Conducting Business Electronically with Michigan Medicaid

The future of health care administration is available today with Electronic Data Interchange (EDI). Now Medicaid’s trading partners can exchange critical data and transaction information instantaneously. Health care partners will enjoy an improved business relationship and less frustration with electronic transactions due to the streamlining of existing processes and procedures by utilizing standard formats and code sets. The benefits include increased administrative efficiency, reduced transaction costs and a quicker payment cycle.

For more in-depth information, download the EDI Brochure and EDI Powerpoint (PDFs).

Reducing the Cost of Doing Business
Since the introduction of electronic billing, the health care industry has been able to reduce the costs associated with business-to-business communications. The tremendous growth in technology has made electronic transactions an essential tool for conducting business efficiently. Its advantages over paper are indisputable. Electronic information is portable, re-usable, retrievable, storable, and interchangeable between partners. Paper billing, by comparison, is inefficient, slow, redundant, costly and frustrating. In fact, paper billing will soon become obsolete for most providers as many major payers will be eliminating paper transactions completely.

Two factors have contributed to increased viability of conducting business electronically: the Internet
and HIPAA.

HIPAA’s Impact on Electronic Business
HIPAA transactions will revolutionize healthcare administration for providers, payers and patients. HIPAA was designed to speed up the adoption of electronic data interchange. National standards were developed to unify formats and code sets, to simplify transactions and to reduce expenses. And, the practitioner-patient relationship will benefit greatly through the portability of patient records.

Benefits to the Health Care Industry
Converting to electronic transactions will lead to improved business practices through administrative simplification. EDI allows for multiple transactions and streamlines processing; operating costs are lower; the information exchange is simplified; and paperwork is reduced.

Save Time and Money Submitting Cleaner Claims
Providers will be able to submit “cleaner” initial claims to payers resulting in a faster payment cycle, less frustration and lower administrative costs. Electronic formats are pre-edited to reduce common claims data entry errors. This eliminates the administrative time wasted on manual tasks like data re-entry saving money and increasing productivity.

Reduce Excessive Paperwork and Storage Needs
Conducting business electronically also reduces the amount of unnecessary paperwork by exchanging and storing information electronically via computers. Accounts payable and accounts receivable will benefit, too. These functions are very labor and paper intensive. Documents such as paper checks, claims, and remittance advice reports are continuously shuffled between various health care organizations. The information exchanged includes extensive handling by administrative personnel in multiple departments with data entry at each health care organization.

Speed Up Your Cash Flow
The speed of information delivery is greatly accelerated due to computer processing power and the Internet. Faster submission of accurate claims produces quicker payments and reduces days in accounts receivable.

Enjoy Improved Communications
With electronic transactions, health care information will be more secure between trading partners; overall, privacy will be enhanced and fortified; and, the portability of patient records will be easier to access for payers, providers and patients. Other improvements will also greatly benefit health care providers. For example, Michigan Medicaid’s trading partners will know when their transactions status because MDCH will send an electronic acknowledgement of receipt. And, coordination of benefits will be improved benefiting both payers and providers.

How to Take Advantage of EDI
1. Hire a full service e-biller, one that can implement multiple transactions to take advantage of the many benefits of electronic data interchange. A good place to start your search for an e-biller is the approved vendor list on the MDCH web site.

2. Convert to Electronic Fund Transfer to speed up your Medicaid payments. EFT is much quicker and the money is deposited directly into your business bank account. There’s no need to go to the bank and it saves everyone time and money.

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Submitting & Retrieving Transactions

The MDCH Electronic Submissions Manual describes how to become an electronic biller and submit data electronically to MDCH via the Data Exchange Gateway (DEG). We recommend that you maintain a copy of the manual for future reference.

Download the Manual Here

OR access the manual from the MDCH web site at www.michigan.gov/mdch. Go to Providers, click on the right quick link HIPAA Implementation, and then scroll down to Sections of the MDCH Electronic Submissions Manual.

For more information on becoming an electronic biller or for a list of authorized billing agents,
e-mail automatedbilling@michigan.gov

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