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Many clients feel trapped in outdated EDI systems. They’re searching for ways to:
- Improve transaction ingestion and transparency
- Enhance traceability across workflows
- Seamlessly connect new and legacy systems
- Save money without compromising quality
- Customize reports and dashboards
- Maintain compliance effortlessly
Their goal is simple: streamlined EDI processes that improve both member and provider experiences.
How can we process more faster and with fewer mistakes?
Tracking every transaction file is challenging, especially with complex business rules, growing data volumes, and multiple “hops” during file transfers. Many systems lack real-time visibility, leading to:
- Delayed member enrollment
- Claims adjudication errors
- Slower electronic payments
From Limited Insight to 100% Visibility
Our EDI Modernization for Healthcare (EM4H) solution solves these issues. It enables accurate, on-time processing and gives clients full control of their business transaction data.
With customizable dashboards and reports, transactions are tracked, traced, stored, and audited precisely—even in high-volume environments.
How can collaboration among multiple systems and parties be improved?
In a rapidly changing healthcare ecosystem, flexibility and adaptability are crucial. Yet many organizations still depend on rigid legacy systems that limit integration.
From Cluttered Connections to Clear Integration
Prolifics simplifies integration through EM4H’s open architecture. The solution directly connects with nearly any system—on-premises, cloud, or hybrid—eliminating hidden schemas and database silos.
Healthcare payers benefit from:
- Seamless data exchange between systems and partners
- A unified, future-ready EDI environment
- Simplified workflows and fewer manual errors
This approach ensures every transaction flows efficiently—regardless of where the data resides.
How can healthcare payers 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?
Start by assessing your current EDI platform:
- Are you stuck in a rigid, high-cost system?
- Are transactions processed accurately and on time?
- Are you paying for unnecessary updates?
- Do upgrades demand large teams and long timelines?
If the answer is yes, it’s time to consider modern, agile solutions like Prolifics EM4H, designed for scalability and compliance in the digital era.
Final thoughts?
Addressing EDI challenges in healthcare isn’t easy—it requires deep expertise and innovative thinking. Prolifics is helping payers transform operations for long-term success, not just quick fixes.
By modernizing systems, fostering collaboration, and optimizing costs, healthcare organizations are not only improving efficiency—they’re also enhancing outcomes for patients and providers alike.
That’s what truly drives us forward.
Visit our website or click below to download our EDI Modernization for Healthcare whitepaper.
