EDI training

How EDI Works and Helps Care Providers (United Healthcare Guides)

Electronic Data Interchange (EDI) is the automated transfer of data between a care provider and a payer. The benefits to care providers include quicker turnaround of information, reducing administrative expenses and avoiding claim processing delays. Using EDI allows payers and care providers to send and receive information faster, often at a lower cost. This overview explains the benefits of EDI to care providers and provides the types of electronic transactions used, in addition to other information on EDI.

EDI Benefits

Using EDI to exchange information with UnitedHealthcare and other payers may benefit care providers and their billing services. The benefits to care providers:

  • Sending and receiving information faster Turnaround times are typically quicker than using manual processes. For example, a payer can receive a claim the same day the care provider sends it, and an eligibility inquiry can be received and responded to in seconds.
  • Identifying submission errors immediately and avoiding claim processing delays Electronic claims are automatically checked for HIPAA and payer-specific requirements at the vendor, clearinghouse and payer levels. This process decreases the reasons a claim may be rejected by the payer. This same level of automated data verification can’t be performed on paper claims.
  • Lowering account receivables Electronic transactions, such as the eligibility transaction, provides the patient’s current coinsurance, deductible and benefit information when they’re in for an appointment and before the claim is submitted to the payer for processing. This allows the care provider to collect a co-payment at the time of service.
  • Reducing administrative expenses EDI cuts down on purchases of paper, forms, supplies and postage. It also saves time faxing, printing, sorting and stuffing envelopes.
  • Spending less time on the phone EDI reduces calls your staff needs to make to UnitedHealthcare to obtain information on our members, claims, claim payments, authorizations and referrals.
  • Exchanging information with multiple payers EDI lets you complete transactions for multiple payers at one time. Transactions can be set up to automatically generate in a practice’s daily workflow. For example, a practice management system could perform a claim status inquiry at the same time it sends eligibility inquiries to verify a member’s benefit coverage and co-payment.

To learn more about EDI and become a certified EDI Professional please visit our course schedule page.

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