Undoubtedly, the healthcare industry deals with enormous data that is related to insurance claims, medication records, critical patient information, and others related to paychecks, emergency service data, and even staff pay stubs. Trust us, there is much more to deal with there!

If we talk about numbers, as per the data revealed by the HealthAffairs, more than 450 electronic formats were used back in 1900 to transfer claims and other data. Apart from this, halfway to 1900, there were no verified claims for patients to take their healthcare information nor any federal deadlines on healthcare data processing. It’s not over here, there was no national health privacy to regulate to complete this tormenting method. Wait, before reading further are you aware of EDI solutions?

In general, if we talk about healthcare there are a lot of situations and procedures that come up in our mind, starting from those life-saving operations, medication bills, to a constant IT professional services staff bound to serve patients by treating them for better lives. But wait, before thinking much, there’s another side of the coin, that too needs shadow to emerge in the industry. 

We are talking about the unknown part of the healthcare industry and it is a massive amount of administration work, the batch of files, and piles of paperwork. This can lead to discrepancies and distressing situations as managing a huge amount of work can lead to human errors and faults. 

But the other hidden part of the healthcare industry is a massive amount of paperwork, and this was quite distressing for the healthcare professionals because managing paperwork at once for the patients was a baffling situation for them. As we are talking about the reports, we would like to mention another important point here. Indeed, we will talk about the managed EDI services later!

We are talking about the US healthcare system, they have taken a step forward towards the paperless procedure in the healthcare industry to make the process accurate, data configuration, retrieval, analysis, and subdivision. 

In addition to this, the Health Insurance Portability and Accountability Act (HIPAA) validated and established healthcare EDI transactions in 1996. HIPAA brought new standards that are related to security, privacy, and strong transmissibility in the healthcare line. Moreover in 1991, the Workgroup for Electronic Data Interchange (WEDI) was inaugurated by the Secretary of Health and Human Services. Fundamentally, WEDI was there to resolve the hurdles faced by the healthcare professionals to label outgoes and also to develop the performance and spirit of IT consultation services.

As said, data processing has always been monotonous and full of complexities that need secure channels and various formats to ensure security at the best! Yes, we know we have taken the name of EDI solutions, earlier. Move to the next section to reveal about EDI.

What Is EDI In Healthcare?

We will start the EDI for healthcare with the abbreviation of EDI, Electronic Data Interchange. It is a state-of-the-art electronic transmission process. EDI is considered the smartest and reliable way to exchange data and other information between two trading partners or organizations. EDI has its own set of protocols and standardized format that emphasizes it to be the more convenient, smart, well-timed solution for business entities. 

EDI for healthcare is ensuring sleek and easy data processing to uplift healthcare professionals with claim processing, sharing confidential data, patients information between health care providers, medicare facilities, and other important entities through secure electronic data interchange. 

Apart from this, the healthcare industry has been serving people for decades and EDI is not a new term in the healthcare line. This is the reason why many hospitals, medical facilities, and institutions are depending on EDI service providers, to decrease hurdles on both companies in the healthcare industry. 

Do you know? EDI standards also managed the claims, compensation, eligibility, inquiries, enrollment, registrations, and also claim status requests. Do you remember we have mentioned a term in the above section about HIPAA, Health Insurance Portability and Accountability Act that was introduced in the year 1996? It has been seen that many people in the healthcare industry couldn’t understand HIPAA EDI Compliance. We are here to help you! 

What Do You Understand By HIPAA EDI Compliance In The Healthcare Industry?

As said above, one of the important reasons why HIPAA was established was because of robust securities and effective healthcare administration in the US. However, earlier the healthcare sector was segregated and was not aligned with the rules and regulations. Due to this many healthcare providers were reporting challenges in the local codes for sharing information between other parties, this was also creating huge loopholes and discrepancies in the system. 

This is why the Health Insurance Portability and Accountability Act has enforced healthcare institutions and organizations to execute and comply with HHS privacy regulations for secure data processing and transmission.  

On the other hand, this law has now become very crucial for the healthcare industry because of many cyberattacks, online threats, and ransomware. There are some specified rules for HIPAA healthcare rules. They are mentioned below: 

What Are The Key HIPAA Healthcare EDI Rules?

  • The HIPAA Privacy Rule — It helps in shielding the patient’s private information 
  • The HIPAA Security Rule — It promotes setting a model for patient data security with a more effective and secure way
  • The HIPAA Enforcement Rule — This dictates the sets of guidelines for investigating HIPAA violations

What Are The Five Titles Of HIPAA? 

There are five sections in HIPAA compliance that are also known as sections. We are sharing them below, make sure you understand them precisely. Before proceeding ahead, are you aware of the term EDI outsourcing? Let us know in the comments below. 

Title I: Health Care Access, Portability, and Renewability

This title protects health insurance for those individuals who have either lost or switched jobs. It also restricts group health insurance plans from withholding coverage for people who have existing or any specific illness. 

Title II: Preventing Health Care Fraud and Abuse; Administrative Simplification; Medical Liability Reform

Apart from HIPPA, it is also enforced by the United States Department of Health and Human Services (HHS) to control electronic healthcare documentation. It also requires healthcare providers to perform secure electronic admittance to medical data and comply with HHS privacy rules.

Title III: Tax-related health provisions governing medical savings accounts

This title covers tax laws and health care guidelines

Title IV: Application and enforcement of group health insurance requirements

This is the application or guide that helps in group health plans. It also accommodates changes in health insurance.

Title V: Revenue offset governing tax deductions for employers

The 5th title presents claims on company-owned life insurance and the treatment of those who lose their U.S. citizenship for income tax purposes.

Final Words

We hope now you have understood the HIPAA EDI Compliance along with the above-mentioned HIPAA rules that are helping many healthcare professionals and medical institutions in safeguarding the significant information of patients. Before HIPAA, healthcare was using a paper-based system that was not secure and full of discrepancies. In addition to this, unauthorized information was also shareable and it was creating inconsistencies between the data and system. 

Therefore, web development solutions and companies, along with other healthcare institutions are also relying on EDI services to administer information with data encrypted in transition. EDI 834 is an important aspect to attain full control in data transmission between two parties. 

Author’s Bio:  Alicia works with the editorial team of A3logics, a leading company offering IT consultation services.  Exploring the latest technologies, reading about them, and writing her views have always been her passion. She seeks new opportunities to express her opinions, explore technological advancements, and document the details. You can always find her enjoying books or articles about varied topics or jotting down her ideas in a notebook.

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Nicky known as Nicky Parker, I am a writer and an industrialist by profession. My age is 33 years. My aim is to gather the attention of the targeted audience without being boring and unexciting. I like to utilize the free time in writing my views and thoughts for my book lovers or readers. My most preferred articles are usually about services and business, finance; however, I have written various topics in my articles. I do not have a specific genre. I get very creative when I have to express myself, I often sing, write, or draw to portray my feelings. When it comes to my free time or you can say ‘ME-TIME’, I love to play with my cat, sleep an extra hour or play my favorite video game