Edi in Healthcare

Intermediaries

With the complexity of the US healthcare ecosystem, intermediaries such as medical clearing houses, RCM/Billing companies, financial clearing houses and HIEs play an important role in connecting providers and payers. Regulatory requirements and constant pressure for efficiency have brought in a lot of technological advances in this industry, which in turn, requires services from a healthcare domain expert like HealthAsyst.

 

Our Expertise for Intermediaries

 

HealthAsyst’s areas of expertise for Intermediaries include:

 

CORE Compliance

Claims Processing

Remits Processing

Real Time Eligibility

Denial Management

5010 Transition

Patient Statements

Virtual Payments

Provider Payment

EOB Generation

EDI in Healthcare

 

Amidst ever evolving regulatory challenges, pressure of rising costs, it is vital for healthcare organizations to stay on top of their efficiency levels. Managing healthcare payment is a significant process which puts tremendous stress on their administrative bandwidth and affects efficiency, regulatory compliance as well as cost of care. Any gap in filing claims could lead to claim rejections and subsequent paper work. Providers and clearing houses have to enable smooth claim processing for providers by leveraging technology.Electronic Data Interchange (EDI) is the electronic remedy to handling healthcare payment challenges. However, EDI in healthcare has its own complexities to handle. The most important aspect of EDI in healthcare are the governing standards. These are extremely vital for medical claims. Every EDI transaction needs a standardized format to ensure quick transfer and interpretation of data. Also, EDI transactions have to be compliant with regulatory requirements such as HIPAA and follow ANSI standards. With supporting documentations and claims being submitted via EDI, healthcare providers and payers are reaping the benefits of fewer denials and rework requests, faster identification of submission errors and claims processing, resulting in increased ROI.

 

Our Expertise in Healthcare EDI

 

Having been associated with clearing houses in developing and supporting software applications since inception, HealthAsyst has a thorough understanding of some key aspects of claims processing as well as the intricacies involved in the electronic transactions between providers and payers.

These include:
 

Real Time Eligibility (RTE) 270-271

Claims Status Inquiry 276-277

Professional & Institutional Claims: NSF, Print Image, ANSI837

Secondary Claims Processing

Online Claim Submission, Correction

Interface for Validation, Coding Edits

Interface with 3rd party Revenue Cycle Management services

Rejection Analysis

HIPAA 5010 EDI transactions