How EDI Benefits the Healthcare Claims Process

Many healthcare partners, payors, and vendors choose EDI as a safe, fast, and cost effective method for automating the business processes that take place.   From the consumer perspective, using EDI

  • helps keep healthcare affordable.
  • improves the accuracy of information exchanged between healthcare participants, improving the quality of healthcare delivery and its supporting process.
  • makes enhanced information available to all healthcare participants as appropriate. This access ensures accurate, fast, reliable, secure and detailed information on patients and healthcare partner plans.

From the business perspective, if you are not taking advantage of all available electronic transactions, you are not maximizing your savings and organizational efficiency. Using EDI you can:

Send and receive information faster.  Providers typically experience quicker turnaround times. A payor can receive your claim the same day you send it. In addition, an eligibility inquiry can be received and responded to in seconds, faster than you could pick up the phone and dial.

Identify submission errors immediately and avoid processing delays.  This process decreases the number of reasons a claim may be rejected once received by the payer. This same level of automated data verification cannot be performed on paper claims.

Lower your receivables.  Integrating EDI into your office workflow and software systems may make a positive impact on your bottom line. Automating electronic transactions such as eligibility will enable you to have current coinsurance, deductible and benefit information readily available while the patient is present, and prior to filing the claim. All EDI transactions may help increase your cash flow due to the expediency and accuracy of information exchanged.

Cut administrative expenses.  Whether time you want to save from phoning, faxing, printing, sorting and stuffing envelopes, or its purchases you wish to avoid (paper forms, supplies and postage) EDI can increase productivity and lower costs.

Spend less time on the phone. Many of the calls received by a payor can be answered by performing one of the following EDI transactions:

  • Eligibility (270/271)
  • Claim Status (276/277)
  • Notifications (278N)

The information returned comes from the same system used by representatives that answer your calls. You can gain administrative cost savings by reducing the amount of time spent on the phone.

Go Green and reduce paper, mail time, and postal costs.  Payors receive electronic transactions in real-time. This eliminates both mail time and the cost of postage and envelopes. EDI is also good for the environment because it reduces the volume of paper you receive from payors. Receiving electronic confirmation of claim submissions, electronic remittance advice (ERA/835), electronic funds transfer (EFT) and other EDI transactions can save time and trees.

Estimate Your Cost Savings from Increased Efficiency. A study by Milliman, Inc. calculated the cost of manual and electronic transactions.  You can use the estimated savings per transaction from the table below to calculate your potential savings.

Estimated Per-Transaction Costs and Savings Opportunity by Transaction Type

Estimated Health Plan Cost Estimated Provider-Facility Cost Estimated Total Industry Cost Potential Savings Opportunity
Claims Submission
   Manual $0.74 $1.84 $2.58  

$2.03

   Electronic $0.26 $0.28 $0.54
Eligibility & Benefit Verification
   Manual $3.28 $3.55 $6.83  

$6.61

   Electronic $0.06 $0.16 $0.22
Preauthorization
   Manual $3.95 $18.53 $22.48  

$17.10

   Electronic $0.18 $5.20 $5.38
Claims Status Inquiries
   Manual $3.84 $2.25 $6.09  

$5.81

   Electronic $0.06 $0.23 $0.29
Claims Payment
   Manual $0.66 $1.83 $2.49  

$1.98

   Electronic $0.21 $0.30 $0.51
Remittance Advice
   Manual $0.45 $1.83 $2.28  

$1.77

   Electronic $0.21 $0.30 $0.51

 

Sources: CAQH, Index; Millman Inc.; United Healthcare

 

The Keys to AS2

The AS2, Applicability Standard 2 for EDI, is quickly becoming one of the most secure, reliable and popular methods for sending and receiving data over the internet.   The concept for AS2 is rather simple and basically involves sending data between two points via the web within a container or envelope created by the AS2, the created certificate and public and private keys keep the information secure.  Only a few components are necessary for an organization to utilize AS2: two computers to connect – typically a computer and a server; internet access; and the data to be sent and received.  The AS2 wraps or envelopes the data, using digital encryption and certificates, which allows the data to be transmitted securely over the internet.  To clarify the role of the certificate, public and private keys within AS2 transactions let’s review these brief definitions:

The Public Key: is used to encrypt and verify digital signatures

The Private Key: is used to decrypt, digitally sign and is always kept private and protected.

The Certificate: much like a driver’s license, is used for identification purposes, identifying the issuer of the certificate, show expiry and give a unique number assigned to the certificate called a serial number.  Every certificate will have its own unique serial number

This is an informative albeit simplistic explanation of the AS2 cert/public/private key relationship and how the AS2 is used to send and receive EDI.  When an AS2 certificate is created two keys are generated which are linked together by an algorithm, one is a Private Key and one is a Public Key.  The Private Key is stored in a repository, for this example in ECS, while the cert along with the attached Public Key is sent to the receiver normally via email but it may be uploaded depending on the receiver’s protocols and standards.  The keys are then used to access the data contained within the AS2 envelope.  The following is an example of a typical AS2 exchange between DataTrans and Wal-Mart:

AS2 Example – Typical AS2 Process between DataTrans and Wal-Mart

  • EDI payload is encrypted using the Wal-Mart cert/public key (on DataTrans AS2 server)
  • EDI payload is signed using the DataTrans (Sender) private key (on DataTrans AS2 server)
  • AS2 connection is made to the Wal-Mart AS2 server wal-mart.com:5080 (on DataTrans AS2 server)
  • Payload contains a request to return an MDN, either sync or async (on DataTrans AS2 server)
  • AS2 IDs/Names are used to identify the AS2 relationship (on Wal-Mart AS2 server)
  • EDI payload is decrypted using the Wal-Mart private key (on Wal-Mart AS2 server)
  • EDI payload has its digital signature verified using the DataTrans cert/public key (on Wal-Mart AS2 server)
  • MDN is returned with a “processed” or “Decryption failure” or “Authentication, unable to verify signature…” status (on Wal-Mart AS2 server)

To effectively utilize AS2 for EDI the receiving parties’ server must be set to openly listen for messages being sent, much like an answering machine, if a call comes in and the answer machine does not answer the call and the message will not be received, which is why a reliable infrastructure is a vital component to AS2 EDI.  Assuming the server has a reliable up-time and is properly set to listen for and accept the message than utilizing AS2 to send EDI is highly effective.

To ensure proper server settings and reliability most organizations will turn to an EDI network provider, such as DataTrans Solutions, to address and handle their AS2 EDI needs.   There are numerous benefits to utilizing DataTrans for your organization’s AS2 EDI needs, such as:

  • The ability to comply with AS2 mandates without the usual barriers to entry and adoption, for example: AS2 software; the internal infrastructure costs of hardware; security protocols such as firewalls; and the ongoing personnel expense of qualified, expert developers
  • Handling the exchange of AS2 setup information
  • Completing all required AS2 testing for your organization and your partners
  • Knowing all documents are exchanged in real-time
  • Benefit from DataTrans’ industry leading reliability, infrastructure, skills, security and expertise

I would like to mention and thank Kenrick Roberts for his contributions to this blog and the AS2 information herein.  We look forward to hearing from you and introducing your organization to the cost savings and logistical benefits of the next generation of AS2 EDI.  If you have any questions please feel free to reach us at any time.

 

Sincerely,

Travis Baldwin

DataTrans Solutions

1 (800) 469-0877

tbaldwin@datatrans-inc.com

 

When e-Commerce, m-Commerce and the Cloud Collide

Traditional commerce is going through a rapid metamorphosis.  The market is constantly adapting and evolving to keep up with the constant advancements in technology and logistical processes.    Today’s consumers are now demanding immediate gratification and greater access to goods which is causing traditional commerce and EDI of yesteryear to evolve.

B2B commerce of the 20th century was once laden with endless stacks of paper stemming from purchase orders and invoices to shipping documents, the endless cycle of filling out forms, scanning documents and manual data entry was an accepted but arduous part of commerce.  Enter EDI, a solution to the logistical needs of businesses everywhere, which allowed businesses to reduce the copious amount of work that was a byproduct of traditional business exchange models.  EDI greatly enhanced business efficiency, transferring documents between business partners instantaneously while reducing the labor hours involved with order fulfillment, input costs such as paper, as well as the need to fax.  E-Commerce was born and systematically changed B2B commerce in the 20th century.    According to the Research and Advisory firm Frost & Sullivan, B2B e-Commerce will hit $12 trillion worldwide by 2020 and they consider this to be the preeminent industry in innovation and market attractiveness (Vidyasekar 2014).

The 21st century and the impact of mobile technology, specifically Smartphones and tablets, has ushered in the next evolution of EDI, m-Commerce.   The internet has provided an entirely new way for consumers to browse, to shop and to educate themselves on products and with consumers now having mobile, on-demand access to the internet via their Smartphones the dawn of m-Commerce is upon us.   The ability of customers to instantaneously access global inventories, compare prices, read blogs and product reviews seamlessly from their couch or while window shopping is changing the dynamic of brick and mortar stores into showrooms.  Fulfillment center advancements are needed to provide dynamic inventory allocations and real-time updates.

M-Commerce is causing drastic logistical changes and business model shifts, and standard retail customers are not the only ones demanding these changes.  B2B businesses are feeling this pressure as well.  As vendors seek to constantly keep up with consumer’s buying and purchasing habits via model adaptations and logistical streamlining, businesses are relentlessly searching out suppliers who can keep up.   The world of e-Commerce is continuously evolving and adapting and the next generation of EDI must be a dynamic solution.

In an effort to further reduce expenses, minimize server space, increase inventory and software accessibility while simultaneously modernizing processes, many companies are turning to cloud-based software solutions.  Although highly contentious, the role and impact of the cloud is and will continue to be far reaching.   The internet has reshaped the world of the 21st century and the companies who have adapted their business models to flourish in this environment are thriving and leveraging their competitive positions, further creating barriers to entry and eliminating threats of competition.  Today’s market place is too dynamic and unforgiving to accept late responders.  Staying competitive must be at the forefront of one’s business model.

The challenge for e-Commerce going forward is finding an EDI solution that can bridge the gap between the e-Commerce systems of the 20th century with that of today’s cloud-based business requirements and m-Commerce’s empowerment of the consumer.  DataTrans Solutions has numerous products that offer resolution to these needs.

If you would like to discuss your organization’s current position and explore the impacts that adapting to e-Commerce, m-Commerce and cloud-based computing will have, please feel free to call me at 1(800) 469-0877.  We will discuss your business’s unique needs and how transitioning your internal systems can help keep you ahead of the competition.

Travis Baldwin

Works Cited

Vidyasekar, Archana Devi. The Global B2B E-commerce Market Will Reach $6.7 Trillion by 2020.  Frost & Sullivan. Dec 31, 2014.  Retrieved on Jan 2, 2015 from http://www.frost.com/sublib/display- report.do?id=MA4E-01-00-00-00

WebEDI Add-On Tools Improve Productivity

DataTrans WebEDI is a great productivity tool for companies requiring a simple EDI solution that complies with trading partner requirements.  However, there’s more to the solution than meets the eye. Over the years we have added many enhancements to make the EDI process more efficient for our customers. Features such as Auto-Pack, Document Associations, Smart Filters and Document Defaults are designed to reduce the number of steps required to process EDI messages.  These improvements provide a more useful data management tool.

In addition to these capabilities, DataTrans has developed a set of optional “Add-ons” which provide even more functionality in certain areas.  The WebEDI QuickBooks Integration creates a link between your QuickBooks and WebEDI allowing integration of information between your accounting system and WebEDI. Thus, purchase orders can be imported into QuickBooks and invoices can be exported from QuickBooks to WebEDI to be validated and sent.  This allows for integration with WebEDI without the need for expensive EDI software.

DataTrans also can provide a Web Services link to UPS and FedEx to allow you to import shipping information into your ASN’s. Each is a separate utility (one for FedEx and one for UPS), but this solution saves the time of rekeying vital shipping information and expedites the process of creating accurate Advance Ship Notices. One more step to bringing the whole process together in one cohesive e-commerce management tool.

These Add-ons provide tremendous benefits in further automation and integration.  We are constantly working on features and improvements to make our customers more efficient. If you would like to learn more about WebEDI or these Add-on’s, contact DataTrans at sales@datatrans-inc.com.

Hot! Coming down the Retail Supply Chain

Some of our latest clients that joined the DataTrans EDI network this week. We deal with entrepreneurs, inventors, and designers every day getting them integrated into the big retailer supply chain.

Bevhat – You’ll be able to find these at your local Bed Bath and Beyond just in time for Summer patio dining.

EDI is helping to keep the bugs out of your drink.

EDI is helping to keep the bugs out of your drink.

NEO3DO – Shop at Fry’s and you’ll come across a whole new 3D tablet experience that does not require glasses.

No need for 3D glasses @ Fry's

No need for 3D glasses @ Fry’s

AVUE – for those who like to keep an eye on things…

Professional Surveillance

Professional Surveillance

EmilioMilano – Put some Italian style and sex appeal into your wardrobe.  Search on Zappos.com for EmilioMilano shoes.

Italian Style at Zappos.com

Italian Style at Zappos.com

PIC Corp. – Everyone seems to have Summer on their mind.  Here is another solution to maximizing the outdoor patio experience.  You can find these online at the catalog retailer Orchard Brands – Solutions – Norm Thompson – Gold Violin.

Pest free outdoor living

Pest free outdoor living

International Durus – Need some BLING… also in the Orchard Brand’s Norm Thompson Catalog.

Designer jewelry in the Norm Thompson catalog

Designer jewelry in the Norm Thompson catalog

Blue Sky – For those trendy teenage kids of yours shop at PACSUN.

Find trendy clothes for your teenager at PACSUN

Find trendy clothes for your teenager at PACSUN

And last but not least…let us connect you to the retail supply chain via a DataTrans EDI solution.  We have WebEDI, Integrated EDI, Quickbooks EDI, integration with UPS Worldship and FedEx.   Call us with your questions.  281-292-8686 x1 .

Our clients inspire us daily.

 

 

Competing EDI Service Providers Partner

Image

After 12 years Dave Rike of Organizational Results and Rob Guerriere of DataTrans join forces

Dayton OH & The Woodlands TX (PRWEB) April 21st, 2013 – Veteran EDI professionals Dave Rike and Rob Guerriere officially came together today in a business partnership after years of direct competition.  The new partnership offers leading edge supply chain solutions based on the DataTrans Solution’s Canonical EDI (Electronic Data Interchange) Network.

The duo’s industry accomplishments are second to none in electronically connecting thousands of companies worldwide to some of the largest organizations.  They are responsible for EDI campaigns at Wal-Mart, Honda, Kroger, Costco, Supervalu, C&S Wholesale, AAFES (Army Air Force Exchange Services), HEB, Albertsons, Circuit City, Nash Finch, Safeway, NEXCOM (Navy), and over 100 other major corporations.

“Rob and Dave have helped connect many suppliers to Nash Finch,” commented Andy Ragan, Former EDI Manager, Nash Finch, “We were able to cost effectively support these initiatives by employing the best practices approach which they prescribed.  It gave the Nash Finch supply chain a competitive advantage.”

“Rob and Dave have a loyal industry following,” remarked Joe Andraski, Founder at Collaborative Energizer and Former President of VICS, “Their leadership over the last 12-15 years has propelled the growth of EDI solutions, technology and the industry into the next generation.”

“I’ve known Dave Rike for over six years and his knowledge in the EDI arena is exceptional.  He led our company into a new EDI program with his knowledge and expertise and has been great to work with.  He knows the market and is very good at getting a program sold, designed and implemented.  I continue to look to Dave for advice and information in this area.  I highly recommend Dave to anyone looking to get into an EDI program.”  Glenn D. Kriczky, Vice President of Information Systems, Associated Wholesalers, Inc.

“There are not many individuals that have made a bigger impact in the last 10 to 15 years,” states Scott Koegler, Editor eCommerce Best Practices Organization, “Even just considering the environmental impact of reducing carbon footprint and paper saved from a connect supply chain, it’s significant.”

“Early in 2001, Dave Rike stepped forward to walk our company through an EDI mandate. His detailed plain ensured 70% compliance with huge cost savings. Over 5 years, our organization was able to double our transactions and efficiencies in processing EDI invoices. In addition, Dave coordinated the quick (one day) transition of a hundred suppliers onto his third party network as another organization closed their doors. Dave’s third party service provided the most cost effective solution for our suppliers. Dave has helped my organization increase efficiencies, enhance data sharing, and resolved countless issues. He has been a great partner with my team implementing new practices benefiting both organizations. He is a great asset to any organization.” Robert Gledhill, Senior Manager – Supply Chain, Safeway

“Dave provided a practical and well-designed solution to our EDI needs while I was at Coldwater Creek. He treated our account as a partnership and remained dedicated to providing us great service throughout our relationship. I would definitely work with Dave anytime I needed an expert in the area of data integration with vendors and EDI.” David Edwards, Former CIO, Coldwater Creek

“I’ve always liked, admired and respected Dave,” stated Rob Guerriere, EVP DataTrans, “He has a lot of credibility with his clients because he talks straight to them, faced the music with challenges and setbacks, but delivers in the end.  He is a professional.”

“Rob has always produced excellent results.  He is well known in the EDI community and highly regarded by customers and competitors alike,” stated Dave Rike, CEO Organizational Results LLC, “Rob and I have become friends over the years regardless of the previous competition and I believe collectively we will bring new energy and a wealth of knowledge to the industry that companies are looking for in order to solve their business issues.  Our individual successes will multiply dramatically as partners.”

“We have the platform that gives professionals the market advantage,” said Mike Franks, DataTrans CEO.  “The solution offering provides mission critical reliability, scalability and performance necessary for veterans Guerriere and Rike to hang their reputation on.”

For EDI clients and users, this partnership will further accelerate the adoption, technology, and lower cost barriers to an expanding worldwide network of supply chain connected EDI ready companies.

About Organizational Results:

Organizational Results LLC drives cost savings and revenue streams for corporations in Healthcare, Manufacturing, Grocery, Wholesale, Distribution, and Government sectors.  The company offering includes a complete Procure-To-Pay solution from requisitioning, approval, and budgeting through a dynamic E-Payables solution that enables clients to turn Accounts Payable into a profit center.  E-Payables drives cash back into the system on a monthly basis while reducing costs for paying invoices. Organizational Results LLC incorporates Supply Chain Informatics, Energy Management, Labor Management, Equipment Maintenance, and Data Cleansing that bring best practice solutions from multiple industries to improve client’s bottom-line financial performance.  Org-Results.com

About DataTrans Solutions:
DataTrans delivers customer centric supply chain and EDI outsourced services in retail distribution, energy, process manufacturing, and healthcare industries.   DataTrans offers a canonical on-demand hosted platform that allows clients to Click to Connect™.   The company mission is to provide constantly improving B2B and data management services that give customers a competitive advantage.  DataTrans leverages industry knowledge, process consolidation, and technology to provide game changing B2B solutions. The company is privately owned and has been profitably grown since it was founded in 1998. DataTrans is headquartered in The Woodlands, Texas.  DataTrans-Inc.com

Contact:

Dave Rike 973-789-7201 dave.rike@org-results.com

Rob Guerriere 773-704-9934 robg@datatrans-inc.com

 

JC Penney’s Veteran Conan Massey joins DataTrans as EDI Analyst

DataTrans’ continued growth has allowed the company to build a top quality team of EDI professionals to provide the highest level of qualified service to our clients.  We are please to announce that Conan Massey recently joined our team as an EDI Analyst.  Mr. Massey will be responsible for EDI implementation projects, analysis of DataTrans EDI infrastructure, and on-going support of DataTrans’ clients.  Prior to joining DataTrans, Mr. Massey worked at JC Penney’s as an EDI Analyst and led several key EDI projects within the company.   Earlier in his career, he was an Inventory and Operations Analyst with Penney’s focusing on the planning and operations side of the business.   He brings over 20 years retail operations and 10 years EDI experience to DataTrans.

“Conan’s unique perspective on a major retailer’s operations and EDI implementation process, along with his knowledge of EDI in general make him a great addition to our team” said Mike Franks, DataTrans CEO.

DataTrans continues to build a team of dynamic, experienced and responsive associates to provide the best overall B2B and EDI solutions.

About DataTrans Solutions:
DataTrans delivers customer centric supply chain and EDI outsourced services in retail distribution, energy, process manufacturing, and healthcare industries.   DataTrans offers a canonical on-demand hosted platform that allows clients to Click to Connect™.   The company mission is to provide constantly improving B2B and data management services that give customers a competitive advantage.  DataTrans leverages industry knowledge, process consolidation, and technology to provide game changing B2B solutions. The company is privately owned and has been profitably grown since it was founded in 1998. DataTrans is headquartered in The Woodlands, Texas.   For more information, visit www.datatrans-inc.com

Compliance Networks and DataTrans Solutions Partnership Offers Improved Supply Chain Performance

EDI Solutions Integration to Drive Cost Efficiency in the Extended Supply Chain

Sugar Land & The Woodlands TX (PRWEB) February 27, 2013

Compliance Networks, the leading provider of vendor performance optimization solutions and DataTrans Solutions Inc., the industry-leading B2B supply chain network, announced an integrated and strategic partnership that will drive EDI collaboration and further cost efficiencies in the retail supply chain.

“It’s a natural fit”, explained Greg Holder, CEO of Compliance Networks.  “Our clients and partners are one in the same.  Both of our teams have been focusing on optimization of our core competencies and it was a client that did the match making.”

Mike Franks, President of DataTrans, states “The integration and automation of processes will further drive down the costs and time associated with the order to cash process.  It will benefit both retailers and their supplier partners.”

As of today, the combined solution is live and in production.  The companies expect this to be the first step in many to integrate solutions to the benefit of the retail industry.

About DataTrans Solutions Inc.
DataTrans Solutions Inc. delivers customer centric supply chain and EDI outsourced services in retail distribution, energy, process manufacturing, and healthcare industries. We offer a comprehensive on-demand hosted platform that allows clients to CLICK TO CONNECT™. Our Mission is to provide constantly improving B2B and data management services to allow our customers to operate at peak efficiency. We operate with integrity to provide our services in a responsive and respectful manner. We will leverage our knowledge and technology to provide the most appropriate and efficient B2B solutions for our customers. The company is privately owned and has been profitably grown since it was founded in 1998. DataTrans is headquartered in The Woodlands, Texas.

About Compliance Networks
Compliance Networks is a leading provider of vendor compliance and supply chain visibility solutions for the entire PO LifeCycle. CN solutions enable retailers to optimize flow with leaner supply chain and make informed supply chain decisions. The net result is increased customer satisfaction, profitability, and shareholder value. Compliance Networks’ suite of retail-centric vendor compliance and distribution management solutions drive continuous performance improvement throughout the extended supply chain. Since 2000, Compliance Networks has offered best-in-class vendor compliance optimization and supplier performance management solutions enabling retail enterprises to make informed supply chain decisions. Compliance Networks is proud to serve leading retailers such as Kohl’s, Burlington Coat Factory, Pep Boys, Stein Mart, The Sports Authority, Bon-Ton Stores Corporation, Bob’s Stores and others.

DataTrans 2012 annual customer growth rate up 283 percent over 2011

The word is out. With the large majority of business growth coming from referrals, DataTrans Solutions Inc. EDI integration cloud and canonical network boasts record growth in healthcare, manufacturing, utilities, automotive and retail industries.

“We continue to drive down the cost of supply chain integration via our canonical network, professional staff and innovative developers.”, states Mike Franks, DataTrans CEO.  “We run a tight ship with our team focused on  responsiveness to our customers.”

The company is currently hiring in all departments.  Some positions can be filled from a remote office in North America.  Interested candidate can submit a resume to employment@datatrans-inc.com .  No calls please.

Mark Cuban s Shark Tank Investment Kisstixx is EDI ready just in time for Valentines

The new and innovative lip balm company, Kisstixx, which creates a chemical reaction when two complementary pairs meet and secrete, has opened themselves to the retail supply chain.  Inventors and entrepreneurs, Dallas Robinson and Mike Buonomo, plugged into the retail EDI supply chain with DataTrans Solutions Inc.  The DataTrans canonical EDI network opens Kisstixx up to be responsive to big retailers with configured integration in the ordering, shipping and payment systems of more than a thousand major retailer buyers.  The fast growing company has an experienced EDI team on their side to comply with the requirements of their clients including Winn-Dixie, Kmart, Fry’s, Associated Food Stores and Party City.

The DataTrans team welcomes our new partners.  We look forward to assisting Kisstixx in their growth, allowing them to scale efficiently.  Our clients growth and success drives our spirit as supply chain professionals.

Watch them close Mark Cuban for $200,000 on Shark Tank below

 

 

Learn more about scaling a business with an EDI service for retailers.