EDI Has Little Impact on Denials Tracking

The adoption of HIPAA Electronic Data Interchange (EDI) specifications has had little impact in terms of providing an effective denials tracking solution.

The hope of the EDI standards instituted by HIPAA was that paper documents such as EOB's and RA's, including denials, would be eliminated as part of the utilization of electronic posting files received from payers.  Unfortunately, this has not yet been the case.

While a few carriers are able to process electronic payment information, most currently do not, and all indications are that it will require a significant amount of time to substantially implement EDI.

The HIPAA EDI format that provides denials coding is the 835 Healthcare Payment format. After analyzing 250,000 denials, we have found that significant denied money is not reported in electronic (835) data.

In addition to a lack of denials information from 835 data, the code sets themselves are limited and cannot provide the level of detail and depth of analysis that is optimal to make a strong impact on denials processing improvements.

We believe that other denial management programs that rely on 835 data are extremely limited. Reliance on 835 data for denials management is premature at best; this approach will fall well short of realizing potential revenue improvements that a capable denials management solution can provide.

Healthcare Reports provides the specialized staff and technology to create a truly effective denials management solution. We make it cost-effective for the hospital business office to use denials identification, analysis, and tracking to increase income, reduce age days, and reduce denials at the source.