Payer Connectivity Services
A claims administration, routing, and first-pass adjudication system for payers that want to consolidate and manage their inbound and outbound transaction streams at a single connection point.
Improve Health Plan Success
Increase first-pass adjudication rate by using standard SNIP edits, as well as advanced custom edits.
Reduce administrative waste across a health plan’s claims, operations, network management, and EDI departments.
Consolidate EDI transaction streams to simplify the claims administration process.
Streamline transaction processing across multiple claim systems and lines of business with advanced transaction routing.
Enhance provider experience with portal research functions and metrics to proactively reduce common provider errors.
Simplify regulatory compliance (CORE Phase I, II, III and HIPAA 5010 compliant) and all standard HIPAA transactions (837, 835, 270/271, 276/277/277CA, 278, 820, 834, 835, 999/TA1).
Enable High-Quality, Effective Transaction Management
A single transaction workflow solution
- Provides a single connection point for transactions, helping enable industry standard and payer-specific business rules and compliance with legislative mandates.
- Simplifies the claims administration process, consolidating submitters and reducing administrative complexity so it’s easier for providers and payers to work together.
- Improves claims routing accuracy and reduces claim rework. With the ability to route transaction data to the appropriate processing path, you can simplify transactional workflows - even one with multiple claims systems and lines of business.
Advanced claims edits and routing
- Applies advanced claims edits and presents edit errors directly to submitters to catch errors up-front in processing so claims can be made cleaner when routed for processing.
- Simplifies compliance with federal regulations, HIPAA, and CORE Phase I, II and III for ACA Operating Rules.
- Reduces administrative waste stemming from low first-pass rates and claim rework due to incorrect routing across multiple adjudication systems.
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