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Automate, manage and extend clinical, pharmacy and administrative data exchange

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Transaction Management

Can your business and IT teams work with any transaction? Is partner interoperability an integral part of your business? Easily access all transactions to review clinical documents, research claims and improve service.

Improving service and increasing operational efficiency requires a 360 degree view of document exchange between partners. Access to current and archived data is essential to adjudicate claims, resolve issues and respond to partner queries. Giving secure, role-based access to time-based views of integrated healthcare events for members and their families—that is best in class.
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Product Spotlight

  • Transaction Management Corrections

    Transaction Corrections is a powerful tool to reduce the cost of compliance and increase automation rates. Reduce manual effort and comply with CORE Operating Rules.  Enable corrections to many transactions (834, 835, and 837), for example, out-of-balance conditions and inbound enrollment files from exchanges. Complete set of workflow tools include tasks, queues, bulk updates, review, approval and escalation processes, and security features.

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  • Transaction Management Archive

    Transaction Management Archive reduces the cost of record keeping and increases flexibility to quickly respond to data requests. Enable non-technical users to quickly find records to support audit inquiries or discovery requests from legal teams. Enables as much as 11 years (customer defined) of storage with powerful structured and unstructured search functions.

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  • Transaction Management EDI Reports

    Transaction Management EDI Reports provide the trends and analysis tools to increase operation efficiency and improve partner/provider relationships. Use the dashboards to monitor volume and rejection rates and then, compare to historical baselines. Monitor claim inventory and reimbursement.  Improve provider collaboration and outreach with scorecards, reports and analysis tools.

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Capabilities

Edifecs Transaction Management. Monitor partner interactions.

Organize all partner interactions into one integrated repository, then activate insight through dashboards and status tracking at summary and detailed levels.

  • Track the entire lifecycle of an enrollment transaction, eligibility request, claim or claim status request
  • Generate scheduled or on-demand reports including metrics, trends, balance and ad-hoc queries
  • Configure automated alerts to notify business and IT users when processing exceptions occur
  • Trigger review when exception conditions are met and use workflows with escalations to correct exceptions
  • Comply with retention policies and meet audit requirements through searchable end-to-end transaction history

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Edifecs Transaction Management. Self-service partner management.

Manage and control partner profiles and connectivity preferences while monitoring performance and sharing results.

  • Provide partners with a secure self-service portal either stand-alone or integrated into existing enterprise portals
  • Enable self-service testing and viewing of transmitted data to ensure partners can create compliant claims
  • Create reports that can be auto-generated and delivered directly (FTP, SFTP, email) to internal users and external partners
  • Aggregate data reporting to streamline SLA management and volume/reject management by partner and document type
  • Monitor daily volumes and rejections and use automated reporting functions to identify trends and conduct error analysis

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Edifecs Transaction Management. Track member activity.

Leverage industry-leading member and family views of correlated clinical and claims data to visually explore encounters, episodes of care and claims.

  • Construct member profiles and build relationships with covered dependents from all data flowing through the gateway
  • Search for member activity across all transaction types, then filter to refine search results
  • Use unstructured search to find all transactions containing a matching value in any field
  • Organize correlated transactions in a timeline view, then zoom-in to a day or zoom-out to a year
  • Display human readable EDI and clinical data including ADT, CCD, patient discharge and referral summaries

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