“Relationship,” as defined by Webster’s online dictionary, is the state of being related; a specific instance of kinship; or a romantic or passionate attachment. I admit that I am engaged in a peculiar benefits bond. Let me introduce you my relationship with Mr. Electronic Data Interchange.
Mr. EDI is pretty high-tech. I first heard about him in a benefits finalist presentation. A carrier told me they could set me up pretty easily, he’d improve my life, and the days of submitting manual forms or Excel spreadsheets loaded with enrollment and eligibility information for my workforce would be long gone. Promises of paradise lifted my spirits, so I took the plunge.
After the honeymoon was over, I realized that EDI relationships take work. Sometimes I feel like my days are spent chasing Mr. EDI and all his friends. One file goes here, another goes there, or maybe one doesn’t run at all (Mr. EDI decided not to get out of bed.) The man sometimes drives me insane.
While I agree he has improved my life overall, I’ve learned a few lessons. You can increase your chances of designing successful electronic benefit interchanges by carefully starting with the building blocks of a good relationship:
1) Commitment. Give the partnership time to materialize and build something meaningful. Nothing important is built overnight, and this certainly includes carrier eligibility files. Don’t rush into an accelerated implementation, or you’ll be frazzled and stressed. There was a point in our relationship when Mr. EDI wouldn’t take me out in public.
2) Honesty. An important factor in any relationship. On your end, let the carrier know how many hours you’re able to devote to the process, and expect the same response in return. Discuss the complexity of the interface, file types accepted, and how they will be transported. I was surprised one time when I received a 250-page document, detailing every data point, loop, and space needed in a file. Mr. EDI is a complex soul.
3) Money. Are support and implementation hours built into the contract? What happens if you exceed these hours? How much will it to cost to modify the interface if you need open enrollment or health reform changes? Mr. EDI can be temperamental – we’ve discussed counseling.
4) Support and communication. A strong relationship takes nurturing. Will you have an EDI point person or team devoted to your account? Will the carrier’s EDI specialists be available when you need them? Pay attention to where they are physically located. If Mr. EDI has a crisis, you might have to sleep on it and wait until morning for a response. Mr. EDI happens to snore, but I don’t mind.
5) Trial and acceptance. Couples nowadays move in together. In the benefits world, we call this user acceptance testing. Loading and analyzing data can be a lengthy process. How long will it take the carrier to report testing results? If it takes one to two weeks for each round of testing, you may never set a wedding date. Please send us an invitation; Mr. EDI likes cake.
My advice? If you’re entertaining the thought of switching to a new carrier, don’t skip over EDI details. Schedule a separate meeting and learn how the process will work. After all, the last thing you want in benefits administration is a blind date!
Karrie Andes, SPHR, CBP, is the senior benefits manager for PGi and a savvy self-funding health care gal. She’s located in the Kansas City area and can be reached at
Has your benefits department implemented EDI? Has it been a smooth process? Share your thoughts in the comments.
