Improve health plan success
Designed for payers and third-party administrators, our Payer Connectivity Services make it easier to navigate claims.
It’s a claims administration, routing and first-pass adjudication system that allows you to consolidate and manage inbound and outbound transaction streams at a single connection point.
Payer Connectivity Services helps to:
- Increase first-pass adjudication rates by using standard SNIP (Strategic National Implementation Process) edits and advanced custom edits.
- Consolidate electronic data interchange (EDI) transaction streams to simplify the claims administration process.
- Improve the provider experience with portal research functions and metrics that help proactively reduce common errors.
- 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.
- Simplify regulatory compliance (CORE Phase I, II, III and HIPAA 5010 compliant) and all standard HIPAA transactions (837, 835, 270/271, 276/277/277CA, 278, 820, 834, 835, 999/TA1).
Navigate claims quickly and accurately
Enable high-quality, effective transaction management.
A single-transaction workflow solution
A single connection point enables industry-standard and payer-specific business rules and compliance with legislative mandates.
Reduced administrative complexity
Consolidate submitters and reduce administrative complexity so it’s easier for providers, payers and administrators to work together.
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.
Regulations safeguards
Our claims system maintains compliance with federal regulations, HIPAA and CORE Phase I, II and III for ACA operating rules.
Reduced administrative waste
Reduce administrative waste stemming from low first-pass rates and claim rework from incorrect outings across multiple adjudication systems.
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