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Why Use EDI in Healthcare?

As the digital world continues to advance, we are privileged to use various software and technologies that make our jobs easier. Once such technology is electronic data integration (EDI). EDI allows for improved healthcare claims processing, including better security and efficiency for patients and healthcare providers.Patient and medical staff


EDI allows for improved security and privacy measures for healthcare claims processing. The Health Insurance Portability and Accountability Act (HIPPA) of 1996 protects patient’s privacy and provides boundaries as to whom medical records can be released to. EDI minimizes the possibility of information over sharing when it comes to medical records and health care claims submissions.

For example, traditional information sharing through paper claims mailed through the postal system or information emailed to an individual increased the chances that more individuals than necessary came into contact with the private information. While these individuals may have clearance to handle this information, it is an inefficient and insecure method of information sharing.

EDI, on the other hand, specifically integrates with a health management system within your healthcare practice to minimize information handling and claims processing. Instead of passing patient information from person to person (or email to email), the EDI software passes the documents through a securely integrated system that is based on specifically coded transactions.

These transactions can only be viewed and processed by another EDI system that can read the agreed upon standard formatting of these coded documents. This ability to share documents and information between EDI softwares that only accept certain codes increases the security of patient information and healthcare claims.


Efficiency is another great reason to use EDI in healthcare practices. EDI significantly decreases the amount of time it takes to submit and process a claim. Not only will most EDI’s help you to identify potential mistakes within the claim to be submitted, it will also assist in the processing by providing real time feedback about the claims submission.

Efficiency in processing allows for healthcare claims to be processed faster, meaning healthcare providers can get paid for services rendered more quickly through an EDI software.

Though security and efficiency are important aspects to any software within a healthcare practice, it is critically important within an EDI. For more information about plans and pricing of Apex EDI software, reach out to us on our Contact Us page. Security and efficiency are of utmost importance to our professionals at Apex EDI. We will be happy to assist you in incorporating a secure and efficient medical claims software into your practice.

Articles with this disclaimer may not represent the beliefs or core values of Apex EDI. The following is simply a summary taken from the industry’s general community to help readers stay up-to-date on what people are talking about. 

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Reasons To Do EDI Claims: Efficiency, ROI, and Expediency

Electronic Data Integration (EDI) has come to the forefront of information transfer in recent years. Exactly what is EDI, how can it be used for medical professionals, and what are the primary benefits of using EDI? Let’s examine these queries further.

EDI Defined

As we have already determined, EDI stands for electronic data integration. EDI the exchange of documents in a standard format from computer to computer. The difference between traditional methods of document exchange, such as a mail, email, or fax, is that EDI eliminates a lot of the processes of the exchange.

For example, traditionally faxed documents involve one individual preparing the documents, the fax machine sending the documents, the recipient receives the documents, the recipient processes the documents, then the recipient sends the documents back through the fax machine to the original sender, and then the process is repeated in order to properly process the documents.

This 5+ step process is inefficient, desperately slow, and minimizes the opportunity for profitable practices. EDI helps to eliminate these inefficient processes, and provides maximum output for profitable earning activities through efficient document exchange.

Use in the Medical Field

CLAIMS CONCEPT man hand on table Business, coffee, Split tone

For medical professionals, this is a wonderful invention. EDI allows the expedient processing of medical claims, patient data transfers, and information requests on medical history. EDI can be used in multiple areas of medical expertise, including but not limited to traditional medical practices, dental practices, chiropractic care, mental health counseling, and beyond.

Apex EDI is the premier EDI software that can be integrated into existing practice management software. EDI provides a host of benefits for medical providers, which we will discuss in the next subheading.


Benefits of Using EDI for Medical Claims

While the benefits of using EDI are vast for medical claims billings, a few stand out in our mind as invaluable. They include efficiency, returns on investment, and expediency.


EDI increases medical claims billing efficiency by eliminating repetitive tasks and expediting the accuracy of documents that allow your staff to improve production and processing of medical claims.


ROI - Return on investment
EDI return on investment (ROI) is a substantial benefit for medical claims billing providers. Elimination of
paper processing such as printing, postage, and illegible faxes allows for a cost savings of up to 35%.


The efficiency of EDI also allows for faster claims processing. Exchange transactions take place in minutes instead of hours or days required by email or traditional postal services.

Overall, EDI systems are a phenomenal method of improving efficiency, expediency, and profitable business practices for medical claims billing. Apex EDI allows for all of the benefits and more. For additional reasons to use Apex EDI for your medical claims billing practices, visit our Contact Us page in order to receive more information.

Articles with this disclaimer may not represent the beliefs or core values of Apex EDI. The following is simply a summary taken from the industry’s general community to help readers stay up-to-date on what people are talking about. 

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Things You Should Know About Submitting Dental Claims

While medical claims billing can be complicated, submitting dental claims is an entirely different beast. Before you submit any dental claims, be sure to educate yourself and your practitioners about the do’s and don’ts of dental claims billing.

Paper or E-File?

Do you stdentist 1ill submit claims for your dental practice through snail mail? It might be in your best interest to consider updating your practice to include electronic filing. Electronic filing processes claims more quickly and efficiently than traditional postal service submission. Even if you currently incorporate electronic filing at your practice, some payers may still require paper submissions. In this case, be sure to keep an electronic record of all dental claims submissions to payers who require paper claims.

If you’re interested in incorporating electronic filing into your dental practice, check out our Dental Claims page for more information about seamlessly integrating this software with your existing dental practice management software.

Are X-Rays Needed?

050803-N-1126D-004 Jacksonville, Fla. (Aug. 3, 2005) - Dental Technician 3rd Class Jose Sanchez prepares a patient for dental X-Rays at the Naval Hospital on board Naval Air Station Jacksonville, Fla. U.S. Navy photo by Photographer's Mate 3rd Class Clarck Desire (RELEASED)

As a dental practitioner, you know that some claims require x-rays in order to be properly processed. Common claims that require x-rays include restorative practices such as crowns, implant supported prosthetics, and fixed partial denture retainers, to name a few.

With Apex EDI, you’ll know exactly which claims will require x-rays for proper submission and processing. Apex OneTouch, the desktop application, will notify your claims professionals of failed claim submissions due to missing items or mistyped information.

Best Practices for Patient Education

Before submitting any dental claims, it is important to educate the patient about the claims process. Your practice may differ from another dental practice in claims submission. It is important to educate the patient about the difference between in- and out-of-network providers, as well as providers that are not accepted at your dental practice, as well as the typical process of claims submission.

This may include the length of time required to process a claim, and how your practice will contact the patient if there is any out-of-pocket expenses required on their part as per their dental insurance provider. By educating the patient about your dental clinic’s best practices, you are hopefully preventing any miscommunication or misleading practices that could cause patient dissatisfaction or overdue accounts.

In order to put your best foot forward in your dental practice, be sure to check out our Dental Claims page for more information about how we at Apex EDI can simplify dental claims submissions for you.

Articles with this disclaimer may not represent the beliefs or core values of Apex EDI. The following is simply a summary taken from the industry’s general community to help readers stay up-to-date on what people are talking about. 

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The Number One Medical Claims Billing Problem

As a healthcare provider, it’s safe to say that you have had your fair share of medical claims billing problems. However, one problem seems to stand out above the rest. That problem being billing disputes.

041019-N-5821P-019 Yokosuka, Japan (Oct. 19, 2004) - Airman Lauren Thurgood of Las Vegas, Nev., pulls patient medical records in the inpatient ward aboard the conventionally powered aircraft carrier USS Kitty Hawk. Kitty Hawk's medical department services between 80 and 100 patients daily, providing around the clock, quality health care. Currently in port in Yokosuka, Japan, Kitty Hawk demonstrates power projection and sea control as the U.S. Navy's only forward-deployed aircraft carrier. U.S. Navy photo by Photographer's Mate 3rd Class Jason T. Poplin (RELEASED)

Billing disputes can occur for a variety of reasons.

Perhaps a billing code was entered incorrectly or maybe a claim was denied for not being a covered service through an out-of-network payer. Or perhaps a claim was denied due to the patient not yet meeting their own out-of-pocket deductible. Regardless of the reason, billing disputes are a hassle for you as the provider and for the patient expecting the service to be covered by their insurance.

What is the solution to this claims nuisance? The solution is to implement a medical claims billing software that partners with your existing practice management software to ensure cohesive and credible claims billing within your healthcare practice.

Apex EDI is the software you have been waiting for. Apex EDI partners with your existing practice management software to provide seamless medical claims billing. Apex EDI verifies medical claims before they are submitted to the payer in order to ensure correct billings and payments to you, the healthcare provider.

By partnering with more than 30 practice management software systems, Apex EDI implements a complete integration that allows your existing software to plug and play into our desktop app, Apex OneTouch. Apex OneTouch allows you to submit claims electronically, verify patient eligibility in real time, as well as review claim history and send and organize claims with custom fields. The Apex EDI system also maximized patient security through secure portals that uphold patient privacy and HIPPA practices.

Apex EDI works to process medical billing claims faster, so that you can focus on providing exceptional healthcare to your patients.  For more information or to review plans and pricing, be sure to contact us with your questions or to sign up for Apex EDI.

Articles with this disclaimer may not represent the beliefs or core values of Apex EDI. The following is simply a summary taken from the industry’s general community to help readers stay up-to-date on what people are talking about. 

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Understanding Medicare’s Role in Advance Care Planning. Five Questions Medical Billing Companies Need to Know.

As a follow-up to our recent article on the 2016 Medicare regulation change that allows physicians to bill for advance care discussions, we thought we’d share a few pertinent details on what “advance care” really means. Though doctors have some leeway to cover what they think is best, the more medical billing companies know, the better they can protect their clients.

Everything from updating patient management software to health insurance claims processing can be affected by the change – here’s a primer on advanced care terms and technicalities.

As a Matter of Fact…

  • ¾ of the 2.5 million Americans who pass away each year are 65 and older.
  • Medicare is the largest health insurance provider for Americans in their last year of life.
  • ¼ of all Medicare health care coverage is spent on beneficiaries in their last 12 months of life.
  • 90 percent of aging adults report that they’d prefer to die at home, though historically only 1/3 actually do.

What is “end-of-life care” exactly?

In simple terms, end-of-life care includes all the services provided for patients in the days (or even years) prior to their death. Medicare covers a comprehensive list of end-of-life health care services, including hospital stays, diagnostic testing, physician visits, home health care, prescriptions, and so forth. Though a patient’s prognosis may be “terminal”, end-of-life services can be intended to either cure conditions or simply provide symptom relief.

What does “advance care planning” entail?

The goal of advance care planning is to help patients and their family members/caregivers better understand all the care options available for them at the end of their lives. Typically, physicians will discuss the various options available (curative treatments, pain management options, at-home care or in-hospital stays for example), make recommendations on a treatment plan, then help the patient to determine which options best align with their individual desires. (In terms of billing for claims processing software, there are two codes to cover these conversations. The first covers the first 30 minutes of discussion – which may be all a patient needs. There is an additional code that covers additional 30 minute conversations as necessary.)

Are physicians the only Medicare-approved resources for advance care discussions?

No. Under the new regulation, Medicare covers advance care planning discussions provided by physicians and other health professionals, such as nurse practitioners, who bill Medicare according to the official physician fee schedule. Discussions should take place in medical offices and approved facilities and hospitals, and can be part of an annual check-ups or wellness visit. (Note for health insurance claims processing: Medicare should be billed separately for advance care.)

What are “advance directives” and in terms of patient management software, are facilities required to keep records of them?

In essence, advance directives are written instructions that define a patient’s wishes for end-of-life care. They become invaluable in instances where a patient is incapacitated or is no longer able to speak for themselves. They are often referred to as a “living will” and typically result from advance care planning discussions. Advance directives define specifically the medical treatments and types of treatments each patient prefers as they are nearing dying.

Advance directives fall under state regulations. Official forms for directives vary from state to state as do the requirements for documentation. Though patients are not required to have one, the Patient Self-Determination Act of 1991 requires that hospitals, skilled nursing facilities, etc. ask each patient if they have an advance directive at the time of admission.

What is “palliative care” and is it covered by Medicare?

As opposed to services intended to cure or treat a specific illness, palliative care generally focuses on managing symptoms and providing comfort to patients nearing the end of life. (Although palliative care is most common for patients receiving end-of-life care, it is not restricted to those with terminal illnesses. It’s also very common for people living with serious chronic illnesses including cancer, heart disease and depression.) In terms of health insurance claims processing, Medicare beneficiaries can claim coverage for palliative care services whether they are offered in combination with curative treatments or not.

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