Medicare Electronic Data Interchange

Medicare Electronic Data Interchange: Benefits And Advantages

Medicare Electronic Data Interchange (EDI) is the computer-to-computer electronic exchange of Medicare files using standard format. Medicare Electronic Data Interchange gives the ability to transmit Electronic Media Claims (EMC) to Medicare in a Health Insurance Portability and Accountability Act (HIPAA) compliant format.

National Government Services administers The Common Electronic Data Interchange (CEDI) contract for EDI services for all DME MAC suppliers. The CEDI provides a single front end solution for the submission and retrieval of DME MAC electronic transactions. CEDI handles these transactions for all DME MACs.

The following information describes the benefits of billing electronically and additional electronic options available. At the beginning of the EDI partnership parties usually exchange manuals that contain valuable information including technical information and enrollment materials. The acceptable HIPAA compliant format is the American National Standards Institute (ANSI) X12N Version 4010A1 837 transaction and the National Council for Prescription Drug Programs (NCPDP) Telecommunications Standard Version 5.1 and Batch Standard 1.1.

Benefits of Medicare Electronic Data Interchange

Electronic Data Interchange (EDI) will simplify time-consuming, labor-intensive jobs and ultimately enable you to increase your productivity. The following are a few of the benefits experienced by utilizing the EDI options offered by Medicare:

  • Faster payments: the payment floor for electronic claims is shorter than that of paper claims
  • Ease of billing electronically (support is available)
  • More efficient and accurate claims filing; data is received precisely as input by your office, eliminating the chance of processing errors
  • Electronic front-end edit reports: confirmation can be downloaded via modem within 48 hours of transmission. This report verifies the acceptance of claims and Certificates of Medical Necessity (CMNs) & DME Information Forms (DIFs).
  • Online or batch versions of Claim Status Inquiry (CSI) and Beneficiary Eligibility (BE)
  • Availability of Electronic Remittance Advice (ERAs) for faster payment posting
  • Lower administrative, postage, and handling costs
  • Ability to submit claims and CMNs/DIFs seven days a week, including holidays.

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