Claim Insight

EDI gateway, data repository and data quality platform for healthcare claims

EDI Gateway Functions

Claim Insight’s Data Integration Graphics

Parse, save and convert X12 EDI and NCPDP files with minimal effort

  • Support for medical and pharmacy claims and payments in X12 EDI, CSV and NCPDP Telecommunication Standard formats
  • Ultra-fast parsing and file ingestion
  • Files can be loaded directly from cloud storage, such as AWS S3, and Azure blob storage
  • All codes are enriched “on the fly” with descriptions and other metadata
  • Export to JSON and FHIR, relational and NoSQL databases
  • REST APIs for searching claims and payments and accessing analytics

Billing and Payment Integrity, Data Quality

Catch a wide range of billing and general issues

  • Extensive rule-based analysis using industry-standard Medicare’s National Correct Coding Initiative Edits (NCCI) and Medicare Code Editor (MCE) edits
  • 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

Claims Analytics

Claim Insight’s Claim Analytics Graphics

Unlock the wealth of information hidden in claims

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

Reference Data Set Management

Reference data sets are taken care off, 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

Claim Insight’s Reference Data Sets Management Graphics

Super-User Friendly UI

Claim Insight’s UI Screenshot

Claim Viewer and EDI Viewer for Mere Mortals

  • Intuitive search and filters to quickly find what you need
  • 100% of fields from claims and payments, nicely formatted and logically grouped together
  • Information about codes and providers is always only a click away
  • Tag claims and other items, so you can quickly find them later
  • Share your work items with your team
Try Claim Insight