Challenges for the Enrollment Team using EDI 834

Any healthcare organisation must constantly monitor its accuracy and productivity levels. When processing enrollments for members in the Commercial, Medicare, or Individual market segments, the operation team constantly has difficulties due to the volume of membership data involved. The enrollment team may have a lot of extra work to do if there are any EDI system problems, such as receiving inaccurate data from the trade partner, missing information in mandatory areas on registration forms, or transactions that are delayed in EDI processing systems because of non-compliance with EDI standards. Maintaining a constant transaction flow is essential for the operation team and EDI teams, especially during the open enrollment time. Any procedure hold-up can prevent new members from enrolling, including communication or the delivery of the necessary welcome kits and ID cards before the policy start date. This may result in more people calling member services, which would cost the business more money.

For the members to be effectively enrolled, data quality is essential.

It may take a while for both sides to adhere to EDI standards and ensure correctness, particularly when working with a new trade partner. The number of trade partners that insurance firms must deal with is growing as more businesses enter the market. It is now more crucial than ever for both parties to adhere to EDI standards and maintain quick and reliable data connection to keep costs down. This is because the volume of data is always growing, the cost of delivering high-quality care is rising, and B2B issues with onboarding new trade partners are becoming more prevalent.