Claims Processing

Health Partners Plans EDI Claims Processing

Electronic Data Interchange (EDI) is the sending and receiving of information using computer technology. Any standard business document that one company would exchange with another; such as a purchase order, invoice, shipping schedule, inventory inquiry, and claim submission; can be exchanged via EDI between the two parties, or trading partners.

The Benefits of EDI

  • Reduced administrative costs
  • Higher claim acceptance rates
  • Data moves faster and with greater accuracy
  • Increased productivity
  • Audit trail of claims submissions
  • Elimination of paper documents
  • Elimination of labor-intensive tasks, such as data entry
  • Greater accuracy of information

Claims Processing

  • Decrease administrative costs
  • Avoid processing delays
  • Increase claim acceptance rates
  • Increase productivity
  • Receive records of claim receipts
  • Receive detailed claims status

You can have speed, convenience and lower administrative costs through Electronic Data Interchange (EDI), or electronic claims processing. Health Partners Plans utilizes the Emdeon Transaction Services, also known as NEIC, ENVOY, or WebMD ENVOY claims clearinghouse.

For all claims (CMS-1500/837P and UB-04/837I) submitted electronically through the Emdeon clearinghouse, Health Partners Plans can electronically return a detailed status for each claim. The status message will show which claims were accepted, rejected and/or pending, and provide the amount paid on the submitted claim once it has been finalized.

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

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