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EDI for Healthcare

Healthcare EDI for improved data management and accelerated business growth.

Electronic Data Interchange in Healthcare from your trusted partner

Enjoy a simplified application database with advanced and innovative EDI healthcare solutions from A3logics.

Electronic Data Interchange or EDI is a secure and electronic system to transfer data between computers or businesses that utilize established message standards or formats. Healthcare for EDI replaces traditional paper-based communication. With this agile and smart solution, healthcare facilities, organizations, providers, centers, and patients can send and receive data via an electronic system to ensure efficient and secure processing. When working with HIPAA data, organizations need to comply with regulations and ANSI standards. Our specialized and tailored EDI tools for healthcare take care of everything on one platform. Whether you need to transmit data between third party administrators, payers, plans, clearinghouses, or other companies, we have covered it all. The EDI for healthcare provided by A3logics supports all transactions, including payment and remittance advice, claims and encounters information, eligibility, coordination of benefits, premium payments, enrollment & disenrollment, and more. So, choose the right and authentic healthcare EDI from us and let our experts handle all the strenuous work for you while you focus on other core activities.

EDI Healthcare Solutions

For optimized healthcare EDI transactions and secure data transfer, we offer an array of EDI solutions under one roof.

EDI Integration

We use EDI mapping to integrate healthcare data to EDI standards. A3logics also utilizes API as an efficient solution as it is connected to the business application database and eliminates import/export effort. Also, our team holds proficiency in developing a reliable EDI gateway system.

Interactive Dashboards

With our healthcare EDI software solution, you get real-time web-based data visibility. This provides you with clarity and understanding of the organization's EDI and helps you detect errors along with exploring market trends which are highly important to make informed decisions.

EDI Healthcare Automation

By streamlining the health claims and improving the speed and efficiency of claim resolution. EDI assists healthcare centers to work smoothly and profitably. It also maintains compliance with HIPAA regulations and ANSI standards which is critical for any EDI structure and effective transactions.

EDI Reporting

EDI analytics and reporting is an important feature to manage the complexities of workflow management and security. With a customized dashboard and ‘Schema-on-Read’ technology,’ you can not only view data on demand but can also track all EDI activities in real-time.

EDI Test Automation

Managing a high volume of claims data without depending on applications is a daunting task. Our meticulously designed healthcare EDI software solution uses heuristic parsing algorithms, a smart reporting system to compare the files and test them automatically for errors.

Compliance validation

Healthcare organizations and centers have to comply with HIPAA and HL78 regulations while sharing X12 EDI files. Our advanced EDI software for healthcare ensures accuracy by identifying the validity of a message and reason for errors while checking other EDI transaction requirements.

Benefit of Getting EDI Healthcare Solutions from A3logics

EDI Editing

Making sense of EDI files can be complicated, time-consuming, and challenging as only computers can understand their raw formats. Also, most EDI systems fail to modify these files due to inadequate features. A3logics’ EDI software includes an automated editing feature and can replace manual injections of carriage returns. It imports the raw data and makes it clear and understandable.

Benefit and Eligibility Verification

One of the most crucial steps in the revenue management cycle for any healthcare organization is benefits and patients eligibility. With our customized software for healthcare, you can easily connect with the payers and evaluate patients’ insurance coverage and determine any discrepancies. You can send requests through API integration, file upload, benefit-level sorting, or direct data entry

Document management

A3logics intends to deliver quality metrics and value-driven healthcare systems through its EDI solutions. Our healthcare EDI software is competent to handle data integration patterns effectively. irrespective of the data sources and formats, it will clean, strengthen, and enrich the data. Advanced document management contributes to analytics reporting, patient care coordination, and research.

Common Challenges Addressed by Healthcare EDI

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Our healthcare EDI software handles all the bottlenecks that hamper your business growth.

Lack of Transparency

Many healthcare facilities face issues with data transparency in business processes. This leads to greater problems, such as the inability to manage and apply rules. Our software solution makes EDI transactions transparent and accessible.

Security of Data

Incompetency to ensure data security in EDI transactions can result in serious consequences. EDI Software allows only authorized parties to access any information. It also lowers the risks related to HIPAA violations and financial penalties.

Medical Treatment

Time & Cost Inefficiency: Manual work demands more time and money but EDI automates the process and eliminates human labor. Organizations no more have to enter information into the system manually as everything is managed by a computer.

Inaccuracy & Errors

Entering data manually also leads to costly errors and inaccuracies. However, with an automated data entry system, these errors and mistakes reduce significantly. Organizations can rely on the information received via healthcare EDI software.

High Data Volume

Healthcare industry deals with a high volume of data and information. Processing it manually through spreadsheets and paper-based methods is just not possible. EDI tools for healthcare provide the required resources to manage data seamlessly.

Non-Compliance

Any ignorance or inability to maintain HIPAA compliance and ANSI standards during EDI transactions can lead to heavy penalties and fines on the organization. Healthcare EDI software solutions make sure that it meets all the regulatory requirements.

EDIFACT or EDI X12 Transactions Our Experts Can Deal With

Our healthcare EDI solutions can take care of all the common EDIFACT or EDI X12 transactions of the healthcare insurance industry.

837- Healthcare Claim Transaction Set

837D- Healthcare Claim Dental

837I- Healthcare Claim Institutional

837P- Healthcare Claim Professional

834- Benefit Enrollment and Maintenance

835- Healthcare Claim Payment/Advice

277/275 -Healthcare Claim Request for Additional Information and Response

270/271- Healthcare Eligibility, Coverage or Benefit and Information Response

276/277 - Healthcare Claim Status Request and Response

278 - Healthcare Services Review - Request for Review and Response

820- Payroll Deducted and Other Group Premium Payment for Insurance Products

Hear From What Clients Had to Say.

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Frequently Asked Questions

Here are some common questions that our customers ask before they start using healthcare EDI

Integrating EDI can positively impact healthcare facilities and organizations in the following ways:

  • Brings standardization by eliminating complexities and confusion. All the messages are in a consistent and clear format.
  • Consistency leads to better efficiency and saves time and costs. There is no human intervention as data is transmitted through automated systems.
  • EDI restricts unauthorized access to any personal information and there is higher security with lower risks of HIPAA violations.
  • There is greater accuracy that reduces time and efforts to support-based processes.
  • EDI integration tools lead to higher productivity and resolve incorrect data entries automatically.

Healthcare EDI enables the exchange of computer-processable data in a standardized format and secure way among healthcare institutions, professionals, and patients. A healthcare provider can send claim status requests and get information using a standard transaction set for compliant and organized information exchange. EDI transactions are not email exchanges but involve electronic transmission of healthcare data between computer systems and applications. EDI HIPAA transaction sets provide various benefits to healthcare professionals and organizations, including reduced transactions, standardization, enhanced security, and improved productivity.

The use of EDI in the healthcare sector has grown substantially over the years due to a plethora of advantages it provides to this increasingly complex industry.

Reduced Costs- Manual processes and paper trails are inconvenient and costly. Healthcare EDI reduces this cost and paper-based work, thereby saving a significant amount.

International Standards- It allows standardized communication and ensures efficiency during transactions. Also, HIPAA EDI standards are implemented for workers compensation.

Improved Security- EDI ensures secure transmission of information between healthcare providers and payers or insurers while complying with HIPAA standards.

Better Productivity- It eliminates human errors that are common in manual data management. EDI is more accurate, efficient, and faster and allows stakeholders to focus on other important tasks.

Several aspects to pay attention to in order to stay compliant with EDI standards are:

A System Architecture- Develop a robust system architecture or upgrade an existing one for efficient information processing, business continuity, quick response to requests, and completion of transactions.

Role-Based Access- To make healthcare applications secure. To protect data from unauthorized access, divide users into groups and grant role-based rights.

Encrypted Communication- Healthcare providers must use platforms that are secure and encrypted with minimum risks to patient privacy. Encryption secures communication channels and infrastructure, keeping the information away from cyber theft.

As EDI is standardized under the HIPAA umbrella, there are various common transaction sets that are based on X12. A few EDI order processing healthcare transaction sets are:

  • Healthcare Claim Transaction Set (837)
  • Retail Pharmacy Claim Transaction
  • Benefit Enrollment and Maintenance Set (834)
  • Healthcare Claim Payment/Advice Transaction Set (835)
  • Healthcare Eligibility/Benefit Inquiry (270)
  • Healthcare Eligibility/Benefit Response (271)
  • Healthcare Claim Status Request (276)
  • Healthcare Claim Status Notification (277)
  • Healthcare Service Review Information (278)

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