X12 EDI: From Electronic Transaction to Paper Format

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Following a brief history of our Tx Manager product, a software solution that converts electronic 837 X12 EDI transactions, e.g. electronic claims, into a visual representation of their paper format, e.g. HCFA-1500, UB-04, and Dental Claims.

Note: Although this is a universal business problem, when the article refers to electronic transactions it specifically refers to ASC X12 EDI 837 electronic claims transactions.

Electronic transactions fail to process everyday.  There are multiple reasons why electronic transactions fail to process:

  • incorrect transaction formats
  • communication issues
  • subpar systems integration
  • availability of core systems
  • etc.

What happens when these electronic transactions fail to process correctly? Do you ask your providers to resend the transactions or do you reprocess them yourself?

In our experience, we have seen that when a customers is able to identify that an electronic transaction failed, they reprocess the transactions themselves. That is, companies seldom burden their customers to resend electronic transactions that have failed to process. How do they reprocess the transactions, you may ask.  The majority of companies manually reprocess failed electronic transactions.  They usually have a data entry department that takes the failed transactions and enters them into the core system.

Having a data entry department process failed transactions can be a time consuming error-prone endeavor. It is very difficult for data entry personnel to read an electronic transaction in its original format and be able to process the data into the core system.  Data entry personnel need that the electronic transactions be converted into a readable format that allows them to understand the data details of the transactions. Once they can read the electronic transactions they are able to enter them into the core system.  But organizations need to be very careful with this approach, because processing electronic data manually can lead to serious data errors and inconsistencies.

At Wovenware, we identified this problem and built the Tx Manager to help healthcare insurance companies overcome this challenge.  The Tx Manager reads ASC X12 EDI 837 electronic claims transactions extracts their data and presents them to the user in a visual representation of their paper format (HCFA-1500, UB-04, or Dental Claim). The TxManager includes workflow functionality that allows multiple users to work in the web application at the same time, ensuring that no two users work on the same transaction. Additionally, the TxManager validates the accuracy of the transaction information in the core system, thus, ensuring data quality of the process.

We have successfully implemented the Tx Manager in various customers and have seen an improvement in the quantity and data quality of all manually processed electronic transaction in the core system. Need to improve your process, what are you waiting for?

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