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Healthcare EDI Market: Claim Status transaction offers significant growth opportunities across the globe
The transaction of claim status enquiries can be conducted easily with the help of electronic data interchange. EDI in claim status can be used for sending an inquiry by a healthcare provider to a health plan/payer for knowing the status of a health care claim, electronically instead of paper means, which could be responded to by a payer electronically.
The global healthcare EDI market was majorly driven by the North American market, followed by the Europe and Asia in the year 2013. The North America will continue to dominate the Healthcare EDI market due to the demographic changes such as increase in the number of aging population propelling the healthcare market, Obamacare Act which is expected to increase the number of insured people in the United States, and the increasing need to be compliant with HIPAA (Healthcare Insurance Portability and Accountability Act). Claim Status transactions dominate all the types of claims management transactions undertaken, with maximum enquiries and responses sent and received for knowing the status of claims, which accounts for more than 80% share of all the transactions undertaken.
Though claim status transactions have been used in various countries, they have been more widely used in the United States. Claim status helps in understanding the status of the claim, once submitted. The standard for Healthcare Claim Status, as per the HIPAA Act 1996, ASCX 12 transactions, is 276/277 in the U.S. The first step of a claim status request/response is the submission of a 276 claim status request to a payer. The EDI Healthcare Claim Status Inquiry (276) form is used for inquiring about the status of a claim. The payers respond to this enquiry with the help of EDI Healthcare Claim Status Response (277) transaction. Though the 277 transaction is generally used for responding to the claim status request, it can also be used for submitting additional information about a claim that has already been submitted.
The 277 transaction generally provides information on the status of a claim as pending or finalized. A finalized claim would generally indicate the transaction as denied, rejected, approved for payment, or paid. The use of EDI for this process helps in receiving of the information more quickly without very little or no manual interventions, thus helping in the reduction of the revenue cycle time and thereby improve efficiency.
As per America's Health Insurance Plans (AHIP) study, claim status transactions conducted electronically, helps in reduction of costs to almost 85% over the ones submitted through papers. Also, studies indicate that the annual insurance administration costs for any practice could be reduced by more than $42,000 per physician, with the use of electronic claim status inquiry. Apart from this, decreased duplication of claim status, lesser time spent on manual work, and improved productivity are some of the other benefits associated with claim status processing with the help of EDI.
Healthcare EDI Market by Component (EDI Software, EDI Services), Transactions (Claim Status, Eligibility Verification), Mode of Delivery (Web-based EDI, Mobile EDI, EDI Van) & by End-users (Healthcare Payers, Providers) - Global Forecast to 2018
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