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Modernizing Your EDI Solution: Three Steps Toward Optimizing Your Migration Strategy

 

6.14.2023 By Sean Kilpatrick, Vice President - Gateway & Clearinghouse Product Management

 

In the first part of our series, How to Modernize Your EDI Solution, we explored the reasons your health plan may consider EDI vendor consolidation. In part two, we explored how to thoroughly evaluate potential EDI vendors. In this installment, we’ll focus on some of the best practices used by payers to migrate—and go-live—with a new gateway clearinghouse.

Availity employs a proven framework for EDI migrations. At a high level, Availity implements our clients within timeframes and budgets agreed upon during contracting.

1. Business assessment/planning. Ideally, your new EDI will not merely replace your legacy system, but enhance your current processes, eliminate bottlenecks and redundancies, and allow your organization to reallocate resources to other initiatives.

Prior to implementation, it’s important for organizations to understand the impacts the new EDI solutions will have on the business. For example, will the EDI gateway:

  • Eliminate redundancies?
  • Reduce manual processes in favor of automation?
  • Improve service and responsiveness with the health plan’s provider network?
  • Scale to meet future business goals and need?

2. Assemble a team to spearhead the project. The team should be led by IT professionals with EDI experience and be comprised of senior management, the vendor’s implementation team, and an cross-disciplinary internal team of experts dedicated to the migration initiative.

3. Communication. EDI platforms are so critical because they are the primary means by which providers and payers communicate information and process transactions. Any disruption to those capabilities can be costly and spark unnecessary abrasion with your provider network.

Consistent messaging on implementation timelines, value propositions, internal communications, and provider education should be considered as important as the technical aspects of an EDI implementation.

Availity makes it easier for provider organizations to intuitively connect, communicate, and collaborate with thousands of health plans on eligibility, authorizations, claims management, remittances, and other critical tasks. Availity’s clearinghouse, API, and electronic data interchange products allow providers to integrate HIPAA transactions and other features into custom applications or through a provider’s preferred PMS, HIS, or EHR system.

As a result, Availity Essentials lowers administrative expenses by reducing unnecessary phone calls to a health plan’s call center and increasing electronic interactions between health plans and their provider networks.

Additionally, Essentials’ multi-payer functionality, workflow automation, transaction capabilities, and HITRUST Common Security Framework certification makes the platform an appealing option for payers looking to upgrade their homegrown provider portals.

Is your health plan ready to consider a vendor consolidation strategy? Take the first step by downloading our eBook.

 

 

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