What is EDI?

Simply put, it is a computer-to-computer transmission of data requiring no human intervention, EDI is generally known to eliminate manual data entry and increases electronic straight through processing and increase  the accuracy of the data.  


Electronic Data Interchange.

 

Just Imagine:

·         Having the ability to Receive Send ALL of your paper transactions electronically!

·         Faster Payments from most Health plans.

·         No More Running out of CMS 1500 Forms or Superbills! 

·         Less Paper processing! 

·         No more errors due to manual data entry!

·         Not having the need to hire additional staff!

·         Being able to handle High volume transactions!

 

Depending on the content, EDI Transactions are transmitted in various formats including:

·         ANSI 837 P (Professional Claims) 4010, 5010

·         ANSI 837 I (Institutional Claims) 4010, 5010

·         ANSI 835   (Electronic Remittance Advice) 4010, 5010

·         ANSI 276   (Claims Status Request) 4010, 5010

·         ANSI 277   (Claims Status Response) 4010, 5010

·         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 Health Plans, MSO's and/or IPA's offer incentive bonuses to physicians to obtain this crucial information needed.

 

Let us guide you to a paperless future.