Overview
Healthcare payer and provider organizations face many challenges in implementing an effective EDI strategy.
As HIPAA and other types of electronic transactions are created, received, responded to and processed by
these organizations, they are massaged and changed at numerous points before they are finally consumed by
the back-end systems.
These processes create risks for business and IT leadership in that they may lose visibility
into what happened to the transaction, why it happened, and may also lose the ability to reconcile the individual
business content in a transaction to similar content in a related transaction. With heightened emphasis on compliance
and accountability, these key events need to be tracked, monitored and exposed to both internal users and trading
partners across the transaction lifecycle.
Each healthcare enterprise must have visibility and understanding of what
happened, whether or not it was in compliance with established policies and procedures, and what were the exceptions
to the process in order to effectively manage their businesses.
Challenges Faced by the Healthcare Industry
- Many enterprises are unable to verify that every claim or other HIPAA transaction that was received was
appropriately acknowledged, or that it met the required levels of service.
- IT departments have to get involved every time a submitter inquires about a transaction that hasn’t made it
through the process correctly or in a timely manner.
- Most organizations are constantly fighting fires rather than proactively planning because of a lack of
visibility into production EDI operations.
- Many have no idea which submitters are sending the majority of your bad files, or what is causing those problems.
- When issues are identified and steps are taken to address them, there is no visibility into whether or not
those steps are having an effect.
Edifecs Transaction Management for Healthcare
Track, Monitor and Manage Exceptions for Maximum Automation and Accountability
Edifecs, the leading provider of B2B solutions for transaction-based interoperability, addresses all of
these challenges with Edifecs Transaction Management, our market-leading solution for transaction lifecycle
management. Edifecs Transaction Management ensures 100% visibility into your electronic interactions with your
trading partners by tracking both real-time and batch transactions at each of the key processing points
in your system and then by analyzing this information to provide a complete picture of the transaction lifecycle.
Edifecs Transaction Management helps you to automate error management and exception handling, and to deliver timely
information directly to the people who need to take action.
Edifecs Transaction Management in the Edifecs Healthcare Suite
Available standalone or as an integrated component in the Edifecs Healthcare Suite, with Transaction Management you can:
- Ensure transaction accountability by tracking every step of the transaction interoperability lifecycle.
- Shorten the time to adjudication and reduce the need for IT staff involvement in resolving problems and
answering inquiries through automation.
- Track incurred risk exposure the minute claims or other transactions such as referrals and authorizations
enter the door.
- Enable proactive intervention to changes in claim distribution patterns by providing real-time trend analysis.
- Simplify error resolution by providing business-focused data views and error reporting.
- Improve overall transaction quality by providing summary feedback and analysis to partners so that they no
longer make the same mistakes over and over.
- Cut expensive adjudication re-work by catching errors upfront before they reach your backend systems.
- Automate partner notification of problem transactions through real-time alerts.
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