An end-to-end data lifecycle claim management solution for payers that want to streamline workflows, simplify status reporting, and facilitate timely delivery to meet ACA Edge Server requirements.
Enhance data visibility with Collection Process Tracking and Outbound File Monitoring. Dashboard views validate data sources, show status, and display files sent to the required counter-party for visibility into submission resolution.
Reduce data drop-off and minimize orphaned claims with enrollment pre-validation processing. This function looks for potential enrollment data problems such as duplicate members, new or dropped IDs, and unexpected masked IDs.
Facilitate error-resolution activities with intuitive error management tools aligned with operational workflows. Risk adjustment and reinsurance insights support error prioritization and client-driven error assignment.
Leverage professional management of edge servers. Minimize challenges and resources to take advantage of the expanded reporting set including the baseline dashboard, orphaned claims management, and pre-enrollment validation.
Seamlessly receive, process, translate, and analyze return response files. For edge servers, Edge Complete provides translation and viewing for all CMS xml reports including risk adjustment and IVA reporting.
Identify and manage orphaned claims to help mitigate risk to revenue. Analytics reporting for interim billing supports collaborative final bill creation.