Claim Insight
835 and 837 X12 EDI Viewer, Remit Manager, Converter, and Analytics Tool
Organize your Claims and Remits
- Upload hundreds of EDI files in a matter of minutes
- Files of any size can be uploaded
- All data elements are ingested, nothing is left behind
- Upload manually or automatically via SFTP or from cloud storage
- Search by any field or use pre-defined filters, including payers, patients, providers, dates, amounts
- Store your entire multi-year history for auditing purposes
Remit and Claim Analytics
- 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
835 and 837 Conversion to CSV/Excel
- 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
Reference Data Set Management
- 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
- 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