Title: What Is Healthcare EDI and Why Does It Matter?
Headings: What Is Healthcare EDI and Why Does It Matter?
What Is Healthcare EDI and Why Does It Matter?
What Is Healthcare EDI?
Healthcare EDI and HIPAA Compliance
EDI and Data Integration Benefits for the Healthcare Industry
Accuracy:
Cost savings:
Start with the Low-Hanging Fruit

Content: HIPAA mandates healthcare organizations to follow a standardized mechanism of EDI to submit and process insurance claims. The logic behind this regulation is to make the administration of healthcare in the US more secure and efficient. In addition, the law requires healthcare organizations to implement secure electronic access to health data and comply with HHS privacy regulations. Before this rule came into effect, healthcare providers had their own local or proprietary codes. The landscape was confusing and difficult to navigate. By using specific standards designed for the healthcare industry, healthcare EDI reduces complexity for all parties. There are standard transaction sets for claims, payments, enrollment, eligibility inquiries, and claim status requests. A corollary step that worked to reduce complexity was the introduction of the National Provider Standard, which requires that each healthcare entity (including individuals, employers, health plans, and healthcare providers) have a unique ten-digit national provider identifier number (NPI). NPI numbers play a vital role in healthcare EDI transactions; you can only submit standard HIPAA transactions with your NPI.