Claim file creation
Our staff is well trained in the process of pushing the claims that were entered on a given day along with claims that were set to resubmit from the previous day, through the internal system scrubbing process and creating a clean claim file (s) as per your requirement.
Error out Claims from Scrubbing Process
There will be some amount of claims that would error out during the internal edits process. These edits could be due to coding, file maintenance, eligibility issues, etc. Our EDI staff is well trained on addressing these issues that are within our limitations of resolution.
Uploading Clean Claim Files
Our EDI staff will upload the claim files to respective clearing house. In addition, we would also confirm the receipt of the file.
Clearing House & Payer Rejection
Our EDI staff are well trained to address any clearing house or Payer rejections rising out of the claims files that were uploaded daily.
- Do daily/weekly/monthly reconciliation (based on requirement) between claims billed from client system and clearing house website to ensure all claims were received.
- Provide clearing house and payer rejection trend every week/monthly (based on requirement) for additional edits to be placed on client system to ensure future claims go out as clean claims.
- Acceptance ratio will be in line with industry standards.
- We have knowledge working on Gateway EDI, Emdeon, Navicure, RealMed, Zirmed, Claims Remedi, etc…