Claiming & Remittance

A claiming and remittance solution for payers and providers who want a smarter, more efficient, paperless solution to accelerate the healthcare revenue cycle.

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Transact Efficiently

Benefit from the latest innovations, such as digital transactions, configurable edits, cloud-based solutions, and blockchain, for a faster and more accurate process.

Integrate seamlessly and flexibly with applications, APIs, and other tools that leverage industry-leading security and compliance.

Leverage direct connections to ensure that transmitted claims and remittances reach their final destinations more transparently, quickly, and accurately.

Accelerate the revenue cycle by acting proactively upon problems, opportunities and trends with dashboard views. Reduce delays in getting paid or processing transactions with intelligent alerts.

Partner with an operations team that is adept at addressing challenges and needs.

Maintain visibility of your transactions through flexible search options, such as patient, payer, batch, and status, with instant access to 15 months of data and multiple export options.

Improve Efficiency and Connectivity

Industry-leading connectivity

  • Connects to more than 800,000 providers and 2,100 payers. With direct connections to nearly all government and commercial payers, we can send most claims straight to their final destinations without rerouting.
  • Improves first pass rates with behind-the-scenes edits and customizations. Our Intelligent Healthcare Network™ houses one of the most extensive repositories of rules and logic to appropriately clean claims before sending.
  • Transmits electronic claims and remittance advice securely through our compliance infrastructure that meets or exceeds industry standards and is poised to handle change.

Digital functionalities

  • Adheres to the broadest and widely-accepted accepted standards (ANSI standards, 835/837). Our solution supports nearly all file formats, including .pdf, .jpg,.tif, and .gif. Automation is streamlined with advanced edits.
  • Provides the platform for transmission of electronic claim attachments - providers can submit via ASC X12 275 transactions or through the secure online portal.
  • Payers can receive batch image and ASC X12 275 index files, and request, receive, and manage using the online portal.

Comprehensive and customized approach

  • Elect services that scale to meet your business needs. Reduce pended and rejected claims resulting in a smoother, more consistent adjudication, and fewer revenue cycle delays.
  • Take advantage of advanced services that are designed to help improve auto-adjudication rates, including pre-adjudication edits and services, intelligent claims routing and electronic imaging for both paper and electronic claims.
  • Gain an accurate and automated process that helps alleviate administrative burden. Transparency throughout the process helps reduce errors, improves communication, and drives results.

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Additional Resources

Streamline Electronic Claim Transaction Processing

Learn how our Medical Network helps payers optimize claims processing efficiency.

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Identify the Most Efficient Path for Healthcare Claims

Learn how Advanced Claim Management can help you increase auto-adjudication rates and decrease manual intervention.

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Reduce the Cost of Claim Attachments

Learn how Medical Claim Attachments help increase claim processing efficiency via electronic attachment submissions.

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Reduce Transaction Costs and Enable Faster Payments with Medical EDI Network

Learn how the size and capabilities of our Medical EDI Network can help you optimize your revenue cycle.

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Boost Efficiency and Cost Savings with Electronic Claims Processes

Learn how electronic Claiming & Remittance can help streamline processes, reduce costs, and improve provider satisfaction.

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7 Criteria for Clearinghouse Success

Learn how the Change Healthcare clearinghouse helps you achieve maximum efficiency and cost savings.

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Access Hundreds of Payers for Real-Time Eligibility, Benefits Data

Learn how RESTful Eligibility API connects you to 2,100-plus payers via a simple, cost-efficient implementation.

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Get Real-Time Eligibility and Benefits Verifications

Learn how access to real-time eligibility and benefits verification facilitates clean-claims, benefiting both providers and payers.

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