Workgroup for Electronic Data Interchange
Encyclopedia
WEDI, pronounced "wee dee" is a not-for-profit user group in the United States
for users of Electronic Data Interchange
(EDI) in public and private healthcare. The organization is sometimes referred to by other names that include some or all of the words: Workgroup for Electronic Data Interchange.
It was established to provide leadership and guidance to the healthcare industry on how to use and leverage its collective knowledge, expertise and information resources to improve the quality, affordability and availability of healthcare, via forums, conferences and online resources, especially in matters of conformance to EDI standards required by the Health Insurance Portability and Accountability Act
, also known as HIPAA
which was enacted by the U.S. Congress in 1996.
WEDI has regional affiliates in 27 US States and the Virgin Islands
.
In November 1991, the Workgroup for Electronic Data Interchange (WEDI) was established in response to the challenge from the Bush administration, specifically, Louis Sullivan MD, Secretary of HHS
to reduce administrative costs in the nation's health care system by up to 10%.
Joseph Brophy, President of Travelers Insurance Company, and Bernard Tresnowski, President of the Blue Cross and Blue Shield Association
agreed to establish and lead a voluntary, public-private task force, named WEDI, to develop an action plan to streamline health care administration by standardizing electronic communications across the health care
and health insurance
industry.
WEDI's 1993 financial analyses concludes that combining the estimated implementation costs and the gross administrative savings potential, the cumulative net savings over the next six years (to the year 2000) is estimated to total over $42 billion.
Although the estimated net savings may not translate directly to hard dollar savings for the nation's health care system, EDI savings will allow health care enterprises to reallocate resources from administrative activities to enhance quality, patient care, and customer service.
To achieve this large cost savings, WEDI's eleven Technical Advisory Groups developed the following major recommendations. These recommendations are summarized below according to the Technical Advisory Group that developed the recommendation:
(CMS) led to the development of Health Insurance Portability and Accountability Act
(HIPAA) which was enacted by the U.S. Congress in 1996.
United States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...
for users of Electronic Data Interchange
Electronic Data Interchange
Electronic data interchange is the structured transmission of data between organizations by electronic means. It is used to transfer electronic documents or business data from one computer system to another computer system, i.e...
(EDI) in public and private healthcare. The organization is sometimes referred to by other names that include some or all of the words: Workgroup for Electronic Data Interchange.
It was established to provide leadership and guidance to the healthcare industry on how to use and leverage its collective knowledge, expertise and information resources to improve the quality, affordability and availability of healthcare, via forums, conferences and online resources, especially in matters of conformance to EDI standards required by the Health Insurance Portability and Accountability Act
Health Insurance Portability and Accountability Act
The Health Insurance Portability and Accountability Act of 1996 was enacted by the U.S. Congress and signed by President Bill Clinton in 1996. It was originally sponsored by Sen. Edward Kennedy and Sen. Nancy Kassebaum . Title I of HIPAA protects health insurance coverage for workers and their...
, also known as HIPAA
Health Insurance Portability and Accountability Act
The Health Insurance Portability and Accountability Act of 1996 was enacted by the U.S. Congress and signed by President Bill Clinton in 1996. It was originally sponsored by Sen. Edward Kennedy and Sen. Nancy Kassebaum . Title I of HIPAA protects health insurance coverage for workers and their...
which was enacted by the U.S. Congress in 1996.
WEDI has regional affiliates in 27 US States and the Virgin Islands
Virgin Islands
The Virgin Islands are the western island group of the Leeward Islands, which are the northern part of the Lesser Antilles, which form the border between the Caribbean Sea and the Atlantic Ocean...
.
History
In November 1991, the Workgroup for Electronic Data Interchange (WEDI) was established in response to the challenge from the Bush administration, specifically, Louis Sullivan MD, Secretary of HHS
United States Department of Health and Human Services
The United States Department of Health and Human Services is a Cabinet department of the United States government with the goal of protecting the health of all Americans and providing essential human services. Its motto is "Improving the health, safety, and well-being of America"...
to reduce administrative costs in the nation's health care system by up to 10%.
Joseph Brophy, President of Travelers Insurance Company, and Bernard Tresnowski, President of the Blue Cross and Blue Shield Association
Blue Cross and Blue Shield Association
The Blue Cross Blue Shield Association is a federation of 39 separate health insurance organizations and companies in the United States. Combined, they directly or indirectly provide health insurance to over 100 million Americans. The history of Blue Cross dates back to 1929, while the history of...
agreed to establish and lead a voluntary, public-private task force, named WEDI, to develop an action plan to streamline health care administration by standardizing electronic communications across the health care
Health care
Health care is the diagnosis, treatment, and prevention of disease, illness, injury, and other physical and mental impairments in humans. Health care is delivered by practitioners in medicine, chiropractic, dentistry, nursing, pharmacy, allied health, and other care providers...
and health insurance
Health insurance
Health insurance is insurance against the risk of incurring medical expenses among individuals. By estimating the overall risk of health care expenses among a targeted group, an insurer can develop a routine finance structure, such as a monthly premium or payroll tax, to ensure that money is...
industry.
Initial task force
The initial task force included members from the following organizations:- The Travelers Insurance Company
- Blue Cross and Blue Shield AssociationBlue Cross and Blue Shield AssociationThe Blue Cross Blue Shield Association is a federation of 39 separate health insurance organizations and companies in the United States. Combined, they directly or indirectly provide health insurance to over 100 million Americans. The history of Blue Cross dates back to 1929, while the history of...
- Self-Insurance Institute of America
- American Medical AssociationAmerican Medical AssociationThe American Medical Association , founded in 1847 and incorporated in 1897, is the largest association of medical doctors and medical students in the United States.-Scope and operations:...
- ANSI ASC X12ANSI ASC X12The Accredited Standards Committee X12 , chartered by the American National Standards Institute more than 30 years ago, develops and maintains EDI and CICA standards along with XML schemas which drive business processes globally...
- Mutual of OmahaMutual of OmahaMutual of Omaha is a Fortune 500 mutual insurance and financial services company based in Omaha, Nebraska. The company was founded in 1909 as Mutual Benefit Health and Accident Association.- History :...
- American Hospital AssociationAmerican Hospital AssociationThe American Hospital Association is an organization that promotes the quality provision of health care by hospitals and health care networks through such efforts as promoting effective public policy and providing information related to health care and health administration to health care...
- Drug Benefit ManagementPharmacy Benefit ManagementIn the United States, a Pharmacy Benefit Manager is a third party administrator of prescription drug programs. They are primarily responsible for processing and paying prescription drug claims. They also are responsible for developing and maintaining the formulary, contracting with pharmacies,...
- United Healthcare GroupUnitedHealth GroupUnitedHealth Group Incorporated is a diversified health and "well-being" company. Headquartered in Minnetonka, Minnesota, UnitedHealth Group offers a spectrum of products and services through two operating businesses: United Healthcare and Optum. Through its family of subsidiaries and divisions,...
- American Clinical Laboratory Association
- Columbia Healthcare CorporationHospital Corporation of AmericaHospital Corporation of America is the largest private operator of health care facilities in the world, It is based in Nashville, Tennessee and is widely considered to be the single largest factor in making that city a hotspot for healthcare enterprise.-History:The founders of HCA include Jack C....
- Medical Group Management
- American Nurses AssociationAmerican Nurses AssociationThe American Nurses Association is a professional organization to advance and protect the profession of nursing. It started in 1896 as the Nurses Associated Alumnae and was renamed the American Nurses Association in 1911...
- Aetna Life Insurance CompanyAetnaAetna, Inc. is an American health insurance company, providing a range of traditional and consumer directed health care insurance products and related services, including medical, pharmaceutical, dental, behavioral health, group life, long-term care, and disability plans, and medical management...
- American Dental AssociationAmerican Dental AssociationThe American Dental Association is an American professional association established in 1859 which has more than 155,000 members. Based in Chicago, the ADA is the world's largest and oldest national dental association and promotes good oral health to the public while representing the dental...
- Health Insurance Association of America
- National Committee to Preserve Social Security and Medicare
- Health Technology Management, Inc
- National Association for Home Care
- Health Care Financing AdministrationCenters for Medicare and Medicaid ServicesThe Centers for Medicare & Medicaid Services , previously known as the Health Care Financing Administration , is a federal agency within the United States Department of Health and Human Services that administers the Medicare program and works in partnership with state governments to administer...
- American Association of Retired Persons
- American Health Information Management Association
- Blue Cross of California
- American Health Care AssociationAmerican Health Care AssociationThe American Health Care Association is non-profit federation of affiliated state health organizations, together representing more than 10,000 non-profit and for-profit assisted living, nursing facility, developmentally-disabled, and subacute care providers that care for more than 1.5 million...
- Department of Income Maintenance State of Connecticut.
WEDI 1992 report highlights
In July 1992, WEDI published a report that outlined the steps necessary to make electronic data interchange (EDI) a routine business practice for the health care industry by 1996. The Workgroup envisioned the entire health care industry transacting business electronically, under a nationwide set of coding and format standards for all transactions. The transaction records would be transmitted electronically, in a secure manner to protect privacy, over private and public interconnecting networks like the internet and intranet. In the year following the publication of the WEDI report, the health care industry made substantial gains with EDI implementation:- ANSI ASC X12ANSI ASC X12The Accredited Standards Committee X12 , chartered by the American National Standards Institute more than 30 years ago, develops and maintains EDI and CICA standards along with XML schemas which drive business processes globally...
approved the claim and eligibility standards for trial use
- The Insurance Subcommittee of ANSI ASC X12ANSI ASC X12The Accredited Standards Committee X12 , chartered by the American National Standards Institute more than 30 years ago, develops and maintains EDI and CICA standards along with XML schemas which drive business processes globally...
formed new workgroups to develop other standards required by the health care industry
- HCFACenters for Medicare and Medicaid ServicesThe Centers for Medicare & Medicaid Services , previously known as the Health Care Financing Administration , is a federal agency within the United States Department of Health and Human Services that administers the Medicare program and works in partnership with state governments to administer...
initiated the use of Health Care Claim and Health Care Claim Payment/Advice standards and developed Efforts toward standardizing data content increased. EDIElectronic Data InterchangeElectronic data interchange is the structured transmission of data between organizations by electronic means. It is used to transfer electronic documents or business data from one computer system to another computer system, i.e...
implementation guidelines for Medicare Part A Intermediaries and Part B CarriersMedicare (United States)Medicare is a social insurance program administered by the United States government, providing health insurance coverage to people who are aged 65 and over; to those who are under 65 and are permanently physically disabled or who have a congenital physical disability; or to those who meet other...
consistent with the ANSI ASC X12ANSI ASC X12The Accredited Standards Committee X12 , chartered by the American National Standards Institute more than 30 years ago, develops and maintains EDI and CICA standards along with XML schemas which drive business processes globally...
standards
- The private sector began developing EDIElectronic Data InterchangeElectronic data interchange is the structured transmission of data between organizations by electronic means. It is used to transfer electronic documents or business data from one computer system to another computer system, i.e...
implementation guides
- EDIElectronic Data InterchangeElectronic data interchange is the structured transmission of data between organizations by electronic means. It is used to transfer electronic documents or business data from one computer system to another computer system, i.e...
awareness and participation heightened as well as efforts to standardize data content
WEDI 1993 report highlights
WEDI reconvened in 1993 to resolve remaining implementation obstacles and to:- strengthen the understanding of and commitment to EDI among the health care industry, policymakers, and consumers by: developing a targeted plan for using industry resources to educate key audiences on EDI, encouraging participation in demonstration projects that prove EDI benefits and cost savings, and expanding membership to reflect more broadly the key constituencies affected by EDI
- work for enactment of preemptive federal confidentiality protection for individually identifiable health care information in an electronic environment
- develop a strategy to facilitate quick, industry-wide transition to EDI, including universal identifiers for patients, providers, and payors; health identification cards; coordination of benefits in electronic environments; and implementation guidance for data standards
- work with appropriate parties to ensure the health care industry can meet WEDI's target of universal adherence to uniform data content by 1996
- provide additional data to the industry on the cost benefits of EDI, using WEDI demonstration projects as a primary source
- monitor the industry's progress toward the use of data standards and EDI
- provide basic telecommunications requirements and promote WEDI's goal of clearinghouse accreditation by 1994
- serve as a resource to work cooperatively with the National Association of Insurance CommissionersNational Association of Insurance CommissionersThe National Association of Insurance Commissioners is an Internal Revenue Code Section 501 non-profit organization which seeks to organize the regulatory and supervisory efforts of the various state insurance commissioners from around the United States. The NAIC was formed in 1871. Its current...
and state governments to coordinate state and national efforts on administrative simplification.
WEDI financials identify $42 billion in potential savings
WEDI expanded its financial analysis to encompass eleven health care transactions. Newly available data were added to estimate the potential savings for providers and to update the estimated savings for payors and employers. Additionally, the cost of implementing EDI was added to achieve a more comprehensive picture of EDI's financial impact on the health care industry.WEDI's 1993 financial analyses concludes that combining the estimated implementation costs and the gross administrative savings potential, the cumulative net savings over the next six years (to the year 2000) is estimated to total over $42 billion.
Although the estimated net savings may not translate directly to hard dollar savings for the nation's health care system, EDI savings will allow health care enterprises to reallocate resources from administrative activities to enhance quality, patient care, and customer service.
To achieve this large cost savings, WEDI's eleven Technical Advisory Groups developed the following major recommendations. These recommendations are summarized below according to the Technical Advisory Group that developed the recommendation:
- require specific and defined instructions through implementation guides to support uniform data content and coding structures (Standards Implementation and Uniform Data Content)
- develop a network architecture to support a broad array of applications, communications, access methods, protocols, and line speeds (Network Architecture and Accreditation)
- enact the model federal preemptive legislation drafted by WEDI to preserve confidentiality and privacy rights of individually identifiable health care information (Confidentiality and Legal Issues)
- identify unique, standard identification numbers to promote industry standardization and uniformity of health care data (Unique Identifiers for the Health Care Industry)
- develop and promote a comprehensive education and publicity work plan designed to provide standardized, economically affordable and geographically accessible education opportunities for all EDI constituents (Education and Publicity)
- develop an ASC X12 standard for data content and format for health identification cards (Health Identification Cards)
- continue demonstration projects that are ecumenical, identifiable to the public, demonstrate industry cooperation, leverage existing infrastructures, add something new, measure results, and meet aggressive time frames to demonstrate that technology is currently available to implement WEDI recommendations (Short-Term Strategies)
- clearly delineate state and federal roles for EDI implementation (State/Federal Role)
- provide ongoing analysis of the financial implications of EDI implementation (Financial Implications)
- automate the Coordination of Benefits process (Coordination of Benefits)
- use electronic environments and standardized data to improve fraud detection (Health Care Fraud Prevention and Detection).
HIPAA
The leadership and guidance provided by WEDI to the healthcare industry on how to use and leverage its collective knowledge, expertise and information resources to improve the quality, affordability and availability of healthcare, via forums, conferences and online resources, especially in matters of conformance to EDI standards required by the Health Care Financing Administration (HCFA), now known as the Centers for Medicare and Medicaid ServicesCenters for Medicare and Medicaid Services
The Centers for Medicare & Medicaid Services , previously known as the Health Care Financing Administration , is a federal agency within the United States Department of Health and Human Services that administers the Medicare program and works in partnership with state governments to administer...
(CMS) led to the development of Health Insurance Portability and Accountability Act
Health Insurance Portability and Accountability Act
The Health Insurance Portability and Accountability Act of 1996 was enacted by the U.S. Congress and signed by President Bill Clinton in 1996. It was originally sponsored by Sen. Edward Kennedy and Sen. Nancy Kassebaum . Title I of HIPAA protects health insurance coverage for workers and their...
(HIPAA) which was enacted by the U.S. Congress in 1996.
See also
- Electronic Data InterchangeElectronic Data InterchangeElectronic data interchange is the structured transmission of data between organizations by electronic means. It is used to transfer electronic documents or business data from one computer system to another computer system, i.e...
(EDI) - Health Insurance Portability and Accountability ActHealth Insurance Portability and Accountability ActThe Health Insurance Portability and Accountability Act of 1996 was enacted by the U.S. Congress and signed by President Bill Clinton in 1996. It was originally sponsored by Sen. Edward Kennedy and Sen. Nancy Kassebaum . Title I of HIPAA protects health insurance coverage for workers and their...
(HIPAA) - Centers for Medicare and Medicaid ServicesCenters for Medicare and Medicaid ServicesThe Centers for Medicare & Medicaid Services , previously known as the Health Care Financing Administration , is a federal agency within the United States Department of Health and Human Services that administers the Medicare program and works in partnership with state governments to administer...
(CMS)