Increase First-Pass Payment Rates, Meet SLA Requirements, Customize Workflows

EDI Healthcare Suite includes a claims management solution developed for insurance providers in all primary healthcare fields including vision and dental. EDI Healthcare Suite’s primary focus is receiving fast and accurate payments while streamlining operational processes.

Claims Management Solution Features

Integrated EDI

Top-level automation with integrated EDI giving you more functionality with inbound and outbound claims while connecting to your internal business systems.

Clean Claims

First-pass payments demand clean claims. Identify problematic claims and claim segments, discover unbilled services, and submit claims automatically.

WEDI SNIP Validation

Testing, validation, and compliance through all seven WEDI SNIP levels keeping your claims compliant with HIPAA requirements.

Automated Remittance

Post payment information electronically, accurately, and efficiently discover denials occurring during billing to quickly remedy.

Accurate Reporting

Discover trends, opportunities, and successes impacting first-time pass rates with both paid and denied claims with your insightful EDI Healthcare Suite Dashboard.

Custom Workflows

Route claims, or segments of claims, to the appropriate staff decreasing manual errors, increasing first-pass payment rates, and saving administrative hours.

Live Visibility

Visibility into each claim lifecycle in real-time provided by Etracks, an EDI Monitoring Tool developed by Focused E-Commerce

Out with the old, in with the new

The time to replace your manual processes or your legacy system is now. The healthcare industry is evolving, and the amount of data you must compliantly manage will continue to increase. You need a claims management solution that continues to meet the demands of the healthcare industry.

Updating or implementing your claims management process will grant you significant cost-savings, faster ROI, and optimize your provider/payer relationships through real-time visibility and reporting.

Do more with your data!

Standard X12 HIPAA Transaction Sets supported by EDI Healthcare Suite:

  • 837 – Claims
  • 834 – Enrollments
  • 270/271- Eligibility
  • 376/277 – Authorizations
  • 276/277 – Claim Status Request and Response
  • 999 – Acknowledgements
  • 835 – Remittances
  • 298 – Post-Adjudication Professional Claims

EDI Healthcare Suite’s powerful translation engine supports data in many formats and can manage any Healthcare EDI transaction set.

Focused E-Commerce has over three decades of EDI Healthcare experience.

We are happy to answer all of your EDI questions!

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