Medical Network Solutions

Network solutions for providers and payers who want to leverage our vast nationwide connectivity to streamline engagement, reduce costs, and improve claims processing and eligibility verification efficiencies.

Streamline Electronic Claim Transaction Processing

Automated connectivity between payers and providers

The healthcare reimbursement process is changing. Increased regulation, growing patient responsibility, and complex administrative tasks have intensified pressure on payers and providers alike.

To succeed in this rapidly changing landscape, payers need ways to reduce costs and improve efficiencies associated with claims processing – now and into the future.

Unparalleled intelligent healthcare network

We connect providers, payers, and technology partners with the nation's largest health information networks for eligibility and benefits verification, claims submission and processing, remittance, and payments.

Our application program interfaces (APIs) deliver the connections you need for efficient insights.

Speed Your Eligibility and Claims Processes

Fast, Accurate Eligibility and Benefits Verification

Efficiency with automation

Our Eligibility and Benefits Verification Network connects payers and providers, communicating critical coverage information directly to your practice.

Self-service provider tools include eligibility inquiries (270 / 271) and referral authorizations and notifications (278).

We offer hosted data solutions for both eligibility and referral authorizations.

Claiming and Remittance

Fewer denials and shortened adjudication

Our claims management solutions eliminate manual processes and improve submission accuracy, helping you create efficiencies, reduce the number of rejected claims, and shorten your adjudication timeline.

Electronic attachments save paper and help to ensure compliance.

Claim status tools provide visibility from submission to payment, enabling self-service.

Electronic Remittance Advice saves you the trouble of printing and mailing remits, enabling streamlined efficiency.

Advanced Claim Management

Advanced claiming and editing

Lower transactional costs, fewer support calls, and higher clean claim rates help to reduce waste and improve efficiency in healthcare administration.

Our Advanced Claim Management product provides edits for member/provider-based claim rejections, data enhancement, and clinical and administrative coding rules.

Claims can be routed to re-pricing networks (PPOs) and other entities.

Explore Our Medical Network Solutions