The informatics nurse is reviewing electronic data interchange (EDI) with a group of new nurse colleagues. Which statement best describes the impact of the EDI?

Question

A) Supplies proof of recovery
B) Eliminates second opinions
C) Interacts with multiple databases
D) Facilitates the approval of patient claims

Answer 1

D) Facilitates the approval of patient claims

Explanation: A) EDI is not used to supply proof of recovery of charges billed for healthcare services provided.
B) EDI is not used to eliminate second opinions.
C) An EDI is a process that ensures billing is complete and uniform with the Centers for Medicare and Medicaid Services expectations.
D) The Center for Medicare and Medicaid Services (CMS) has mandated that all providers and insurers submit all claims for reimbursement–for any service or for verification or certification of services–in a consistent format. This order compelled all providers to buy or contract with electronic data interchanges (EDIs) so billing is complete and uniform.