Understanding the importance of monitoring EDI reports

Electronic Data Interchange (EDI) plays a crucial role in streamlining modern healthcare by standardizing claims communications between you, insurers, and other stakeholders. Understanding and interpreting the standardized formats EDI uses to exchange information is paramount to enhancing claim processing efficiency and reducing delays for you and your patients.

Key EDI reports — the 277 file and 835 file

The 277 file and 835 file are automatically generated during the claim process, each providing a different set of important data. Understanding the distinct functions of each file is essential to proficiently monitoring your claims processing and promptly addressing issues:

• The 835 file provides:
• Explanation of Benefits (EOB).
• Information on your payments from insurance payers.
• Details of any adjustments made during processing.
• The 277 file provides:
• Notification of unapproved claims.
• Reasons the claim was not approved.
• Details of required corrections.

Advocate proactive EDI monitoring

Emphasizing awareness and promoting best practices amongst your EDI submitters to monitor these reports plays a crucial role in maximizing their efficacy. Consistent review of file 835 prevents unaddressed claim issues and delayed reimbursements. Regular analysis of the 277 files can identify patterns in claim issues and inform implementation of corrective measures.

Proactively monitoring EDI reports is an effective front‑line approach to improving operational efficiency, elevating approval rates, and accelerating your revenue cycles.