Solutions for HealthCare EDI

HIPAA EDI 834 – Health Care Benefit Enrollment and Maintenance

Imagine that you are an ERISA Enrollment TPA whose mission is to offer a comprehensive, integrated benefits administration services, simplifying benefits administration within the human resources department by acting as a central resource to take care of all of an employers benefit administration needs. To fulfill this mission, you need technology and business process to manage the benefits process for a large number of your clients. You have seen a lot of changes in benefits administration since you started. Early online solutions were designed to eliminate paperwork and streamline processes in the human resources department. Today, benefits management companies must constantly adapt to ever changing business requirements when providing benefits management to a wide variety of employers. As they are focused exclusively on benefit management, they have developed sophisticated systems and solutions to manage the benefit process for multiple employers to multiple insurance carriers.

For any organization, be they an Enrollment TPA, large employer who implements Enrollment management in-house or a payer receiving EDI Enrollments, the HIPAA EDI 834 Benefit Enrollment transaction is an excellent option for improving the extremely administrative and labour-intensive benefit Enrollment process. The Enrollment TPA use this document as it allows them to gain a significant gain in productivity while reduces error rates.

The reason this transaction is generally easier than other HIPAA EDI Documents (such as the EDI Claim, Claim Status, Eligibility etc), to implement than other more complicated transactions is because benefits information, plan subscription and employee demographic information are usually available from an organizations back-end applications. Since the demographic information is already in the employers H.R. system and the benefits/plan subscription information is available from the TPA (or in-house), it’s a matter of extracting the appropriate information, combining it and then forming into one document and sending it to the payer. From the payers perspective, a standard 834 is welcomed as it also reduces their efforts to signup and maintain benefits.

 

More Information on Enrollment Solutions from SoftCare

Download the WhitePaper "EDI 834 - Improving the Benefit Enrollment and Maintenance Cycle"

 

 

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