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Article: Using EDI for utilization management. (electronic data interchange) (Electronic Data Interchange.)
- Article from:
- Healthcare Financial Management
- Article date:
- July 1, 1994
- Author:
CopyrightCOPYRIGHT 1994 Healthcare Financial Management Association. This material is published under license from the publisher through the Gale Group, Farmington Hills, Michigan. All inquiries regarding rights should be directed to the Gale Group. (Hide copyright information)
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Medicare and indemnity claims processing have been the main focus of electronic data interchange (EDI) insurance standards developments to date. But the first EDI standard developed expressly to meet the needs of the managed care industry should be approved this year. In the meantime, providers considering EDI implementation should examine two new proposed standards--the Health Care Services Review (279) and the Health Care Services Review Information (278).
These standards are designed to automate the process of utilization management. Developers of the standards say that the standards can help automate 80 percent of utilization management information exchanges now ...