The healthcare industry makes great use of Electronic Data Interchange (EDI) transactions — understandably so, since there are many players involved at every stage of the game. The EDI 834 transaction is particularly key, as it represents a Benefit Enrollment and Maintenance document.
The information in an EDI 834 must be transmitted accurately since it contains vital member enrollment information. The EDI 834 flows between three entities:
Unfortunately, transmission is not always easy or trouble-free, even with the EDI format. Data can get lost or corrupted in transmission, with negative impact on each of these entities and on the consumer.
For example, if an EDI 834 gets corrupted, people don’t get enrolled. Healthcare exchanges lose their credibility in the marketplace. Brokers don’t get notified of new clients. Payers can’t send invoices or get paid. The business of delivering healthcare crumbles.
It is possible to have your EDI 834 transactions travel without any mishaps, simply by adding an EDI integration architecture with a services layer. The services layer allows you to manage the underlying flows without affecting how the EDI 834 files are transmitted. The services layer primarily consists of web services (SOAP or REST), mappings, meta-data of schemas, and business rules that are applied on the EDI 834 files.
Here’s what the architecture looks like:
The EDI 834 integration architecture removes all concerns with data formats. In fact, the data schemas of the inbound EDI 834 and outbound payer’s canonical formats do not need to be changed as you modify your underlying business processes over time.
With such an architecture in place, you can create ‘templated’ process flows to handle the common steps of data transformation and routing where the behavior of the process is determined by the type of data being received from a given source. For example, if a state sends an EDI 834 that requires specific handling in mapping, that particular map can be applied at runtime based on which state or marketplace is sending the file. Therefore, there is no need to create individual processes for each healthcare exchange.
If you are a player in the healthcare arena, an EDI 834 integration architecture is critical for your business. With data flowing effortlessly and accurately, you can deliver the service your partners, vendors, and customers are looking for.