Multiple EDI vendors? Three reasons to consider consolidation

A health plan’s EDI infrastructure is mission-critical, serving as the foundation for communication between health plans and providers. As a result, health plans prefer not to make changes that could potentially disrupt their provider network. While caution is understandable, it can also lead to a status quo bias that prevents organizations from evaluating new processes that can lead to operational improvements. 

A good example of this is maintaining more than one EDI gateway vendor. In the early days of electronic data exchange, it was common for health plans to work with multiple vendors. Today, EDI processing has largely commodified, leading to industry consolidation and economies of scale for the remaining vendors. For health plans, this means three really good reasons to consider a vendor consolidation strategy:

Reduced operational expenses

The cost of maintaining multiple vendors goes beyond the contracts themselves. The more EDI vendors in the mix, the more internal resources are needed to handle account management, technical support, onboarding, etc. With a single point of contact accountable for all aspects of connectivity, health plans can deliver a better experience for providers and trading partners, allowing them to reallocate staff to other strategic priorities.

Improved clean-claim rate

One of the best ways to reduce claims rework is to prevent claims with errors from reaching the health plan in the first place. But preventing errors is more difficult when claims are received through different gateways. Health plan-initiated changes, like edits or other updates, are often implemented inconsistently across all vendors, leading to pended or denied claims and calls from providers. Using a single gateway vendor not only streamlines the deployment of edits, but with Availity, health plans can create custom edits within the Intelligent Gateway that stop inaccurate claims, preventing the cost of reworking them.

Deeper insights from better data

Having a single gateway to capture, standardize, and normalize incoming data goes a long way in helping ensure data integrity. In a multiple gateway model, this process is more challenging because there are more inputs to manage. Access to better data allows health plans to understand operations at a more granular level, and it serves as the foundation for deriving insights through AI and machine learning technology.  

Is your health plan ready to consider a vendor consolidation strategy? Take the first step by talking to one of our Intelligent Gateway experts.