835 Remittance Advice Claims Payment Management ERA

835 Payment Reconcile

Enable Outbound 835 Remittance Advice

Enable Inbound 835 Remittance Advice

• 835 Remittance Loader Load 835 ERA files with our scalable ERA Loader optimized to handle large load. Claim Payments are loaded in Graph Database and available to process in seconds.
  

• 835 ERA SNIP L1/L2 Validator SNIP L1 / L2 Validation of claim payment files 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.
  

• 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
  

• 835 ERA Fle Generator Generate 835 ERA files based on database or claims adjudication status
  

• Availity Integration Integrate with Avality and validate and send claims payment 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 Payment ERA data View Claims Payment ERA 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 Payment ERA Create claims ERA Payment manually via our data entry screen
  

• Compare ERA to Claims - Auto compare Configure the rules to compare ERA data to claims data using our front end rules engine. Th 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 and line items matching. The rules also can point to crosswalk tables to check the lookup values.
  

• Manage ERA Comapre Error Queues Manage ERA compare errors to send to work queues to be worked on by business analyst.Compare claims and ERA side by side. Make corrections
  

• Auto Correction and Auto Learning Configure and setup auto corrections of repeating data mistakes by trading partners and providers so that the claim payments can be reconciled. Define workflow to hold the ERA 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 835 ERA files Create 835 ERA 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 Payment 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, npi, clpid, status - accepted, reconciled all or by claims type, check date
  

• Data entry EOB Enter EOB data received using front end. Claims Payment Kafka Server Stream claims payment data in kafka queue to be accessed by other applications.