Custom EDI Solution

Electronic data interchange in healthcare is a secure electronic medium of communicating data between healthcare organizations, payers, and patients using specific messaging standards and formats. Healthcare EDI software accelerates all the workflows that happen amongst organizations involved in healthcare by enabling a fast, paperless mode of information exchange. The concept of an electronic data interchange solution is decades old but faces problems due to hundreds of messaging standards. There was conversion, interoperability, high IT overhead, and data security problems. The current version of the EDI solution standardized messaging to enable seamless information exchange.  

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Explore Electronic Data Interchange

Electronic data interchange (EDI) streamlines the health claims process, helping the healthcare organization in the USA run smoothly and more profitably. Compliance with HIPAA regulations and ANSI standards is a key part of any enterprise’s EDI System Development structure. EDI modernization has a huge impact on the speed and efficiency of claims resolution and overall workings of a clearinghouse. Healthcare EDI System Development modernization can help in streamlining the operations by enhancing submissions onboarding, processing, and reconciliation, with an independent console for claims exception management across the USA. It improves accuracy by providing deep visibility into transactions and metadata, while allowing automatic review, flagging, and error corrections for diverse EDI formats. OSP’s custom-made healthcare EDI solutions can reconcile data transactions and provides real-time data on transaction status and HIPAA compliance.

Our Electronic Data Interchange solutions employ mapping to integrate clinical data to the accepted EDI standards in the USA. We utilize the Application Program Interface (API) as an alternative method for mapping. The API is more efficient than mapping as its directly connected to the business applications database and can help to avoid the need to import/export. Being one of the renowned healthcare EDI companies in the USA, OSP’s healthcare EDI solutions help to implement EDI/X12 transaction across payers, providers as well as clearinghouses in the USA. Our team of expert EDI specialists in the USA can develop a full-proof system of EDI gateway that has the potential to implement 834, 837, 820, 835 successfully, 27x, 274 transactions. We help to reconcile multiple sources of Healthcare data with CMS, Medicare, state, exchanges, and providers.

Analyzing EDI System Development records effectively assess the variances at the file and database level is the need of the hour. Many find managing bigger batches of claims data while eliminating the dependencies on the applications is highly challenging. We help with our custom-made healthcare EDI solutions by employing heuristic parsing algorithms to conduct the required file comparisons and automatically test the EDI files for errors. A smart reporting mechanism can be developed to mark EDI-related data comparisons and variations in the EDI file and the database. We engineer next-gen EDI in healthcare with scalability in tests to add or remove additional claims of files. The advanced tools, metrics, and techniques are specifically designed for EDI to allow stakeholders to track the statuses of projects.  Our healthcare EDI solutions help in expediated test automation with positive ROI gains across the USA.

Electronic data exchange in healthcare is a long and complicated process where workflow management and security are of paramount importance. To capitalize on the transfer of health EDI data, an easy-to-use EDI reporting and analyzing feature makes a better difference. Customized dashboards and ‘Schema-on-Read’ technology’ can be leveraged to view data on demand and track EDI activities. OSP can program top-notch healthcare EDI solutions with inbound analytics and reporting module across the USA. It can provide a real-time monitoring console and reporting dashboard for more thorough compliance auditing. Comparative remittance analytics can be delivered through easy-to-understand EDI reporting formats. We strive to help you with customized reports that enable you to access, analyze, and track EDI data and performance.

Visualizing the EDI System Development integration and management is highly important to have a clear and complete picture of your organization’s electronic data interchange. We help you gain access to real-time web-based healthcare data visibility to detect errors and uncover market trends in the USA to enhance your decision making. OSP can engineer electronic data interchange solutions to empower the ecosystem of healthcare stakeholders in the USA by allowing them to visualize their data intuitively, supporting a high standard of self-service capability, and reducing call volume. The real-time data access enables the stakeholders with robust decision-making ability and boosts the operational workflow. With the interactive dashboard, you can track every 837 files, claim, and line item. Our custom healthcare EDI software in the USA offers flexible and advanced dashboard templates to review work in progress claims, daily rejection, examiner productivity view, denial reasons, and analysis, etc.

It is mandatory for healthcare organizations in the USA to follow HIPAA and HL78 compliance while sending or receiving X12 EDI files. The electronic exchange of valid documents between diverse healthcare partners across the USA with greater accuracy is highly essential. We can healthcare EDI software helping you to quickly establish if a message is valid or not and provides you with the correct position and reason for any errors. We engineer healthcare EDI solutions with custom validation attributes that check for mandatory items and regulatory compliance, too many or too few repetitions, data type or EDI code of a data element, and the correct length of EDI, etc. Our validation engine first assesses EDI for structural changes such as missing trailer segments or reference number matching. Then it evaluates all items in the DOM tree and executes the pre-defined validation logic for each attribute.


It is an understatement to say that healthcare in the United States is complicated. When a patient walks into a hospital for treatment, there is access to EHR, prescription of tests, submissions of claims, and so on. All of these activities entail the exchange of medical information between concerned entities. OSP can build electronic data exchange platforms to accelerate all the workflows in healthcare by enabling rapid data exchange between providers and payers.     

The safety and integrity of patients’ health information are important not only from a clinical standpoint but also from a legal one. Loss or misuse of data can result in serious legal consequences like fines and imprisonment. In light of this, the EDI tools for healthcare that we can develop to ensure that the information exchanged between stakeholders is safe. This safety is achieved through established protocols and standards that facilitate privacy and integrity.

Using an electronic data interchange solution in healthcare eliminates the need for physical documentation to be stored, transported, handled, filed, or retrieved. By minimizing the need for managing physical papers, a healthcare organization greatly accelerates the speed of operations while also minimizing human errors. By avoiding the need for physical document management, an EDI solution reduces the operating overhead and, ultimately, the cost of care.

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Healthcare EDI Software Development Services


Electronic Data Interchange Integration Services

  • Assessment of digital infrastructure to formulate integration roadmap
  • Development of customized APIs to facilitate seamless integration
  • Compliance with HIPAA and other data formats
  • Security and integrity of data communicated among endpoints
  • Comprehensive system testing to ensure smooth functionality

Development of Custom EDI Tools For Healthcare

  • Development of custom EDI tools to facilitate data transfer
  • Automation of back-office processes for greater productivity
  • Customized features to reflect existing workflows and operations
  • Standardized information exchange between all stakeholders
  • Seamless connectivity among existing systems and other applications

Design and Development of Customized Electronic Data Interchange Solution

  • Development carried out according to the needs of the organization
  • Feature for automated data transfer in standardized format between providers and healthcare plans
  • Features for transmission of details like claim status, payment data, and coordination of benefits
  • Seamless information exchange between providers, clearinghouses, insurance companies, etc.
  • Timely support in case of downtimes

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Frequently Asked Questions

EDI stands for Electronic Data Interchange. It is the inter-organization communication of operational data in a standardized format. EDI works in the following way –

  • The documents to be sent are prepared in the electronic format
  • The documents are then translated into the standard EDI format using appropriate software tools
  • Connect is established with the recipient through established means like an internet protocol
  • The documents are transmitted

Electronic Data Interchange in healthcare is the secure, electronic means of exchanging data between organizations involved in the healthcare industry using established formats and standards. Those organizations include providers, payers, patients, and clearinghouses.

EDI services consist of all the processes involved in developing and implementing an EDI software or infrastructure for organizations in healthcare. The services in EDI involve everything from requirements assessment, to the design of a software platform, to its implementation and the integration of existing systems.

EDI (Electronic Data Interchange) is the digital exchange of business information and documents in electronic format between organizations involved in mutual trade. In the context of healthcare, it is a means of exchanging medically relevant information amongst providers, payers, patients, and clearinghouses.

Benefits of EDI include –

  1. Faster turnaround times due to rapid business transactions
  2. Lowered overhead
  3. Reduced carbon footprint due to minimal paper usage
  4. Accelerated timelines due to increased speed of data interchange
  5. Improved data security since all information is sent and received securely

EDI stands for electronic data interchange. As the name suggests, it is the electronic exchange of business information among organizations involved in mutual business deals. It offers a safe medium of exchanging vital operational data without compromising security or integrity of the information.

EDI enables providers to transmit the billing information to payers rapidly and securely. It accelerates the submission of claims as well as the process of tracking them and later, processing the EOB (Explanation of Benefits) received from payers. As a result, the use of EDI software reduces the turnaround times associated with revenue cycles for providers.

1. Standard Document Format – It is the accepted format of the way documents are prepared to be sent over to the recipient.

2. Translator and Mapper – The mapper translates the data structures of a proprietary file into a format that is compatible by the recipient’s system. An EDI translator converts data from a large number of formats into a standardized structure that complies with EDI standards.

3. Communication Software – This is the software platform that is used to transmit the data from one organization to the other in the standardized format.

4. Communication Network – These are private networks for the interchange of information over the EDI. These networks offer an environment for senders and recipients to connect for exchanging data.

1. Healthcare Claim Transaction Set (837) – For providers and patients to submit healthcare claim information and receive the same.

2. Healthcare claim payment/advice transaction set (835) – For payers to reimburse providers and send EOB.

3. Retail pharmacy claim transaction – For medical personnel and regulators to submit retail pharmacy claims.

4. Benefits enrollment and maintenance set (834) – Used by employers, unions, government agencies, payers, and healthcare organizations paying the claims.

5. Payroll deducted and other group premium payment for insurance products (820) – This is used for premium payments for insurance health plans.

6. Healthcare eligibility/benefit inquiry (270) – Used by medical organizations to send enquiries about benefits and patient eligibility to payer organizations.

7. Healthcare eligibility/benefit response (271) – This is used to respond to enquiries about benefits and patient eligibility

8. Healthcare claim status request (276) – Used to request the status of claims already sent to payers.

9. Healthcare claim status notification (277) – Used by payers to report on the status of claims to providers.

10. Healthcare service review Information (278) – Hospitals use to request an authorization for medical procedures from payers.

Healthcare Electronic Data Interchange (EDI) is a means of exchanging medical data among different organizations electronically. The ability to exchange data instantaneously through digital means accelerates all the workflows and processes significantly. Most of all, it eliminates the need to handle physical paperwork and documentation, thereby reducing the operational overhead involved and maximizing data security. Since the data is exchanged digitally, there is minimal chances of its confidentiality or integrity being compromised.

Finally, the replacement of paper-based workflows with digital ones reduces the carbon footprint of the whole industry, as the use of paper is minimized.

EDI in healthcare allows the computer systems of organizations to exchange medical data digitally. The steps involved in implementing an EDI are –

    1. Finalize The Organizational Structure

A robust organizational structure makes it easy to follow protocols while operating the EDI.

    2. Assessment

It highlights the priorities for EDI deployment and helps establish operational applications for the system.

    3. Develop the EDI

The assessment provides insight into the specifications needed for the EDI system.

    4. Select an EDI Network Provider

The selection of an EDI network provider should be done based on the operational requirements, instead of existing technical capabilities. If need be, the required technology components need to be implemented.

    5. Integrate the EDI

This is perhaps the most important aspect of implementing an EDI. It needs to be integrated with other applications to facilitate data transfer.

    6. Integrate Data of Businesses

It is necessary to identify the varying formats of data used by cooperating businesses before the EDI is implemented. This ensure that different systems can share data seamlessly.

    7. Map the Data

Mapping the data shows how the data being actually transacted relates to the data on the systems. It is necessary for utilizing the data that has been transmitted or received.

    8. Conducting Tests

Once the EDI system is ready and the data mapped, it is time to test the whole system to know if everything is working as desired. It highlights potential problems and enables the management to take appropriate measures.

    9. Deploy the EDI

Following the successful testing, it is time to deploy the EDI among all the organizations that will be communicating.

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