EDI

EMD supports submitting electronic data via billing clearing houses and direct payers. Our EDI broker and SDK provide the ability to build CNS-1500 ASC X12 EDI data message, transmit the EDI message, receive EDI message, and process received EDI messages. Our EDI technology is most commonly used to provide HIPAA compliant insurance claims, insurance claim status, insurance eligibility (270), and insurance authorization (278).

EMD is an active member of ASC X12. This ensures that we are fully up to date and knowledgeable about the progression and use of the EDI standard.

EDI STANDARS

Electronic data interchange (EDI) is the structured transmission of data between organizations by electronic means, which is used to transfer electronic documents or business data from one computer system to another computer system, i.e. from one trading partner to another trading partner without human intervention. It is more than mere e-mail; for instance, organizations might replace bills of lading and even cheques with appropriate EDI messages.

In 1996, the National Institute of Standards and Technology defined electronic data interchange as "the computer-to-computer interchange of strictly formatted messages that represent documents other than monetary instruments. EDI implies a sequence of messages between two parties, either of whom may serve as originator or recipient. The formatted data representing the documents may be transmitted from originator to recipient via telecommunications or physically transported on electronic storage media." It distinguishes mere electronic communication or data exchange, specifying that "in EDI, the usual processing of received messages is by computer only. Human intervention in the processing of a received message is typically intended only for error conditions, for quality review, and for special situations. For example, the transmission of binary or textual data is not EDI as defined here unless the data is treated as one or more data elements of an EDI message and it is not normally intended for human interpretation as part of online data processing."

EDI can be formally defined as the transfer of structured data, by agreed message standards, from one computer system to another without human intervention.

http://tools.ietf.org/html/rfc3335

INSURANCE CLAIM

Electronic Claims Submission is also known as EDI. This allows health care providers to automatically send and receive health care claims information. Insurance company’s portal syncs with all HIPAA - compliant electronic transactions and the benefits are multiple.

Claims can be made by taking recourse to two methods, either directly to insurance provider or through a third party clearing house.

In the insurance business the submission of claims will be one of the most occurring, time-consuming and complex tasks in an office. With the introduction of electronic method or EDI there is more accuracy of claims, better tracking and improved office productivity. There is easy identification of errors and hence claims can be easily corrected before submission. The end result is fewer payer rejections and complications which means faster claim payments.

EDI facilitates easy submission and faster claim payments
The BMC HealthNet Plan makes it convenient for BMC HealthNet Providers to submit claims electronically. This has vastly reduced their administrative costs and the claims get paid faster by more than a week compared to manual submission. More than 90 percent of the network medical, behavioural health and hospital providers are submitting claims electronically, and reaping the benefits.

The benefits include:

As far as from 2003, BMC HealthNet Plan has been receiving and processing provider claims online using clearinghouses such as Allscripts/Payerpath, Capario (ProxyMed/MedAvant), Emdeon (WebMD/Envoy), Gateway EDI, Relay Health (Mckesson), or the SSI Group. EDI claims from providers who submit claims through NEHEN, and providers who submit claims directly are accepted. BMC HealthNet Plan can also provide electronic remittance advices to those providers who submit electronic claims. It takes only five minutes to submit the claim electronically.

If you are associated with Emdeon, NEHEN, Capario, Gateway EDI, RelayHealth, Allscripts/Payerpath, The SSI Group, or any other clearinghouse or billing agency, then you can contact their representative and let know that you would like to start submitting claims electronically to BMC HealthNet Plan. Most importantly, direct submission of claims using 837 claims submission format is promoted by us.

INSURANCE CLAIM STATUS

INSURANCE ELIGIBILITY (270)

INSURANCE AUTHORIZATION (278)

EMD EDI SDK