Claim Insight
835 and 837 X12 EDI Viewer, Remit Manager and Converter
Organize claims and remits in one workspace
- Upload hundreds of EDI files of any size in minutes
- Review and analyze each claim in a clean, biller-focused UI
- Preserve every data element so nothing is lost
- Search any field or use predefined filters for payers, patients, providers, dates, and amounts
- Store your multi-year history for fast audits and trend checks
- Upload manually or automate via SFTP or cloud storage
Remit and claim analytics
- Track key metrics including billed/paid amounts and claim/service counts
- Analyze your adjustments and rejections
- Group and filter by providers, payers, patients, claim statuses, and more
- See totals for procedure and diagnosis codes over time
- View monthly and annual trends in billed/paid amounts and volumes
835 and 837 conversion to CSV/Excel
- Convert thousands of files and claims with a single click
- Select claims to convert using our powerful search and filters
- Multiple CSV/Excel layout options: claims and lines in a single file or separate files
- Customize the output columns to include only the fields you need
- Convert directly to Excel format
- Support a fully automated process: new files can upload automatically and CSV files are generated in the background
Reference dataset management
- All codes are automatically annotated with descriptions and guidelines from authoritative sources
- Reference datasets include ICD, CPT/HCPCS, NDC, Type of Bill, and many others
- Updates are applied as soon as a new version is released, while historical codes are preserved
- Procedure code classification using BETOS/RBCS
- Support for provider taxonomies, adjustment codes, and X12 codes
Billing integrity and data quality
- Claim scrubbing against Medicare’s National Correct Coding Initiative Edits (NCCI) and Medicare Code Edits (age and gender exclusions, etc.)
- Suspicious billing and outlier detection
- Identification of duplicate claims
- Support for a manual review workflow with statuses and notes
- Strict validation against X12 EDI specifications and reference code sets