Working effectively and efficiently is crucial when it comes to performing medical billing functions. Several factors help in the enhancement of medical billing functions of a provider to save money and time. Among them, EDI set-up plays a key role in promoting faster medical claims processing and quicker reimbursements. Though EDI (Electronic Data Interchange) has been around for some time now, its adoption rate is still less. To emphasize its efficacy, the Health Insurance Portability and Accountability Act (HIPAA) had mandated the EDI set-up. Once EDI is set-up, the Providers can send their claims and also receive the payments and denials electronically which reduces the revenue cycle time to a large extent. There are two ways in which this complex process can be set up for one’s practice and they are as follows:
- Clearing House: EDI set-up can be done using the help of a clearing house. To accomplish this process, Providers or medical billing companies will have to submit an enrollment form initially. An agreement emphasizing the fulfillment of HIPAA security and privacy requirements are signed between the Provider and the clearing house. Once it is done, Providers can start exchanging their patient information with the clearing house for further medical claims processing. Clearing houses help in promoting faster reimbursements, reducing denied claims and offer more medical billing solutions. They act as a bridge between the payer and the Provider. To ensure auto payment posting, clearing houses use ERAs (Electronic Remittance Advice) and EFTs (Electronic Funds Transfer) instead of paper EOBs and checks.
- Direct Approach: It is another way of setting up EDI where all EDI transactions are done directly to the payer. Here again, a Healthcare Provider or Facility will be expected to submit an enrollment form. Following the enrollment, it has to sign an agreement binding to HIPAA security and privacy requirements with the payer. EDI can also be set-up during provider credentialing. The process of collecting and verifying a Provider’s credentials is known as provider credentialing. Providers who are already in the payer’s network can also subscribe to EDI set-up during re-credentialing.
Whether Providers follow the clearing house or direct payer approach of EDI transactions, they must make sure that the normal medical claims processing workflow is not affected in any manner. For successful EDI set-up and uninterrupted medical billing, Providers or medical billing companies can get help from a reputed offshore medical billing company like e-Care. This ISO certified and HIPAA compliant offshore vendor will take care of the complete EDI set-up process.