What is Healthcare EDI?
When discussing healthcare EDI, it's important to understand the application of EDI technology within the healthcare process. There are two major uses for healthcare EDI technology:
- Healthcare EDI Supply Chain Management
- Claims Management and Patient Information Exchange
When discussing healthcare EDI, most people focus on the management of claims and patient record aspect of the business. This part of healthcare EDI has been developed under the auspices of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) which aimed to combat waste, fraud, and abuse in health care delivery and insurance while improving the effectiveness of the health care system. The HIPAA regulations for healthcare EDI focus on security and information transfer. Since claims management and supply chain management are often separate departments within institutions, it's quite common for "turf wars" between departments to confuse the issue of healthcare EDI adoption. Often institutions will have two different healthcare EDI systems in use, one for claims processing and one for supply chain management. The unfortunate reality is that healthcare EDI technology allows for one system that could easily be used to handle both sets of information. Ensuring the use of a single healthcare EDI system must be a critical first step of adopting the technology.
