What is the term for the computer-to-computer transfer of data between providers and third-party payers?

The term for the computer-to-computer transfer of data between providers and third-party payers is electronic data interchange (EDI). EDI is a standardized method for transmitting various types of data, including billing information, insurance claims, and patient information, directly between different computer systems without manual intervention. This process enhances efficiency by reducing paperwork and the potential for errors that can occur in manual data entry.

In the context of healthcare, EDI plays a critical role in streamlining communication between healthcare providers and insurers, leading to faster processing of claims and payments. The use of standardized formats ensures that the information is consistent and easily interpretable, facilitating smoother interactions and transactions.

Other terms, while relevant in the healthcare data exchange context, do not specifically refer to this computer-to-computer process. For instance, HIPAA primarily focuses on the protection and privacy of patient information rather than data transfer mechanisms. Health information exchange (HIE) involves broader systems that allow for the sharing of health information across different organizations for better patient care, but it is not limited to the direct transmission of data to payers. Health data exchange (HDE) may refer to the transfer of health data more generally but does not capture the specific payer-provider data transfer implied in the question.