EdiVal Claims Management

Inbound Claims - Insurance & TPA

Outbound Claims - Providers & Hospitals

• 837 Claims File (I, P, D) Loader Load 837 Institutional, 837 Professional and 837 Dental files with our scalable Claim Loader optimized to handle large load. Claims are loaded in Graph Database and available to process in seconds.
  

• 837 SNIP L1/L2 Validator SNIP L1 / L2 Validation of claims before loading. 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
  

• 999, TA1 Response Create and send 999, TA1 based on SNIP L1 / L2 Validation results based on the Companion guide configuration. Outgoing 999 is attached to Claims Graph Node and available to audit
  

• 277 CA Generator Generate 277CA based on response of L3-L7 Validation and status from back end adjudication system
  

• Availity Integration Integrate with Avality and validate and load claims files. Integrate to other large trading partners
  

• Prebuilt mappings - QNXT, Facets and Healthedige Prebuilt mappings, connectors and integration to QNXT, Facets and healthedge systems
  

• View Claims 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 Create claims in familiar formats screen Professional (CMS 1500) Institutional (UB-04) and Dental (ADA 2012)
  

• SNIP Level 3 to Level 7 Validation Configuration 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.
  

• Manage Validation Error Queues Manage SNIP L3-L7 validation errors to send to work queues to be worked on by business analyst. Edit the error and Resubmit the claims or reject the claims via 277 CA
  

• Auto Correction and Auto Learning Configure and setup auto corrections of repeating data mistakes by trading partners and providers so that the claim can be processed. Define workflow to hold the claims for specific conditions.
  

• Views and Alerts Setup different business threshold alerts and notify business. Define analysis views by Provider, by trading partner, Submitter and others.
  

• Create 837 Claims Files (I, P, D) Create 837 Institutional, 837 Professional and 837 Dental files with our scalable Claim engine optimized to handle large load. Connect to your database to get data and create claim files and batches
  

• Manage outgoing Claims Batches / Files Batch outgoing claims in groups and files by receiver. Manage the batch submission and results
  

• Get Claims API All the claims are loaded are avalable to access from external systems by get claims RESTful API based on filters like filename, claim id, status - accepted, rejected, all or by claims type, claim date
  

• Generate 837 Outbound files Create 837 Outbound files from claims systems or claims database. Manage sending the claims files to different destinations and trading partners
  

• Claims Kafka Server Stream incoming claims data in kafka queue to be accessed by other applications.
  

• EDI to FHIR mapping Prebuilt EDI to FHIR mapping with USCDI US CORE EOB FHIR resources