What is EDI Enrollment and What Are the Benefits of an EDI Clearinghouse?

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The introduction of the electronic claims process changed healthcare forever. In a system that was riddled with inefficiencies and inaccuracies due to paper claims management, digital billing offered a solution. For providers looking to eliminate these problem areas in their claims process, EDI enrollment is necessary. Electronic Data Interchange (EDI) is an innovative digital communication tool that is used to deliver data from a provider to a payer. In order to be eligible to submit electronic claims to an insurance company, providers must complete EDI enrollment. 

What is EDI Enrollment? 

Some payers require EDI enrollment in order for providers to submit electronic claims or complete EDI transactions. In other words, until your organization has completed all necessary registration processes, you will be unable to submit electronic claims to that insurance agency. 

While some organizations allow for the exchange of paper claims, they are quickly becoming outdated. The industry as a whole is transitioning to digital claims management. Many payers are requiring the completion of EDI enrollment for providers to be able to submit claims at all. 

In a perfect world, providers would only have to complete one form and distribute it to all payers, but this is not the case. Providers work with dozens of insurance companies who each have their own list of demands. 

EDI enrollment can quickly become overwhelming to a healthcare organization that works with more than one or two payers. Each insurance company has differing procedures and requirements to qualify for EDI. This triples the workload for your team when it comes time to enroll and maintain that relationship. This is where a clearinghouse comes in. 

A clearinghouse in healthcare functions as the middleman between payer and provider, helping you complete EDI enrollment and EDI transactions. Apex EDI is the perfect solution for providers looking to join forces with an experienced clearinghouse.   

Why are the Benefits of EDI/Clearinghouse? 

1. Fast Transfer of Data 

Paper claims take an eternity to process. With Apex EDI, procedures, including EDI enrollment, that used to take days now only take seconds. A payer can receive a claim the same day it is submitted by the provider. This high-speed transfer of data streamlines your billing workflow, saving valuable time that is best spent on patients. 

2. Quick Error Identification 

Manual claims submission is notoriously riddled with inaccuracies and mistakes. There is no room for those issues if you are a provider looking to advance their bottom line as well as their practice. After EDI enrollment, digital and automated tools stop errors in their tracks. Apex EDI automatically scrubs your claim for faults to prevent denials. 

3. Timely Payments 

The quick transfer of information partnered with error identification leads to an increase timely payments. Streamlining your billing process and reducing the chance of denial means that your payment will be on the way in no time. This breed of efficiency only exists post EDI enrollment. 

4. Cost-Effectiveness 

Paper claims are costly. Providers spend thousands of dollars a year on expenses including paper, printing, printing supplies, postage, and more. After EDI enrollment, your practice will no longer have those expenses, allowing it to save valuable resources. 

5. Decreased Administrative Burden 

Time that should be spent on patient care is being wasted on the administrative responsibilities related to paper claim management. Your staff has to print claims, sort them, stuff them in envelopes, address them and mail them out before they are even on the way to the payer. Your staff also wastes time on the phone with insurance companies tracking down patient coverage information and eligibility. Now, eligibility confirmation can be completed in seconds. EDI enrollment disposes of the need for these tasks, allowing your staff to focus on more patient-critical matters. 

How Do I Get Enrolled? 

Rather than attempt to complete EDI enrollment with each payer they wish to do business with, most providers utilize a clearinghouse like Apex EDI. They avoid having to keep track of payer requirements, regulations, forms, and more. Apex EDI does the hard work for you. 

If there is a modification within your organization, such as a change in address or phone number, Apex prevents your team from having to spend hours updating that data with each payer. 

We are a leader in developing new tools that improve claim location, status, and enhancements to the paperless office. As a national clearinghouse solution that integrates with virtually any practice management software, we offer support and quality interactions with healthcare payer organizations. 

Rather than go directly to the payer, EDI transactions pass through our clearinghouse, facilitating the inquiry, reducing the chance of denial, and increasing timely payments. 

Working with a clearinghouse like Apex EDI, providers can effortlessly complete EDI enrollment. We interact with more payer organizations than any other EDI solution yet still manage to disentangle the process for providers more effectively than any other competitor. 

To learn more about EDI enrollment and how Apex EDI simplifies claim processing, schedule a demo of our clearinghouse solution today.  



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