Why EDI 834 is the Key Driver of Healthcare Industry?

It’s the busiest time of the year when the entire benefits industry is occupied with the wholesome task of open enrollments. Healthcare industry majorly runs on Electronic Data Interchange (EDI) transactions, in order to comply by the data privacy standards. Also, as there are a number of participants involved at every stage while carrying out the transactions, so it is understandable to have a standardized format for executing the process.

EDI 834, as all know, is used for the Benefits Enrollment and Administration, thus the information to be transmitted must be accurate as it carries personal and related details of the enrolling entities.

Basically, the information flows among three channels. First are the healthcare exchanges where the customers can go and select their health care plans. Second are the benefit brokers, who facilitate all the processing for different enrolling groups. Right from ensuring that the enrollments made at the exchanges are correct, to mapping the enrolment data to preferred formats, brokers have a key role to play. Lastly, the insurance carriers or the payers who own and offer the insurance plans for the individuals.

Despite of the number of protocols adopted, transmissions do fail, even in the EDI format. Sometimes, the data may get lost or the file get corrupted, due to which the respective individuals don’t get enrolled. As a result, the exchange may lose its reputation while the other involved channels may not be able to function properly due to discontinued flow of data.


Having the EDI tools properly implemented in your service layer or enrollment system can help you ensure hassle free and smooth transactions. This will help you manage the basic data flow without affecting the EDI 834 files. For this, you must have expert assistance on EDI implementation.

An ideal EDI 834 implementation architecture eliminates all data format concerns to the extent that the data schemas of inbound EDI 834 and outbound carrier’s specified formats need not to be changed as the underlying business processes are modified accordingly over the time. Having such well-synchronized architecture, process flows can be templated to ensure proper handling of the common stages of data transformation and routing. The performance of the process will be determined by the data received from the specific source.

Therefore, EDI 834 integration architecture is critical for all the participants of the healthcare domain. Having a system in place will facilitate the accurate and effortless data flow that every entity looks for.

TeemWurk provides 3D EDI tool that simplifies mapping of HIPAA compliant segments in 834 transactions. It also enables users to setup EDI feeds within a few minutes, sync enrollment data in any required format and create schedules for automated transmissions.


Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s