Payers and TPA can receive and validate all EDI transactions; 837 (I, P, D), 835, 834, 820, 270/271, 276/277, 278, 275, 274. Receive paper claims and paper prior auth. Enable Real time and batch transactions

We support L1-L7 validation, Claim edits, reconciling inbound and outbound transactions. CORE compliance, CMS and HIPAA compliance EDI gateway. 

Inbound 834:

Manage all inbound claims 834 from various Trading Partners, Clearing Houses, Medicaid, MediCal, CMS and Large Groups. Configure custom 834. Validate Claims L1-L7, send 999. Auto corrections using our smart AI Capability.

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834 Audit , Full File and Daily File:

Compare Audit full file with membership before processing it to find differences - PCP changes, demographics changes, rate code changes, dual plan codes, coverage, retro coverage and more. Resolve data issues before loading to membership

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Outbound 834:

Generate outbound 834, receive and reconcile 999.

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Realtime and Batch 270/271 EDI Transaction:

Enable real time and batch Eligibility status check using 270 transaction

275 Attachments:

Enable real time and batch claims and prior authorization attachments

Manage end to end prior authorization. Receive prior auth, approve or request additional data. Map prior auth to submitted claims. Claims and Prior Auth data available in one place.

Integrated Gen AI to validate claims, pend claims, reject claims,  approve and denial claims. Validate every inbound claims with set of predefined rules, historical data and patterns. Identify and detect Claims fraud patterns.

Inbound 837 I/P/D:

Manage all inbound claims 837 I/P/D from various Trading Partners, Clearing Houses and Providers. Validate Claims L1-L7, send 999, 277CA. Auto corrections using our smart AI Capability.

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Claims Attachments:

Manage all inbound claims attachments and assign to claims

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Claims Edits:

Edit inbound claims and resubmit​

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Outbound 835 Claims Payment:

Generate and reconcile outgoing Claims Payments 835 files. Manage 277CA and Denials. 

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Data Entry for UB04 and CMS-1500:

Simple data entry screens to manually add claim and claim payments

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Outbound 837 I/P/D:

Generate outbound 837 I/P/D, receive and reconcile 999, 277CA and 835 payments.

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Realtime and Batch 276/277 EDI Transaction:

Enable real time and batch claims status check using 276 transaction

CORE Compliance and integrated with CMS and Plans

270/271 Eligibility:

Enable real time and batch Eligibility status check using 270 transaction. Enable FHIR

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276/278 Claims Status:

Enable real time and batch claims status check using 276 transaction

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278 Prior Auth:

Enable real time and batch prior Authorization check using 278 transaction and attachments​

274 Directory:

Enable Network directory and submit it to CMS or state

Load, Validate and Reconcile 820 Payments with membership data, retro charges, pcp charges, outgoing provider payments. 

Automatically reconciles 837, 835, electronic remittance advice (ERA), treasury records, lockbox transactions and Self Pay. Compare 837 and ERA side by side. Auto load paper claims and ERAs.

We also automatically identify self pay and integrate to payment. Easily upload your self pay payment files, lockbox files and automate payments, Generate EOB statements