National Dental EDI Council Girds for Real-Time Transactions and PHR Challenges

NDEDIC has begun to focus on driving real-time transactions among its participants and ensuring the participation of dental insurance stakeholders in the development of personal health records.

Last year the National Dental EDI Council's (NDEDIC) insurance carrier members crossed the 50 percent threshold for electronic transactions. With the goal of having virtually all transactions completed electronically in sight, the organization is turning its attention to the challenges associated with real-time transactions and electronic health records.

Founded in 1991, NDEDIC unites individuals from carriers, clearinghouses, practice management software vendors and other relevant organizations to foster the use of electronic data interchange (EDI) standards for claims, eligibility and benefits requests, explanations of benefits, and other transactions. Individual members range from company officers to IT professionals involved in developing solutions.

NDEDIC currently has 150 members, most of whom represent dental carriers, including the dental operations of household-name health and other insurers. However, the organization is open to all stakeholders in the dental transaction process, including third-party administrators, dental office and practice administrators, and consultants. In addition to meeting at an annual conference, members interact monthly through conference calls, exhibit at industry events and develop working relationships among themselves to solve specific problems.

"You could describe NDEDIC as a work group platform," comments the organization's chairman, Ross Gosnell, who is also CIO of Delta Dental of Illinois (about $500 million in gross written premium).

For the greater part of its existence, NDEDIC saw transaction rates increase a couple of percentage points annually. That began to change in 2004 with the federal mandate to adopt HIPAA transactions and code set rules, Gosnell relates.

"NDEDIC was the only organization at the time that was doing this work — that is, developing electronic commerce for the dental industry — and was a likely meeting place for the industry stakeholders," he reports. "NDEDIC helped through this networking process and was important in the facilitation of bringing the critical people together from the different stakeholders to bridge any gaps in the flow of data from end to end."

Despite the fact that the systems of transaction parties are already electronically connected, many dental practices still prefer to print out multipage claim forms, according to Gosnell. "They like to file the paper claim form instead of sending it electronically and trusting that they're going to be paid," he says. "We're trying to communicate the message that they could save a lot of time and effort."

That saved time and effort translates into significant savings. For example, Delta Dental of Illinois enjoyed an increase of approximately 250,000 claims between 2007 and 2008, Gosnell offers. "We paid about 10 cents less for electronic claims, resulting in a $25,000 savings just for delivery of claims to the system," he says. "Our estimate for the overall savings, including conversion of information from paper to electronic format and adjustments of claim data on the two different sources, adds another $20,000 to $25,000."

Anthony O'Donnell has covered technology in the insurance industry since 2000, when he joined the editorial staff of Insurance & Technology. As an editor and reporter for I&T and the InformationWeek Financial Services of TechWeb he has written on all areas of information ... View Full Bio