WHAT WE DO
EDI SOLUTIONS
We provide a full suite of products and services to automate key business functions. We offer a number of electronic medical claim processing solutions based on the HIPAA EDI X12 industry standards that allow healthcare institutions to significantly lower cost of business, enhance customer care, and increase revenue.
Provider Portal for Claim Processing
The EDIEngine Claims Portal is a web based application which has a variety of features such as processing legacy healthcare formats, providing validation reports and scrubbing facility using standard healthcare forms. This solution is an optimal way to allow providers/practices with existing software systems to connect a healthcare claims hub. The backend services of this portal are powered by various EDIEngine Components.
The main features of our EDIEngine Claims Portal are:
• Uploading and processing of a variety of legacy and X12N healthcare format files
• Claim data enrichment on the fly
• L1, L2 and L3 validation reports
• Payer specific validation
• Data summary, scrubbing and data correction
• Data views and data reports
Medical Billing Solutions
The EDIEngine Medical Billing Solution (eMBS) makes claim processing more efficient and cost effective by capturing and managing patient billing, claim and payer data while connecting all stakeholders through the internet.
The main features of our EDIEngine Medical Billing Solution are:
• Automated 997 and 835 processing
• Eligibility Enquiries, Claims Status modules
• Customized data edits and business rules
• HCFA-1500, UB-92, ADA form based data entry, editing and batch printing
• Support ICD9/CPT codes
• Audit trail
• Advanced reporting
• Web access
• Direct Payer connectivity
• Complete Claim life cycle management
Payer Solution
The EDIEngine Payer solution enables small to medium size payers to become HIPAA compliant rapidly and interfaces with their existing systems seamlessly. The solutions offered also interface with their existing adjudication systems. This interfacing may need additional custom programming.
The main features of this solution are:
• Ready made interface that processes all 9 HIPAA transaction sets
• Perform L1 & L2, L3 validation
• Dynamic 997 Functional Acknowledgements
• Modules for customizing and performing data edits and business rules
• Support for legacy format transformations
• Audit trail and a reports module
• Ability to generate delayed payer report
• Custom built Payer adjudication interfaces
• Additional features can be built on demand
Billing Clearinghouse Solution
The clearinghouse solution is a derivative of our EDIEngine Claims Reconciliation. This solution supports handling of a variety of legacy healthcare formats and performs effective secure communication with different carriers. Additional custom features can be added on demand. The custom features may include support for any proprietary or any unsupported healthcare formats, and support for custom view and reports. The EDIEngine Portal application manages uploading, downloading and viewing of various reports and claim files.
The main features of the Clearinghouse solution are:
• Handles a variety of healthcare formats
• Allows direct-payer-connectivity
• Handles high volumes of transactions
• Supports Process driven approach
• Supports Command line and graphical interfaces
• This solution is suitable for small to medium sized clearinghouses that handle a few million claims a month