Electronic Data Interchange (EDI) is an electronic exchange of information, in a standardized format that adheres to all Health Insurance Portability and Accountability Act (HIPAA) requirements. It is the transfer of structured data, by agreed message standards, from one computer system to another without human intervention.
Reduced Overhead Expenses – Administrative overhead expenses are reduced, because the need for handling paper claims is eliminated.
Improved Data Accuracy – Because the claims data submitted by the provider is loaded directly into Kaiser Permanente's computer by the clearinghouse, data accuracy is improved, as there is no need for re-keying or re-entry of data.
Additionally, "up-front" edits applied to the claims data while information is being entered at the provider's office, and additional payer-specific edits applied to the data by the clearinghouse before the data is transmitted to the appropriate payer for processing, increase the percentage of clean claim submissions.
Reduced Turnaround Time – EDI claims bypass manual processes and paper handling at Kaiser Permanente; therefore, the turnaround time for processing EDI claims is substantially reduced (as compared to processing paper claims).
Bypass U.S. Mail Delivery – Providers save time by bypassing the U.S. mail delivery system.
Reduced Payer-Specific specific "Exceptions" – Industry-accepted standardized medical claim formats will tend to reduce the number of "exceptions" currently required by multiple payers.
837P Claim/Encounter – This is used for professional services and suppliers.
837I Claim/Encounter – This is used for facilities and hospitals.
Please note: Payer IDs are for both 837I (UB) and 837P (CMS1500) transactions.
If your clearinghouse is not directly affiliated, they may re-route claims to one of our direct trading partners!