Intermediaries

Regulatory requirements and constant pressure for efficiency have made it imperative for intermediaries to drive technology adoption.

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. There is a lot of technology advancement that this segment is witnessing in the last few years, which in turn, requires services from a healthcare domain expert like HealthAsyst.

Expertise

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. Payers and clearing houses have to leverage technology to enable smooth claim processing. 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.

Expertise in Healthcare EDI

Real-Time Eligibility (RTE) 270-271

Interface for Validation, Coding Edits

Rejection Analysis

Claims Status Inquiry 276-277

Secondary Claims Processing

Online Claim Submission, Correction

Interface with 3rd party Revenue Cycle Management Services

HIPAA 5010 EDI transactions

Professional & Institutional Claims: NSF, Print Image, ANSI837

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