Much valuable time is spent by human resource departments to send employee enrollments to benefit providers such as Blue Cross. Instead of completing clumsy Web forms or sending spreadsheets, cost conscious companies export enrollment data from their business application. They linked their Human Resources and EDI systems to send Enrollment data to their health insurance carrier. Your existing EDI system sends an outbound Benefit Enrollment and Maintenance (Transaction Set 834). This document is used for both the first report and subsequent changes. Then the data is sent through your existing AS2 or VAN, which meet HIPAA requirements. The result: EDI for enrollments boosts accuracy and cuts cost.

Overview

The benefit management process is accuracy oriented. All details must be correct and changes (adds/deletes) must be done timely. Or, visible, morale eroding embarrassments occur.

EDI savings and speed, for routine business documents, has been proven for decades. Unfortunately, insurers have not offered incentives for automation of the enrollment process. Gradually, though many are moving towards automation when it can economically be done. This lowers cost of processing and permits closer scrutiny of claims. Their automation means that you have the opportunity for faster compliance and cost cutting.

The management process should be extended to include the transmission of the data. Fortunately, the X12N specification is preferred by most health insurance providers – the Blues, HMO’s, and private carriers. Also, most dental, life, and LTD carriers prefer this format too. A plus - this format will likely prevail throughout the national health care evolution ahead.

Since most large companies already support EDI, it makes sense to use existing EDI and secure Internet data transmission (AS2) systems to speed processing and reduce cost. Fortunately, most Human Resource systems have a data export capability upon which EDI can be based. This means that one, automated data transmission process can reliable support all insurers. A plus, since the Blues are non-competitive, they are able to closely align their EDI Guidelines. This simplifies mapping and reduces complexity and cost.

Here are the steps:

• 1. Ask your human resources department about their enrollment processes
• 2. Contact the carrier to confirm their preference for the 834
• 3. Map and test
• 4. Train the H.R. staff in the new process and I.T. for troubleshooting

A key benefit is the confirmation of the change from your health insurance carrier. This goes a long ways towards reducing undiscovered overcharges because you know immediately they received or rejected the change.

Conclusion

Process automation remedies a labor intensive process, which should be automated. An investment in automation can have a quick return and later build outs can yield further savings. DCS knows the processes of large carriers, so setup is quicker and economical. Our DCS GROW™ development service ensures your EDI implementation will be smooth. On-going improvements are also easier when DCS is there to assist as needed. Your first step is easy, email us for our Free Assessment.