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EDI set-up

e-care can do a complete EDI set-up for new practices or practices moving from paper based claims to electronic forms. The process includes setting up the user and database on the EDI (Clearing House) website, testing with sample batches to ensure that the 837 and 835 are processed correctly and integrating the EDI with the Billing system for ‘one touch’ transmission of claim batches. Other aspects that can be set-up are 276/277 (Claim Status) and 270/271 (Eligibility and Benefits verification).

Electronic Claims submission

The crucial step in the medical billing process is submission of the claims through EDI. The healthcare claims contain sensitive information including patient data and insurance information. Submitting claims through EDI reduces processing delays and ensures higher acceptance rates with Payers.

e-care teams have the skill and expertise to check for transmission related errors at a ‘loop level’. This ensures that any re-current errors like skipping of a line-item can be analyzed and resolved in conjunction with the Clearing House support teams.

The e-care team for each client typically identifies one key member to be responsible for the EDI. This person is responsible for

Daily EDI transmission of claim batches

Track the EDI transmission reports every day

Identify ‘rejections’ from EDI transmission reports

Send rejections back to Billing team for fixing the error

Co-ordinate with Clearing House and resolve any field mapping issues

With EDI submission, carrier confirmation report is also instant and prevents any time delays due to transmission errors. Also, tracking claims has become easier, corrections can be done for claims being rejected and re-transmitted without much delay.

Once set-up, the electronic transmission process is very simple. But many organizations/practices do not understand the importance of constantly tracking the reports and the impact on revenue flow when not done diligently. The teams at e-care, realize the importance of tracking the reports on a daily basis so that EDI rejections are handled immediately and re-submitted for processing. This ensures that there is no delay or lag in the payments from the Insurance payers.