Claim Insight

835 and 837 X12 EDI Viewer, Converter, and Analytics Tool. See the demo here.

Decipher Your 835/837 with Our User Friendly UI

ERA and Claim Viewer for Mere Mortals

  • Upload hundreds of EDI files in a matter of minutes
  • Search by payers, patients, dates, amounts, and many other fields
  • Make sense of your claims and remits with our intuitive viewer
  • No need to archive older claims and remits; your historical data is always available
  • Work with your team using our multi-user support

Claim Insight’s UI Screenshot

835 and 837 Conversion to CSV/Excel

Claim Insight’s Data Integration Graphics

Convert X12 EDI files to Excel and CSV

  • Ultra-fast parsing and file loading; support for large EDI files
  • Convert multiple files with a single button push
  • Select what to convert using our powerful search and filters
  • Convert directly to Excel format; no need to manually import CSV
  • Customization of the CSV/Excel layout
  • Files can be loaded automatically via SFTP or from cloud storage
  • REST API for automated conversions from your application

Claims and ERA Analytics

Unlock the wealth of information hidden in EDI Files

  • Understand your key metrics, including billed and paid amounts and claim volumes
  • Analyze your adjustments and rejections
  • Group and filter by providers and specialties
  • Gain insight into procedures and diagnosis
  • Perform temporal analysis, including trends and spikes over time
  • Understand your patient demographics and their conditions: group and filter by age, gender, location

Claim Insight’s Claim Analytics Graphics

Reference Data Set Management

Claim Insight’s Reference Data Sets Management Graphics

Reference data sets are taken care of, automatically

  • All codes are automatically annotated with descriptions and guidelines from authoritative sources
  • Reference data sets include ICD, CPT/HCPCS, NDC, Type of Bill, and many others
  • Updates are applied as soon as a new version is released; historical codes are preserved
  • Procedure codes classification using BETOS/RBCS
  • Support for provider taxonomies, adjustment codes, and X12 codes

Billing and Payment Integrity, Data Quality

Catch a wide range of billing and general issues

  • Claim scrubbing against Medicare’s National Correct Coding Initiative Edits (NCCI) and Medicare Code Edits (age and gender exclusions, etc.)
  • Suspicious billing anomaly and outlier detection
  • Identification of duplicate claims
  • Support for a manual review workflow with statuses and notes
  • Strict validation against X12 EDI specification and reference code sets

Claim Insight’s Data Quality Graphics
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