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Enrollment EDI

Healthcare Enrollment Through EDI Boosts Accuracy and Cuts Cost

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EDI in Healthcare is Time Tested, Proven, and Preferred

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. DCS configures your existing EDI system to send 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.

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Overview

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

EDI savings and speed, for routine business documents, has been proven for decades. Many are gradually moving towards human resource automation when it can economically be done.

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. 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.   An example is the SAP Benefits (PA-BN™) component, which uses the BENEFIT3™ . IDoc. (Similar modules are Oracle’s E-Business Suite™ Human Capitol Management module, JD Edwards Enterpriseone Human Resources Management module, Microsoft’s Dynamics AX, and Infor’s ERP LN and XA.) This means that one, automated data transmission process can reliable support all insurers. Since the Blues are non-competitive, they are able to closely align their EDI Guidelines. This simplifies mapping and reduces complexity and cost.  This means that one, automated data transmission process can reliably support all insurers.

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 HR staff in the new process and IT for troubleshooting

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Benefit

This lowers the cost of processing and improves decisions made by HR executives. Automation means that you have the opportunity for faster compliance and cost cutting. A key benefit is the confirmation of the change from your health insurance carrier. This goes a long way towards reducing undiscovered overcharges because you know immediately they received or rejected the change.

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Conclusion

Process automation remedies a labor intensive and error prone 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 development service ensures your EDI implementation will be smooth. Ongoing improvements are also easier when DCS is there to assist as needed. Your first step is easy: contact DCS for our no-cost assessment.