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Modernizing Your EDI Solution, Vendor Selection

In the first part of our series, How to Modernize Your EDI Platform, we explored the reasons your health plan may consider EDI vendor consolidation. In this installment, we’ll focus on best practices for evaluating an externally managed EDI platform.

In healthcare, EDI transactions between providers and payers are done in one of two ways:

  • Direct data entry (DDE) through a payer portal
  • Clearinghouse

Regardless of your preferred methods for EDI transactions, it’s important to remember that you are investing in more than just stuff in a box—technology, features, and capabilities. You are also investing in a partnership to help ensure a smooth migration, communicate your strategy to your provider networks, and scale with your evolving business goals.

Platform Security

Security is one of the most critical parts of a vendor evaluation process and it is important to ensure that your EDI vendor, at minimum, meets all industry standards for information security. As the first health information network to achieve Common Security Framework certification from HITRUST, Availity understands the value of affirming adherence to an industry-developed and supported security framework.

Customer Support

The healthcare industry is filled with horror stories of organizations investing significant amounts of capital and resources on technology, only run into trouble and the vendor is nowhere to be found. Robust customer support—from implementation to go-live and beyond—should be a non-negotiable factor in any vendor evaluation.

This is especially critical during inevitable downtimes—whether planned or due to unexpected technology issues. It’s important for your organization to understand the strength of your EDI vendor’s communication and backup processes, and the level of support provided during downtimes.

Service Delivery

Technology is one of the leading causes of burn out and frustration in healthcare. The complexity of systems and inconsistent interoperability not only impacts staff morale, but also operational costs and efficiency. Your platform should cause minimal disruptions to established workflows (in fact, the right platform should be able to consolidate, streamline, or improve current workflows). Finally, the best platform is one that plays well with your existing technology investments. When exploring your options, ask about education and onboarding services.

Can the EDI solution scale as you grow?

As your business grows the solution should be able to handle the changes. A good EDI solution should be able to let you extend or increase the number of EDI business relations such as customers, vendors, or warehouses with ease. Also, you should check that the EDI provider offers an expedited onboarding process for all your vendors and customers can help you get started with EDI quickly. That’s why you should try to find a provider who has experience in your industry and has established relationships with your trading partners already, which will make the onboarding process faster.

Going to multiple vendors for different EDI needs can be time-consuming and frustrating. It’s important to identify a vendor who offers a complete range of EDI solutions and services under one roof. This can make your job easier and as a business owner, you don’t have to look for different vendors for different services.

As your business scale, the total data transaction number will also increase. So, it is important to note how much volume of data your vendor system can handle at any given time and is it easy to scale this volume as your business grows. Also, another important thing to consider here is the pricing, with increased data transaction volume there is a chance of an increase in pricing as well, so it’s better to understand your vendor pricing model and how it going to cost you as a business owner before signing up with any EDI vendor. The tip here is to choose a vendor who offers flexible paying options.

Implementation time and cost

As we all know time is money. The more time it takes to find a suitable solution the more money you lose as a business. So, it is important to ask your new vendor before onboarding their services how long will it take them to complete the implementation and get running. You need to ask what the time was taken for similar projects in the past and can they provide you with tentative deadlines to complete the project on time. The most important step is to check for references of past implementations. Once you learn about other companies and their experiences and challenges, it might be easier to decide.

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