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December 17, 2024
By Renee Clark, Care Coordinator & Interoperability Manager, CareQuest Institute
Although the medical industry has used electronic data interchange (EDI) for years to share patient health information among health care providers, systems, and organizations, the dental industry is still lagging. But a recently released fact sheet from Workgroup for Electronic Data Interchange (WEDI) represents a significant step forward in addressing the challenges of interoperability and efficiency in secure information exchange within the dental industry.
WEDI, founded in 1991, promotes the use of health IT to improve patient care. (The organization played a pivotal role in the implementation of HIPAA standards by serving as a key advisor to the US Department of Health and Human Services.) The new fact sheet, “Healthcare Transactions Used in Dentistry,” is a valuable resource and the result of hard work and dedication from the organization’s Dental Subworkgroup (Dental SWG).
Below, I explain more about EDI and the fact sheet and offer some answers about how this new tool can help foster systems-level change to improve access to care and enhance patient outcomes:
What is EDI?
EDI is the secure transfer of structured data between systems, replacing manual, paper-based processes. EDI streamlines workflows such as claims submission, eligibility verification, and payment processing, reducing errors and saving time.
What is inside the fact sheet?
Within the fact sheet, readers can expect:
- A clear explanation of EDI and its role in health care
- A detailed overview of common dental transactions like eligibility verification, prior authorizations, and claims processing
- Practical steps to integrate EDI into dental practices for cost savings and operational efficiency
- Insights into how electronic transactions can improve patient experiences
Why is the fact sheet valuable?
The fact sheet highlights the transformative potential of EDI in dental care. By adopting standardized electronic transactions, dental practices can save time, reduce costs, and enhance accuracy. With potential industry-wide savings of nearly $2 billion annually, according to the 2023 CAQH Index Report, the fact sheet serves as a road map to achieving administrative simplification and aligning dental workflows with current health care practices.
Why should oral health providers care about EDI?
EDI adoption delivers significant benefits to oral health providers, including:
- Lower administrative costs
- Faster payments and improved cash flow
- Fewer errors in claims and patient data
- More time to focus on patient care rather than paperwork
How would EDI improve the patient's experience?
Patients would experience:
- Faster claims approvals
- Better care coordination and communication among providers
- Transparent and accurate billing
Would industry stakeholders benefit from full adoption of EDI in dentistry?
Yes, the dental industry would benefit from full EDI adoption. For stakeholders like providers, patients, payers, regulators, policymakers, clearinghouses, and technology vendors, full EDI adoption:
- Reduces manual processes such as faxing and translating from paper claims
- Reduces the dependency on paper checks
- Automation of eligibility verifications, claims submissions, and remittance functions
- Visibility of a claim status across the lifecycle of a claim
Why has the dental industry not embraced EDI yet?
The dental industry’s current system evolved without consistent standards, resulting in fragmented workflows and limited interoperability. The WEDI Dental SWG aims to address these issues by promoting and encouraging the use of industry-wide standards in dentistry.
Why is CareQuest Institute part of the WEDI Dental SWG?
The fact sheet emphasizes data exchange standards as a foundational tool to promote interoperability and collaboration among stakeholders, aligning with CareQuest Institute’s mission to advance innovative solutions for an equitable health care delivery system. Integrating these standards into dental record systems and workflows directly supports the Institute’s efforts to foster systems-level change that will improve access to care and enhance outcomes for underserved populations.
How can industry stakeholders get involved in this work?
Stakeholders can contribute by:
- Joining WEDI and participating in workgroups
- Supporting standards organizations like HL7 and ASC X12
- Advocating for interoperability and standards compatible technology adoption
- Participating in educational initiatives and industry discussions
Exploring organizations like HL7 (HL7.org), ASC X12 (X12.org), and ASTP/ONC (HealthIT.gov) provides deeper insights into the standard development process, including ways to get involved and contribute to ongoing efforts in health data exchange.
To learn more, visit WEDI’s official website (wedi.org) for information on workgroup opportunities and available resources.
Read more Transforming Oral Health: Ask the Experts blog posts, covering topics like health equity and interoperability, at carequest.org/latest-news/blog.
Editor’s note: Renee has more than two decades of experience supporting inpatient, emergency department, and outpatient care settings. Throughout her career, Renee has directed various health care IT initiatives including meaningful use, integration, and interoperability with client EHR systems. Notable achievements include leadership on a statewide CMS meaningful use project to assist providers, as well as serving as interoperability consultant for the Office of the National Coordinator for Health Information Technology on their vendor EHR certification program.