Complete X12 837 Claims Management Functionality
837 I, P, D Loader and Validator, generate 999, TA1, 277CA, Link 835, Real time Claims Status 276/277. Generate Outbound 837 I, P, D. Enable Claims corrections
AI/ML driven validation rules and edits
Standard and Custom Edits, Automated Data Corrections. Configure Claim edits-front end rejections
SNIP L1-L7 Validation of claims. 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. Fully accept or Partial accept the claims files.
Configure the rules for Level 3 to Level 7 validations using our front end rules engine. The 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 for things like npi lookup, member match and others. The rules also can point to crosswalk tables to check the lookup values. Diagnosis Codes, CPT, ICD-10 and HCPCS code set validations
Single View of Claims Data
View Claims 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 claims in familiar formats screen Professional (CMS 1500) Institutional (UB-04) and Dental (ADA 2012). Claims data available via API. Claims to FHIR Conversion