIPAA EDI standards.
According to the 2021 CAQH Index, the US healthcare industry saved around $166 billion by automating administrative transactions with further potential for cost reduction. Proper integrations minimize paperwork and human errors, speeding up operations.
If you are interested in EDI, we recommend hiring a specialized software development company experienced in creating products for healthcare organizations and awareness of industry-specific needs. This way, you can spend less time creating requirements specifications. Also, an experienced provider may advise you on features that can positively affect your financial results in the future.
Build your effective ecosystem, save time and focus on your strategic goals by automating transactions.
EDI (Electronic Data Interchange) is an efficient method of exchanging data between two businesses. It lets companies quickly and accurately share critical documents in a standardized format for seamless integration into their processes.
EDI consists of four integral elements – standardized documents, transformation and organization capabilities, preferred modes of sending information, and reliable networks for document exchange. By utilizing EDI’s features, businesses can improve the speed & accuracy of their digital communication on both national & international levels.
If you want your deployment to run smoothly from start to finish, look no further! Our 7-stage process or specialized integration and deployment services get the job done quickly and effectively.
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