Consulmed: Medical Billing & Consulting Specialist

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EDI

Electronic Data Interchange

When looking to streamline your cash flow having a strong understanding of the Electronic Data Interchange(EDI) is key. Monitoring all EDI transactions and requesting the appropriate information from the different clearinghouses and insurances will help keep money flowing into your office. Without an understanding of how the process works, practices will have an immediate drop in revenue if any problems arise. All major insurances prefer EDI over paper, and some require EDI.

Electronic files are sent to insurances using a clearinghouse or a direct connection, and it is important to know which insurances use which clearinghouse and which ones allow a direct connect. Put simply, a clearinghouse is like an electronic post office service. You send your files to a clearinghouse and they either route or sort your files to the insurances billing.

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Insurances will then send their responses to the clearinghouse for you to pickup. Some of the most common clearinghouses include UHIN, Capario, and Emdeon. If you contact a clearinghouse, they can send you a list of payers they cover and also what steps are needed with each payer.

When transmitting files to an insurance, it is important to monitor them each step of the way and to send additional files asking for updates to your claims.