Products | Transaction Management

As soon as a transaction is received by a healthcare organization, it begins a complex journey spanning multiple systems through the organization. On this journey, the transaction is acknowledged, processed, and modified at several points in its lifecycle, often with limited or no visibility for the operations staff. Healthcare organizations that lack visibility into their transaction lifecycles spend unnecessary time, resources and expense while processing transactions and supporting trading partners.

Edifecs Transaction Management (TM) provides a secure end-to-end view of the healthcare transaction lifecycle to internal users and trading partners. It enables better business decision-making, monitoring of performance against internal and external performance metrics, increases claims first-pass rates by reducing provider’s claim errors, and improves delivery of customer support.

Edifecs Transaction Management is a central console and database that lets business and technical users track, find, view, monitor and report on healthcare transactions. For instance, in a few seconds a provider support representative can find a submitted claim, check its current status, view modifications made to the claim, and see all of the acknowledgements and status updates sent to a provider.

Edifecs Transaction Management provides end-to-end visibility and insight into the entire lifecycle of a healthcare transaction from eligibility, authorization, claim processing through payment. Transaction Management provides reports that show trending of detailed metrics and comparisons of activity against pre-defined thresholds. It generates alerts for transaction-related problems or other events, both from within Edifecs’ solutions as well as third-party applications. It also enables support organizations to quickly respond to questions and troubleshoot transaction issues.
 

• Make better operational decisions by monitoring operational metrics and running reports to facilitate analysis of operations and business activity.
• Monitor performance against internal and external performance metrics, such as Service Level Agreements (SLAs) and Member Touch Metrics (MTM) by configuring alerts to trigger when processing exceptions occur and by running reports on performance-related metrics such as turnaround time on claims.
• Improve claims first-pass rates by using ad hoc reporting to analyze root causes of provider claim errors and by empowering partners to self-test their own claim submissions.
• Improve delivery of customer support by providing a secure self-service portal that lets internal as well as partner users search and view transaction-related information in a business-friendly format.