Business Value
Improving Claim First Pass Rate
Resubmission of claims due to errors in EDI transactions results in increased cost and frustration for both you
and your trading partners. Getting claims through on the first pass is a goal shared by all participants exchanging claims transactions.
Edifecs Claims Correction is a valuable tool to assist you and your trading partners to increase the efficiency of data exchange
by reducing errors before they reach your host systems.
Helping Your Providers Understand Submission Issues
Providers have a financial incentive to submit clean claims that will move quickly through the adjudication system.
However, most providers do not have sufficient EDI skills to grasp concepts like loops, segments, elements,
qualifiers and other terms specific to EDI. For a provider, the concept of the “Rendering Provider” is easily understood,
but understanding the complex rules for how the “Rendering Provider” is defined in an 837 transaction can be overwhelming.
Edifecs Claims Correction “hides” complex EDI logic and presents an understandable set of business-normalized data
elements that allow the provider to correct EDI issues without necessarily having to understand technical EDI rules.
Using Your Business Staff More Effectively in Dealing with EDI Issues
As electronic sharing of data becomes a bigger part of the payer and provider business environment, your business
staff needs to have more control of the interaction, with less involvement of your technical EDI staff. Edifecs Claims Correction
allows both payer and provider staff who may be unfamiliar with EDI technology to rapidly solve problems around electronic claims submission.
Developing Partnerships with Your Providers in Exchanging Data
Once business staff on both the payer and provider side can view claims data and errors in a business normalized view,
the opportunity to collaborate in resolving issues is greatly increased. Through Edifecs Claims Correction’s shared portal view
of the claims data, payer and provider business users can work together to understand and resolve many of the issues that impact
efficient submission of clean claims data.
Key Benefits
- Provides a business friendly view of the electronic transaction
and its status in the payers business process
- Presents errors associated with business elements in a
way that is understandable to providers and business office
staff
- Assists the provider in correcting errors according to the
HIPAA standard and payer-specific requirements
- Converts transactions that would have been rejected into
valid transactions that can be processed by payer host
systems
- Creates a working environment that allows your providers
and business users to work together on solving claims
submission issues, and improves service for your provider
community
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