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What is EDI?
Electronic Data Interchange simply put is a computer-to-computer transmission of data requiring no human intervention, EDI is generally known to limit manual processing and increases the accuracy of the data.
Just Imagine:
- Being able to Receive/Send ALL of your paper transactions electronically!
- Faster Payment!
- No More Running out of CMS 1500 Forms!
- Less Paper processing!
- Faster Turn-around!
- No Errors due Manual Processes!
- Not having the need to increase Staff!
- Being able to handle High volume transactions!
An EDI Claims Transaction is transmitted in many formats including:
ANSI 837P (Professional Claims)
- ANSI 837I (Institutional Claims)
- ANSI 835 (Electronic Remittance Advice)
- ANSI 276 (Claims Status Request)
- ANSI 277 (Claims Status Response)
- NSF (National Standard Format)
- HCFA spool file (Image of a HCFA/CMS 1500).
In order to comply with the requirements of the Health plans, CMS, and National Committee on Quality Assurance (NCQA) and to provide Health plans with data on the complement of services that are being delivered to members. Encounter information is required from physicians offices on capitated services and fee for service visits. This information is to be reported to Health plans on a monthly basis in order to remain compliant.
Some Healthplans and/or IPA's offer incentive bonuses to Providers so that they can more easily obtain this crucial information needed.