Health Information Technology   EDI  

Electronic Data Interchange

Overview

Electronic Data Interchange (EDI) is the exchange of standardized electronic documents between organizations from one computer application to another. The health care industry has used EDI for more than 20 years as a way to create efficiencies in third party payor billing. The electronic exchange of health information reduces administrative costs, lessens claim errors, and improves productivity. EDI offers several benefits to both payors and providers. A few of these benefits include: improves cash flow, reduces administrative costs, improves productivity, and eliminates paper waste. Beyond the costs-savings associated with using electronic transactions, EDI offers many other advantages over paper, including that the transactions are portable, re-usable, and interchangeable between payors and providers.

Many factors influence the rate of EDI activity including financial resources and technical infrastructure. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) Administrative Simplification provisions allow for the electronic exchange of standard transactions between payors and providers. HIPAA requires payors to accept electronic transactions but does not mandate its use by providers.  

COMAR 10.25.09, Requirements for Payers to Designate Electronic Health Networks, requires payors operating in Maryland with an annual premium volume exceeding $1 million to report census information to the Maryland Health Care Commission. Each year MHCC examines the administrative transaction data from payors and develops an information brief.  Payors and providers use this information to monitor and enhance their use of administrative technology.

The EDI Information Brief for the 2015 reporting period is located here.

Electronic Data Interchange Transaction Annual Reports and Information Briefs (2000-2014)

This is a listing of the archived annual EDI Administrative Transaction Reports and the list of reporting payors by year.  Maryland law requires payors operating in Maryland with an annual premium volume exceeding $1 million to report census information to MHCC regarding electronic administrative transitions.  Each year, the Maryland Health Care Commission examines the information from payors and develops an industry brief.  Payors and providers use this information to monitor and enhance their use of administrative technology.


Last Updated: 11/14/2016