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Direct Data Entry: Claims Submission Methods to Review

Healthcare companies use the Direct Data Entry (DDE) method to manually enter, correct, and adjust entries. Medicare developed its information transfer mode, and it is still in use.

Direct Data Entry

DDE in Medicare Fiscal Intermediately shared system FISS is a common practice in most healthcare facilities. The DDE users use it to manually enter, correct, adjust or cancel Medicare transactions in FISS. The manual data entry may affect revenue cycle management. The critical issues of DDE are time and data reconciliation.

Presenting claims through DDE, the back-office staff must re-enter complete data into FISS. This duplication of work takes double the time for presenting a claim.

While working with DDE, the Host system may not update the changes in claims. Therefore, the update in host systems will cause discrepancies in claims.

Electronic Data Interchange

Electronic data interchange (EDI) is defined as the Computer-to-computer transfer of data. The data is transferred through the appropriate application from one computer to another.

Order Management System is an example of EDI. It does not involve any human handling. EDI can replace postal mail, fax, or email. Email is also an electronic method of data transfer handled by a human being. A typical manual process involves paperwork and people.

EDI transactions include an invoice for payment or transfer of funds, claims status, eligibility, Enrollment and disenrollment, referrals, coordination of benefits, premium, claims, and patient/provider encounter information.

With the introduction of AI in healthcare, the industry has been transformed at large.

Benefits of EDI over DDE


EDI is a time-saving method through which your staff doesn’t need keen working — whereas your staff must be keen enough to make correct entries at a fast pace. EDI does not involve human handling, the chances of duplication, and discrepancies.

Usually, Medicare process the claims on certain days of the month, so the clean submitted claims are cleared, and the provider gains the Accounts Receivables. The fast processing of claims helps to maintain the revenue cycle management.

Usually, trying to keep a fast pace of data entry may lead to human errors. Your staff needs to re-enter complete data in FISS, which is time-consuming, but the chances of human error and chances of not up-date data cause delays and discrepancies in the claims process.

Chances of Duplication of data omission

Human involvement increases the chances of human error. Human error involves chances of duplication or data omission.


EDI documents have a standard format that is readable for computers and easily translatable. Therefore, EDI has a translator, whether in-house software or via an EDI service provider.

Easy Data Distribution

Through EDI, data distribution, retrieval, and analysis are made easy among different entities. In 1991, The Workgroup for Electronic Data interchange was formed by the Secretary of Health and human resources for the first time.

The Goal of Paperless hospital office.

The Goal of the US healthcare system is a paperless hospital office. As a result, the paperwork of the hospital has decreased. In addition, in 1996, the Health insurance portability and Accountability Act established US National standards for healthcare EDI transactions.


Hospitals and healthcare facilities can cut their handling costs of processing paperwork. Through EDI, information is transmitted quicker, without printing or compiling reports.


EDI transactions help hospitals enable organized, compliant, accurate, and efficient healthcare data exchange. These standards apply to patient transactions and health information exchange.

The use of healthcare EDI simplifies the methods of information management that are an opportunity for care providers to provide better care at low cost.

Privacy and Security

Data security is a significant concern of the healthcare industry because it involves health information of the masses. The HIPPA-compliant EDI ensures the secure transfer of data.

Healthcare EDI assists systems in transmitting information between healthcare providers and payers.

Or insurers. EDI transactions are end-to-end encrypted because these transactions are accessible to authorized users only. These transactions support secure healthcare data management without any human handling. EDI minimizes errors in insurance claims, shipping and billing address errors, and document errors.

EDI is helpful for insurance claims. It is an efficient documentation tool that supports errorless documentation. It reduces the chance of errors in the file attachment, email id, etc. In addition, EDI simplifies and automates the process of claim submission.

EDI in denials helps the care reduce claim denials and rejections. Rework for claims reduces. EDI can process multiple claim files at one time. As a result, revenue cycle management becomes easy.

EDI for patients: EDI has multiple benefits. It helps every stakeholder of health care. For patients, EDI helps speedy processes. After the approval of the rights of patients to access their health information, the patients will be able to know about the diagnosis.

Secondly, if EDI speeds up the claims process, it is much easier for the patients to clear the dues and switch their consultants.

You can reap the maximum benefits of EDI if you use Data-Centric solutions that fit their organizational size and culture.

Data-centric Healthcare EDI

Suppose you are planning to install EDI in your facility. In that case, you must consider critical factors like security level and compliance with multiple systems or solutions, ease of use, and time management.

Healthcare EDI systems offer an organization of health care data through EDI HIPPA transactions. Hence, EDI requires a platform that can organize a huge quantity of data in an automated manner. It also helps in sorting out the correct information from the wrong one with the automated set patterns.

The companies like Medifusion provide platforms, systems, value-added services, and data-centric solutions for healthcare data management. Enable data-centric healthcare EDI to gain data security benefits and maximized profitability.

Technological advancement in healthcare

Technological advancement in the healthcare industry affects data management. For Example, Telehealth has often replaced face-to-face meetings with the care provider.

To keep pace with these technological trends, EDI systems must be supported with a data-centric platform that ensures data quality and security. Partnering with the third-party developer will help you ensure efficiency, effectiveness, patient satisfaction, and overall profitability.

In addition, the tools and software help providers in patient engagement (medifusion dotcom) and attract new patients to their offices.

To become a competent healthcare institute, you need to implement modernized technology.

Source: ReadWriteWeb