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Carrier Integration
The Electronic Data Interchange (EDI) Benefit Enrollment and Maintenance Set
(HIPAA 834) can be used by employers, unions, government agencies, associations,
and insurance agencies to enroll members to a payer. The payer is a healthcare
organization that pays claims and administers insurance, benefits, or similar
products. Examples of payers include an insurance company, health care
professional (HMO), preferred provider organization (PPO), government agency
(Medicaid, Medicare, etc.), or any organization that may be contracted by one of
these groups.

Though an EDI standard exists for health care transactions, the standard allows for
variation between implementation. This allowance for variation means that every
payer's standards for EDI transactions may be different. To account for this, every
payer specifies in detail their requirements for organizations to submit HIPAA-
compliant files in a Companion Guide. Each entity may have a different
method of delivery, ranging from mailing hard media such as a CD-ROM disks or
tape backup to online delivery through FTP. Some entities may elect not to support
different methods of delivery depending on a trading partner's expected volume.

For employee benefit plans administered using EmCentrix's HRMS, participants
have the ability to research qualifying expenses, view current elections, enroll in
plans, change information (direct deposit, email address, etc.), all using secure,
state of the art technology. Eligible employees can enroll through the online system,
reducing processing time. Customized paper enrollment forms can also be
generated for new hires or those without internet access.

Streamlining this process allows benefits and IT staff to focus on other tasks
important to their organizations. Eligibility and enrollment data is shared between the
company, the system, and insurance carriers according to HIPAA compliant 834 EDI
File Standards. Companies get online enrollment information to establish payroll
deductions and insurance carriers receive coverage data for covered employees.
Company deductions are automatically kept in sync with the system's enrolled
participants, liberating staff from having to manually enter deductions or sort and
store additional paperwork.
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EmCentrix’s HRMS is not necessarily a “what you see is what you get” product. It is a highly flexible solution that can be tailored to your needs. Our experienced developers can modify the
system in countless ways; we can create new custom functions, reports, screens, exports, and integrations to make the system uniquely suited to your company’s needs. Our goal is to develop
your ideas and visions.
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