EDI for Healthcare Payers: Your Challenges Solved

February 7, 2024
EDI for Healthcare Payers: Your Challenges Solved

Navigating the complexities of Electronic Data Interchange (EDI) supporting the healthcare industry can be challenging. Challenges with custom business rules, integration of technologies, and ensuring compliance add to the burden. However, Andrea (Andi) Minarcin, Director of Healthcare Business Development at Prolifics, says there’s relief. We asked Andi how she helps clients navigate complexities and drive transformative change on their EDI platform. Here’s what she said! 

Q&A with Andi Minarcin 

What challenges are healthcare payers facing, and what are their objectives? 

I work with healthcare payers, like this leading health insurance provider, who are committed to improving the way they manage EDI, aiming to make operations smoother, reduce costs, and improve member and provider experience. 

Many of my clients feel “trapped” in their current EDI system. They’re looking at new ways to improve transaction ingestion and increase transaction ingestion, transparency and traceability, seamlessly connect new systems with existing technologies, save money without sacrificing quality, and tailor reports and dashboards to fit their business needs all while staying compliant. 

How can we process more faster and with fewer mistakes? 

It’s tough to track every transaction file, ensuring each one is processed on time. My clients require more visibility into the life of each file. Yet, due to the increased complexity associated with business and compliance rules, high volume of transactions, and number of “hops” in the life of each EDI file, many solutions lack real-time status. This leads to delays or failures in member enrollment, claims adjudication, electronic payment, etc.

From limited insight to 100% visibility 

Our (Prolifics) EDI Modernization for Healthcare (EM4H) solution addresses these limitations and enables timely and accurate processing. We give you personalized access to your business transaction data, including easily customizable reports and dashboards – any way you need it. The transactions are not just processed; they are tracked, traced, stored and audited with precision in high-volume environments. 

How can collaboration among multiple systems and parties be improved? 

Flexibility and adaptability are key focuses for healthcare payers in a rapidly changing market. However, many struggle with rigid systems that are difficult to modify or integrate with newer technologies. 

From cluttered connections to clear integration 

Prolifics opens the door to complete integration capabilities. No more hidden schemas or databases. Due to the use of off-the-shelf software EM4H directly integrates with virtually any current and future business system, preserving critical IT investments. Businesses can enjoy a more streamlined approach to connectivity, eliminating unnecessary hurdles and paving the way for efficient operations. 

Additionally, healthcare payers can smoothly exchange data between different systems and partners. It doesn’t matter if their environment is on prem, in the cloud, or both  – we make sure everything flows smoothly, making the transactions process a whole lot easier.  

How can we reduce operational costs? 

Healthcare payers know that maintaining and updating legacy EDI systems can be quite an expensive headache year over year. Budgets take a hit every time changes are made.

From budget headaches to manageable costs 

Prolifics offers a cost-effective alternative with transparent pricing, allowing organizations to modernize their EDI platform without breaking the bank. Once deployed, the solution is theirs without the need to be locked into an expensive multi-year contract. 

 I tell my clients to say “goodbye” to exorbitant pricing schemes. No “per-anything” fees—just transparent pricing that aligns with their budgets. 

How to prepare for the future?  

Here’s my advice: Start by taking a hard look at your current EDI platform. Are you feeling trapped in a rigid, costly system? Are transactions processed accurately and promptly without errors? Are you stuck paying for updates you don’t really need? Does the size, time and cost of an upgrade require a large project team? If so, it’s time to explore alternatives like Prolifics EM4H.

Final thoughts? 

Addressing the EDI challenges in healthcare is no small feat. It’s critical to have the right expertise and thinking outside the box. Prolifics is leading the charge with innovative solutions. Quick fixes are just that, quick and short-lived. Revolutionizing the way healthcare payers operate is necessary for longevity in the healthcare industry. By optimizing systems and fostering collaboration, Prolifics is helping them manage costs more effectively. And the best part? It’s not just about the numbers—it’s about improving outcomes for patients and providers alike, something that truly drives us forward. 

Visit our website or click below to download our EDI Modernization for Healthcare white paper.  

Download Whitepaper