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Solution suite

EDI Network

Leverage our vast nationwide payer network to enable swift and secure sharing of information between providers, payers and patients.

Advanced interoperability with healthcare networks nationwide

The EDI network offers eligibility verification, claims management, attachments, claims status, electronic remittance advice and API connectivity. Leverage a platform that provides connectivity, scale, support, stability and adherence to the highest standards of security.

EDI Network modernizes claims processes for all parties

Speed transaction processing with secure cloud-based solutions

  • Ensure swift, accurate and secure claims and remittance transmission via direct connections.
  • Minimize delays with intelligent alerts and dashboards for proactive issue resolution.
  • Help to improve first pass rates with behind-the-scenes edits and customizations.

Improve processing cost-per-claim by reducing manual intervention

  • Identify the most efficient path for claims to be delivered to the final claim adjudicator.
  • Enhance accuracy by validating and normalizing data.
  • Support supplemental data needs and facilitate PPO repricing.
  • Automate workflows with personalized pre-adjudication rules.

Streamline processes and focus on core business competencies

  • Outsource mailroom operations with advanced scanning and data capture technology.
  • Reduce errors, enhance data quality and minimize pended claims through validation tools.
  • Automate mail processes and convert paper to EDI, significantly lowering administrative costs and resource investments.

Improve claims accuracy and help support timely, appropriate care

  • Get real-time eligibility verification for providers, payers and administrators.
  • Improve claim accuracy and streamline authorizations.
  • Ensure regulatory compliance, including HIPAA and CORE, with our ENHAC-certified clearinghouse.
  • Access our secure network of 2,400 payers.

Send and receive electronic claims attachments to drive efficiency

  • Submit the correct documentation the first time by accessing payer-specific requirements.
  • Help reduce customer-service calls with visibility into claim and attachment status.
  • Decrease the administrative burden and costs of paper workflows.

Key benefits

Secure solutions designed to drive accuracy, improve efficiency and reduce costs.

Built to support your business

Leverage multiple options to streamline eligibility verification and the submission, processing, and tracking of claims and attachments.

Use APIs to access our network

Our productized APIs are easy to implement and scale, giving you fast access to advanced functionality available with our solutions.

Help ensure accuracy of eligibility and benefits

Our broad connectivity facilitates the secure exchange of information to drive time and cost efficiencies, and support accelerated reimbursement.

Gain connectivity, flexibility and innovation

Our EDI Network offers smarter transaction processing and advanced interoperability with healthcare networks nationwide.

Let’s start a conversation

We’re here to help you find out how our services could benefit your organization. Complete the form, and we’ll reach out to you soon.

Our experts will:

  • Discuss your individual use case and business needs
  • Explain our features, benefits, and services
  • Show how this solution can help achieve your goals

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Complementary solutions

Hosted Payer Services

Integrated technology helps lower costs of maintaining high-availability systems needed to support dental and medical providers and members.

Payer Connectivity Services

Our claims system for payers and TPAs consolidates transaction streams at a single point to manage administration, routing and adjudication.