NRPM: Standard Health Care Provider Identifier. E. Benefits of Increased Use of EDI for Health Care Transactions


Some of the benefits attributable to increased EDI can be readily quantified, while others are more intangible. For example, it is easy to compute the savings in postage from EDI claims, but attributing a dollar value to processing efficiencies is difficult. In fact, the latter may not result in lower costs to health care providers or health plans but may be categorized as cost avoidance, rather than savings. For example, a health care provider may find that its billing office staff can be reduced from four clerks to three after standards are implemented. The health care provider could decide to reduce the staff size, to reduce the billing office staff and hire additional clinical personnel, or to retain the staff and assign new duties to them. Only the first option results in a “savings” (i.e., fewer total dollars spent) for the health care provider or the health care industry. However, all three options allow health care providers to reduce administrative costs associated with billing. We are considering these to be benefits for purposes of this analysis because it is consistent with the way the industry views them. The benefits of EDI to industry in general are well documented in the literature. One of the most significant benefits of EDI is the reduction in manual data entry. The paper processing of business transactions requires manual data entry at the point in which the data are received and entered into a system. For example, the data on a paper health care transaction from a health care provider to a health plan have to be manually entered into the health plan’s business system. If the patient has more than one health plan, the second health plan would also have to manually enter the data into its system if it cannot receive the information electronically. The potential for repeated keying of information transmitted via paper results in increased labor as well as significant opportunities for keying errors. EDI allows for direct data transmission between computer systems, which reduces the need to rekey data.

Another problem with paper-based transactions is that these documents are mostly mailed. Normal delivery times of mailings can vary anywhere from one to several days for normal first class mail. To ship paper documents more quickly can be expensive. While bulk mailings can reduce some costs, paper mailings remain costly. Using postal services can also lead to some uncertainty as to whether the transaction was received, unless more expensive certified mail options are pursued. A benefit of EDI is that the capability exists for the sender of the transaction to receive an electronic acknowledgment once the data is opened by the recipient. Also, because EDI involves direct computer to computer data transmission, the associated delays with postal services are eliminated. With EDI, communication service providers such as value added networks function as electronic post offices and provide 24-hour service. Value added networks deliver data instantaneously to the receiver’s electronic mailbox.

In addition to mailing time delays, there are other significant costs in using paper forms. These include the costs of maintaining an inventory of forms, typing data onto forms, addressing envelopes, and the cost of postage. The use of paper also requires significant staff resources to receive and store the paper during normal processing. The paper must be organized to permit easy retrieval if necessary.