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Modern EDI Integration for Healthcare B2B Connectivity

Healthcare systems in the United States currently reside in a financially unpleasant atmosphere. Payment methods for meeting healthcare needs across the country are highly fragmented where a multitude of payers as well as providers use multiple formats for remittance. As a result, patients, healthcare providers, and insurance firms have to face numerous challenges that cause frustration and make them hard to do business with, particularly at a time when rising costs is a huge problem.

To solve this issue, many industries rely on B2B automation in standard languages such as EDI to automate financial systems, but B2B healthcare space still poses unique challenges. In this post, we’ll take a deep dive into the pressing B2B challenges in healthcare and ways to curb them.

Healthcare Systems Facing B2B Challenges

After the Affordable Care Act was signed, some new initiatives on healthcare payment reform were introduced – most important among them being the transition from fee-for-service to value-based care. These transitions have severe ramifications for payers. Payers have to hone their capability to provide value to their customers across the healthcare system and manage risk more closely.

In addition, payment reform has put a lot of pressure on consumers. Health insurance premiums have outpaced income growth in the past year, leading to a steep rise in out-of-pocket expenses.

Owing to such a staggering increase, end-consumers are left with no choice but to go for low-cost insurance coverage and healthcare options. This helps payers along with providers develop a strong competitive advantage by promising digital experiences, thus enabling them to better manage healthcare costs.

However, a general consensus supports the fact that the administrative costs involved in healthcare are too high. As per 2016 CAQH index report, an amount of more than $31 billion is spent each year by healthcare units alone in the name of conducting business transactions with health plans. A large portion of this whopping amount can be attributed to manual processes employed by healthcare units.

The report also states that on reducing manual transactions, the healthcare industry could save as much as $8 billion annually.

Despite the apparent benefits, US healthcare has been incompetent in automating electronic B2B transactions, primary reasons being the fragmented and multifaceted payment system. However, market pressures and a multitude of legislative mandatesare driving the shift in the industry and creating an impetus to overcome these B2B challenges.

Overcoming the B2B Challenges with Modern EDI

Efforts have been made since the 90s to streamline healthcare transactions through electronic B2B communication, and EDI implementation proves to be an effective method to save both time and money.

EDI document has a particular standardized format, which allows healthcare providers to ensure that data can be quickly sent and interpreted through business process automation. EDI integration approaches are employed to provide higher-quality experiences to patients while controlling costs.

Apart from controlling the healthcare costs, EDI integration helps to:

Transfer and receive information faster: Faster turn-around times helps healthcare providers provide better patient experiences.

Recognize submission errors in time to avoid delays: EDI integration solutions decrease the number of reasons of rejection of a particular claim received by the payer. Paper claims are unable to execute this level of automated data verification.

Reduce Administrative expenses: EDI integration approach helps lower per-transaction costs through automation that accelerates productivity and growth.

How Adeptia can help

Adeptia’s modern EDI integration solution is an API-led approach that allows healthcare providers curb these major B2B challenges. It allows providers increase agility and decrease the time for partner onboarding, and create better experiences for patients, providers, and other stakeholders while reducing cost and risk.

Take a look at how our solution drives innovation in the healthcare sector.