Often the focus is on the shareability of clinical data. But data sharing can also provide opportunities for efficiencies and cost savings in claims submissions and patient payments — tasks that affect revenue cycles.
While many providers manage these to some extent with the use of a basic electronic data interchange, next-generation EDI capabilities remain largely underutilized. These functions are known as Intelligent EDI.
Intelligent EDI includes embedding additional functionality within the EDI data stream to automate revenue cycle management (RCM) processes, enabling organizations to improve first-pass payment rates for claims, reduce claims denials, increase collections and accelerate cash flow.
According to the Center for Health Transformation, when EDI capabilities are fully leveraged providers have the potential to save:
- $2 for every copayment that is collected while the patient is on site
- $3.70 for every claim that pays on first pass
- $3.40 for each new electronic claim status request
- $15 to $37 for each claim rework that is prevented
- $2 for every reimbursement that is posted automatically
Those savings can now be realized with little investment, as Intelligent EDI services are now available essentially free of charge.
You can learn what prompted the Optum decision to drop fees and discover how providers can access free EDI in the latest #5in5 episode.
- What factors contributed to EDI transaction fees in the past and what’s changed to allow for no-cost transactions
- The typical fees that add to an EDI cost structure
- New efficiencies of automation and e-commerce
The #5in5 series features industry experts answering five questions in five minutes on issues surrounding the changing health care industry. Click here to take five minutes and read the latest episode.
About the Author:
Billy Parrish is senior director of product management and works as part of the OptumInsight strategic product management team focusing on their Intelligent EDI and Link solutions. He is responsible for the driving new Optum approaches to the commoditized EDI functions and is driving to not only promote adoption but enhancement of these communication standards via new and creative methods of enabling value to our provider and payer clients. Billy has over 15 years of experience in X12 and EDI experience. He graduated with a Bachelor of Science from the University of Alabama.