Merge Wellness Programs With Benefits to Ensure Employee Well-being & Engagement!


Employee wellness programs have become a new criterion to measure any organization’s performance and its capability to engage and satisfy its workforce. Moreover, wellness programs do not remain the same and have evolved becoming more comprehensive and innovative now. Therefore, it has become very crucial to frame your organization’s wellness programs smartly that will not only make your present employees happy but also help you attract some new skilled candidates.

The foremost requirement of taking care of employee wellness is offering them relevant and appropriate benefit plans. Here are the few things that can help you in making your employee benefit plans right and attractive:

Expand Your Benefits Range!

Benefit offerings are not just limited to providing coverage for few dental check-ups and flu treatments, they have become much wider with new concerns and issues that need to be addressed. For example: what effect your offerings will make on the mental and emotional health of your employees? Will they be able to fulfill their healthcare needs by your offerings? And also how can you measure how apt your offerings are for your employees?

Instead of offering narrow benefits, opt for plans that work and will fulfill the needs of your employees. The best way to measure the success is by analyzing employees’ engagement and morale change you will witness with the  time.

Personalize Your Offerings By Segmenting Your Workforce!

Create a personalized platform to segment employees and determine their healthcare needs and requirements. This will help you deliver the right choices to them and your employees will find it easy to choose the right fit for themselves. But also make sure that your employees’ privacy  is not compromised on this. Make them understand that their information is fully protected by HIPAA rules. This will create a sense of assurance among your employees that will help them use your tech resources and other wearables involved in your benefit programs.

Encourage Your Employees To Participate!

Apart from benefit offerings, design your wellness programs properly to help your workforce fight and reduce stress. More employers are adopting this strategy and according to a  poll conducted by NPR recently, 51% of the employees agreed that they have formal wellness or health improvement programs in their employers’ offerings. These plans can be anything from weight control to nutrition to gym offers to smoking cessations, even drugs rehabilitations. But, even after offering such wide comprehensive programs, only 40% participated in the programs.

Therefore, offering your employees wide range of choices will not serve you the right purpose. Instead, make sure are they interested in the same. Know their preferences first and try bring out the similar offers and encourage them further to participate.

The Bottom Line:

The wellness programs have evolved a lot and keeping your offerings limited to same obsolete ones will not just degrade your brand value among your employees, but will also hamper their engagement. Therefore, it is very crucial to pack your offerings with comprehensive benefits and also, motivate your employees to opt those that can solve their present problems and meet their needs. Above are some points discussed that will help you prepare your benefit offerings strategies for the smooth enrollment.


Learn About HIPAA Implication for Completing Forms 1095-C

ACA Reporting HIPAA Implications

2016 is the year of ACA Reporting! All the employers have reporting requirements at the top of their priority list and leaving no stone unturned to execute it perfectly!

Thus, you must be extra cautious while completing and submitting the reporting forms-1094/95. Form 1095-C is the crucial one as it is used by the employers to report their minimum essential coverage offerings to employees (Part I and II), as well as to report the employee enrollment in self-insured minimum essential coverage (Part III).

The employer’s medical plan is a covered entity that is subjected to HIPAA security, privacy and breach notification rules. In case the plan is insured, then the carrier will be liable to comply with the HIPAA rules (but, the employer must not receive any Protected Health Information (PHI), except for a few limited reasons). Whereas, if the plan is self-insured, then the plan is subject to HIPAA rules and not the employer. Thus, it must depend on members who are involved in plan administration and TPAs for administering the plan.

The employee information cannot be considered as PHI if the employer extracts information from general employee records and not from the self-insured medical plan records. Moreover, if the employer is handling the medical plan enrollment activities for employees, then it is not PHI and is not subjected to HIPAA. This is known as enrollment exception and must be well understood before using it in the form. For any information to get subjected to HIPAA depends on how the employer obtained it and what part of the information is used in the Form.

The information related to employee’s enrollment in medical plan coverage is put in Part III and is considered enough to be called PHI. Also, if the information is obtained from any medical plan information or a TPA medical plan administrator and not from the general employment database, then it will get subjected to HIPAA. Similarly, demographic details of employee (Part I) and offered coverage information (Part II) is not subject HIPAA depending on source of information.

Self-insured employers who need to complete Part II for enrollment in coverage should, preferably, consider the data to be filled in as PHI. Thus, such employers must follow the following considerations to stay HIPAA compliant while completing the Forms 1095-C:

  • Educate the employees on HIPAA compliance and how to complete the Forms.
  • To make sure that you complete, distribute and file forms accurately, take assistance from the experts and consultants who will help you get the job done efficiently.
  • Ensure that the forms are well-placed in a secured environment with limited access.
  • In case, any error has occurred such as the Form is delivered to wrong recipient or is lost or stolen, then you must notify the HIPAA privacy and security officials who will further look into the matter.

These are a few HIPAA implications while completing the IRC Section 6055 and 6056 reporting forms. In order to stay compliant, you must learn about the privacy, security and breach consideration of the data and should take care of them while completing the forms.

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.

5 Points to Consider While Buying An EDI Software

Getting data integration system for your organization has always been a painstaking process. Whenever you look out for the system, you get entangled in demos, price quotes, etc. and are not able to concentrate on your organization-specific requirements. Indeed, you must jot down your pre-requisites and then find a solution that matches up to your requirements.

Key Points for EDI Software - TeemWurk

A perfect idea to address your concerns would be to ask the key questions to your EDI software vendor:

Handling Communications:

Ensure that whether your software vendor is capable enough to handle all the communications related to benefits enrollments and EDI file transfer. The service provider should take the responsibility to maintain coordination between the employee, employer, health insurance carrier, TPAs, brokers, etc. Many EDI software come with in-built communicating ability to communicate with these partners via FTP, SMTP, HTTP and AS2.

Operating System:

You must be aware of the operating system that the software will use. This will help you determine whether your in-built systems are compatible with it or not, since it is a long-term requirement.

File-Format Support:

The software must be capable of supporting different file formats in addition to EDI format. These include XML, JSON files, etc. This multi-format compatibility allows you to transmit files and integrate data efficiently.

See >> How To Select A Healthcare EDI Solution Provider

System Upgradation:

Another aspect that you need to consider while buying the software is whether it is upgradable or not! Technology keeps on updating and in order to be in pace, the software should not be obsolete. Most of software providers provide free upgrade feature and can help you save up-gradation costs.

Security Protocols:

For any HIPAA transaction, software must have the minimum security specifications as prescribed by HIPAA. Since the transactions are highly confidential, proper security measures must be taken while sending and receiving data files.

These are the basic requirements, but many of the companies overlook these aspects while deciding the right service provider. TeemWurk, leading EDI solutions and services provider takes in consideration all these basic requirements of users and provides them with its perfect 3D EDI tool.

Check If Your Healthcare EDI Transactions Are HIPAA Compliant?

HIPAA Compliant Transactions with TeemWurk

HIPAA requires all health care transactions to be done according to the EDI standards. This means that all those related with health care transactions, i.e. the health care providers, carriers, and even employers need to transmit all health information in EDI format.

Integration of these transactional requirements is a crucial process and requires proper understanding of all the HIPAA mandates along with those of Affordable Care Act provisions. Any kind of variance or non-compliance can directly make you liable to pay penalties and fines.

Since the process may consume your considerable time and money and also entails multitude of complexities, it is preferable to employ a service provider that can efficiently handle all the transactions with complete compliance. This will not only help you save time but also drive down costs and administering efforts for the process.

To execute the process in accordance with the federal rules and regulations, the deployed service provider must have a combination of cutting-edge technology and skills.

TeemWurk, with its Advanced 3D EDI Tool, can expertly handle data integration and mapping. In addition to it, the broad functionalities offered by the tool help you adhere to the EDI standards and meet all ACA requirements. With the deadline coming up, TeemWurk is efficiently handling the enrollments with bulk uploads and zero errors!

Do You Know How HIPAA Came Into Effect?

In the previous blog, it was discussed how important is HIPAA compliance for adopting EDI in American healthcare system. It is however, imperative to discuss the history and evolution of EDI.

Everyone is well-aware with Health Insurance Portability and Accountability Act (HIPAA), but where it came from?

In 1991, Workgroup for Electronic Data Interchange (WEDI) was created in correspondence to the rising concerns for increased healthcare costs. Eventually, WEDI led to the enactment of HIPAA as majority of its directives were based on WEDI recommendations. Thus, in 1996, HIPAA was signed into law and American healthcare system changed as every move was led by and according to HIPAA. Prior to it, over 400 different patterns of medical forms were used, but later, EDI was mandated and everyone was required to use the EDI format.

HIPAA - TeemWurk

There were many reasons associated to EDI implementation in healthcare. Paper usage was time consuming as well involved increased probability of human errors. Even the research studies estimated that EDI can save approx $20-$40 billion in the healthcare industry. Even in the industry, healthcare insurance section has seen maximum changes in HIPAA mandates. These include EDI healthcare forms 834 (Benefits Enrollment), 270 (Healthcare Eligibility Inquiry), 271 (Healthcare Eligibility Response), 837 (Healthcare Claim), 276 (Healthcare Claim Status), and 835(Healthcare Clam Payments).

The major issue that HIPAA and EDI resolved was that of security and privacy of critical data. In fact, today majority of individuals consider HIPAA as a security and privacy law! Whereas, EDI is considered as a mechanism that allows critical patient information to be transmitted through a secured channel.

Later, security provisions went into effect for all covered entities. Every EDI Tool must be well-structured and formatted to comply with the guidelines. TeemWurk has been providing secured Benefits Enrollment Administration with complete compliance with guidelines and also guiding users to select their plans wisely.

Overcoming Challenges in Healthcare EDI with a Reliable EDI Tool

EDI or Electronic Data Interchange can be referred to as the document standard and considered as a common interface between two or more computer applications for transmitting any information. Today, EDI has its significance in a number of industries, one of which is Healthcare EDI, where healthcare insurance data transactions are done in this format.

The adoption of this format in Healthcare has brought in many significant benefits such as reduction in administrative costs of health coverage as well as shortened transaction process resulting in faster processing of healthcare enrollments, patient claims handling and for cross verification by health care providers.

TeemWurk 3D EDI Tool-Key Features

However, the adoption was followed by certain challenges such as only large organizations were able to enjoy the benefits due to higher adoption costs, limited IT resources, etc., major challenge was to incorporate the technology in compliance with the regulatory mandates.

US healthcare department very cautiously imposes that HIPAA complaint EDI transactions are mandatory and any deviation in it may led to serious penalties to be paid by the organizations. HIPAA also gets updated with new versions from time to time. The latest version is HIPAA 5010 and as per standard directives, it is compulsory for all organizations to adopt it by April 2014. Till now, organizations have been using the older version 4010 and now to switch to newer one, many critical changes need to be implemented.

TeemWurk has always taken care of organizational interest and offers such a Robust Web-Based EDI Tool that complies with all EDI standards and facilitates effective benefits enrollment processing. TeemWurk also enables clients to switch to newer HIPAA version in an easy and manageable manner by taking responsibility of entire implementation process.