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REMITTANCE MANAGEMENT

835 REMITTANCE PAYMENTS GENERATOR

Smart corrections and validation for SNIP L1-L7 & codes

FEATURES

835 EDI FILE GENERATOR AND LOADER

  • 835 ERA File Generator Generate 835 ERA files based on database or claims adjudication status

  • Load 835 ERA files with our scalable ERA Loader optimized to handle large load. Claim Payments are loaded in Graph Database and available to process in seconds.

  • Setup Trading Partners and Clearing House

  • Submit Outbound 835 Files 

  • Manage outgoing Claims Batches / Files Batch outgoing claims in groups and files by receiver. Manage the batch submission and results

  • Receive 999, TA1 Response 

SMART AI CORRECTIONS

  • Smart correction on repeating data error

  • Automated AI learning rules to correct data

  • Codes and values to mark for rejections

  • Compare with other file or external data source

  • Audit every correction

  • Manual Corrections via Work queues

  • Auto Correction and Auto Learning - Configure and setup auto corrections of repeating data mistakes by trading partners and providers so that the claim can be processed. Define workflow to hold the claims for specific conditions.

FULL API INTEGRATION

  • Everything in EdiVal is accessible via API. Validation results and 999, TA1 and 277CA can be accessed via API

  • For Realtime access – Call API with the Payload data.

  • For Batch access, load the file to S3 bucket and call the API with filename. 

  • API response includes EDI Validation Results:

    • 999 Response

    • TA1 Response

    • HTML with error

  • Trading Partner Information  – You can use it to validate Trading partner

  • API are available for access claims, enrollments and all EDI data – validated or errored 

  • APIs are available to run complex query and lookup any data EDI data element

  • Prebuilt mappings, connectors and integration to QNXT, Facets and healthedge systems

  • Get 835 API - All the 835 are loaded are available to access from external systems by get claims RESTful API based on filters like filename, claim id, status - accepted, rejected, all or by claims type, claim date

  • 835 Kafka Server Stream incoming claims data in kafka queue to be accessed by other applications.

  • EDI to FHIR mapping - Prebuilt EDI to FHIR mapping with USCDI US CORE EOB FHIR resources

SINGLE VIEW OF EDI

  • View Payments data on HiPaaS UI. Check the file load status, Check the claims validation status. Volume analysis. Find any claim and claim line items. Drill down on validation error

  • Create Manual ERA entries

  • Powerful dashboard gives audit tracing across files and transaction level

  • Plugin any BI tool to write your own analytics

  • Real time visibility to data as it is validated and Loaded

  • Realtime visibility to edi errors and corrections

  • Audit trail of every change

  • Same data view for edi analyst and customer service

NOTIFICATIONS

  • Views and Alerts Setup different business threshold alerts and notify business. Define analysis views by Provider, by trading partner, Submitter and others.

SNIP L1-L7 VALIDATIONS

  • SNIP L1 / L2 Validation of claim payment files before loading. Generate error file. The companion guide can be configured by Trading Partner, payer or provider. Companion guides can be changed on fly and tested with incoming files.

  • 999, TA1 Response Create and send 999, TA1 based on SNIP L1 / L2 Validation results based on the Companion guide configuration. Outgoing 999 is attached to Claims Graph Node and available to audit

VALIDATION TEMPLATES

  • Companion guide templates

  • SNIP L1 to L2 rules Templates

  • Compare 835 and 837

  • Configure the rules to compare ERA data to claims data using our front end rules engine. Th rules can be applied to trading partner, Sender or globally. The rules can be set to ignore, warning. The rules can call enterprise API services and line items matching. The rules also can point to crosswalk tables to check the lookup values.

  • Manage ERA Compare Error Queues Manage ERA compare errors to send to work queues to be worked on by business analyst.Compare claims and ERA side by side. Make corrections

CLEARING HOUSE INTEGRATION

  • Integrate with Availity 

  • Integrate with Change Healthcare

  • Integrate with Office Aly and other clearing houses

LOAD 835

  • Load 835 files from State or external Plans

  • Send 999, TA1

  • Validate incoming 835 files

  • Compare and link them to outgoing 837 Files

  • Manual Data entry of ERA

  • Clearinghouse rejections, Payer rejections

  • Denials- ERA, Paper EOB, Payer websites

  • Top 10 denial reasons

  • Map denial reason codes

  • Extra front-end screening for eligibility denials

  • Policy and coverage changes

  • Fee schedule updates

BENEFITS

  • Increase Auto Adjudication Rate
  • Increase Claims Data Quality Rate
  • Reconcile Remittance with Inbound Claims
  • Real time view of work in progress claims
  • Save 30% time on Manual Analysis
  • No Claims Left behind - Account for every claim
  • Timely Response to Providers
  • Transparent view to Providers

REMITTANCE ADVICE ERA

835 Remittance Advice Claims Payment ERA

  • Generate Outbound 835 

  • 835 Loader and Validator

  • Generate 999, TA1

  • Reconcile 835 ERA to inbound 837 claims

  • Standard and Custom Edits

  • Automated Data Corrections

  • Simplified Trading Partner onboarding 

  • Simplified Dashboard

  • Integrated with QNXT, Facets, HealthEdge

  • Integrated with Availity

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ENCOUNTERS MANAGEMENT

BENEFITS

  • Submit accurate Encounters to State and Medicare

  • Validate based on State Edits

  • Reduce Encounter rejections 

  • Correct data manual before submission

  • Auto data correction based on state rules

  • Track Encounter responses from state

  • Fix encounter rejections and resubmit

  • Increase acceptance rates > 95%

  • Reduce analysis time by 30% 

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GET STARTED

Invest your time where it's needed. Set it up once and auto-scale

HIPAAS supports AWS Cloud, Azure or GCP or On-Prem for Enterprise customers. 

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