Improve health plan success
Smart healthcare EDI helps payers and third-party administrators streamline EDI processing and reduce costly denials by applying advanced edits and validations before reaching the payer, improving first-pass rates and operational efficiency across medical and dental transactions.
Smart EDI helps to:
- Increase first-pass adjudication rates by enabling CCI edits, custom EDI validation and advanced edits, including the ability to validate claims against patient coverage information
- Identify denial trends through EDI analytics capabilities via a user-friendly payer research portal, allowing you to better educate and partner with your providers
- Reduce administrative waste across a health plan’s claims, operations, network management and EDI departments
- Process transactions faster across many claim systems and business lines with advanced transaction routing
Navigate claims quickly and accurately
Enable high-quality, effective transaction management.
Simplified transactional workflows
Route transaction data to the appropriate processing path to streamline workflows, even with multiple claims systems and lines of business.
Advanced claims edits and routing
Apply advanced claims edits directly to submitters to catch errors upfront so claims are cleaner when routed for processing.
Payer research portal
Our payer portal provides analytics, warnings and alerts. The portal also highlights rejection details in an EDI or paper claim view.
Reduced administrative waste
Reduce administrative waste stemming from low first-pass rates and claim rework from incorrect outings across multiple adjudication systems.
Industry insights
Report
Discover 5 key trends that can help healthcare organizations streamline processes, minimize errors and deliver faster, more reliable services.
Article
Discover how real-time eligibility, benefits and claim status inquiries can improve accuracy and efficiencies for payers and providers.
White paper
Discover how the final shift to electronic transactions can save billions and transform healthcare operations.
Complementary solutions
Software
EDI Network
Leverage our vast nationwide payer network to enable swift and secure sharing of information between providers, payers and patients.