Solution Bundle

Payer Connectivity Services

A claims administration, routing, and first-pass adjudication system for payers and TPAs that want to consolidate and manage their inbound and outbound transaction streams at a single connection point.

 

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ImproveHealth Plan Success

  • Increase first-pass adjudication rate by using standard SNIP edits, as well as advanced custom edits.

  • Consolidate EDI transaction streams to simplify the claims administration process.

  • Enhance provider experience with portal research functions and metrics to proactively reduce common provider errors.
  • Reduce administrative waste across a health plan’s claims, operations, network management, and EDI departments.

  • Streamline transaction processing across multiple claim systems and lines of business with advanced transaction routing.

  • Simplify regulatory compliance (CORE Phase I, II, III and HIPAA 5010 compliant) and all standard HIPAA transactions (837, 835, 270/271, 276/277/277CA, 278, 820, 834, 835, 999/TA1).

Enable High-Quality, Effective Transaction Management

  • A single transaction workflow solution

    • Provides a single connection point for transactions, helping enable industry standard and payer-specific business rules and compliance with legislative mandates.
    • Simplifies the claims administration process, consolidating submitters and reducing administrative complexity so it’s easier for providers, payers and administrators to work together.
    • Improves claims routing accuracy and reduces claim rework. With the ability to route transaction data to the appropriate processing path, you can simplify transactional workflows - even one with multiple claims systems and lines of business.

  • Advanced claims edits and routing

    • Applies advanced claims edits and presents edit errors directly to submitters to catch errors up-front in processing so claims can be made cleaner when routed for processing.
    • Simplifies compliance with federal regulations, HIPAA, and CORE Phase I, II and III for ACA Operating Rules.
    • Reduces administrative waste stemming from low first-pass rates and claim rework due to incorrect routing across multiple adjudication systems.

Our outcomes

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