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EDI Claim Processing

A3logics provided modern architecture with new EDI integration claim processing solution

About Client

The client of A3logics is a leading healthcare clearinghouse offering claim data exchange along with Health Information Exchange. The provides a secure gateway that allows the healthcare providers and financial institutions to exchange critical information, such as the claims in no time. The client has over 2700 payers to serve globally for which they need a robust and modern EDI architecture.

The clearinghouse service includes a continuous and seamless flow of data, which contains medical administrators, medical plans, GAP insurers, and primary care providers to gain significant and unique advantages, which improves competitive position.

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The Real Challenge

The client needed a system that not just replaces the unstable infrastructure but seamlessly retains old connection functionality. The client had engaged a lot of resources and finances for the maintenance and development of the key requirements of the clearinghouse yet failed to address all the issues.

The clearinghouse client had a legacy system with unstable infrastructure that hung over many times during critical data transmission. They were struggling with validating and manipulating millions of X12 HIPAA claims files.

They were upset with the rigid and prone to failures system and wanted to pace with the new evolving standards and technologies. The team of the clearinghouse client lacked the bandwidth to respond to the data editing and validation request from the client base.

The client had troubleshooting issues with their existing system and could not integrate new features that could underline changing business needs.

Our Solution

A3logics observed the key challenges of the client that includes lack of transparency, disrupted transitions, and maintaining numerous endpoints. The team of A3logics encompassing Senior and Junior Solutions architecture worked with the client on-site to understand the business needs and challenges and create a paradigm for new claim processing architecture.

When the team of A3logics and the client mutually agreed on the prototype, a framework was created for handling data connectivity, manipulation, and validation. The framework cultivated effectively replaced it while enhancing the legacy system.

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Key Highlights of the EDI Claim Integration

A3logics integrated solution was the amalgamation of internal teams and relevant tools to structurize the infrastructure and position the organization at greater heights.

Quick Turnarounds

Healthcare providers have the leverage to send and receive information faster, which means sending and receiving claims could happen within a day. Moreover, sending and receiving eligibility inquiries can be made in seconds.

Cost Savings

An electronic transaction can reduce the cost affected by manuals. Not just organizations can save cost per transaction but time as well.

Time Management

EDI transaction sets such as Eligibility (270/271), Claim Status (276/277), and Notifications (278N) can be quickly answered. Additionally, one can easily manage multiple payers while responding to them at the same time.

Minimizing Administrative Expense

The time and cost spent on calling, faxing, stuffing envelopes, sorting, & other manual work are reduced as the paper requisite for these processes are no longer needed and have been dominated by electronic data interchange.

Lowering Receivables

Integrating EDI for claim processing can streamline workflows and software systems. Organizations can easily access and manage benefit information, current coinsurance, and deductible of the patient, which also increases the cash flow due to accuracy in the information.

Identifying Errors

Healthcare information through EDI reduces errors compared to manual processes. Electronic level processes leverage multi-level editing prior to sending a transaction to the payment system. This process reduces the level of claim rejections.

Here are the Results/Numbers That Speak of EDI Integrated Services

  • 70% of the orders were automated

  • 10 days of work was achieved in 1 day

  • 80-90% B2B traffic is now conducted on EDI

  • 93% of users are satisfied with the improved performance

Tools & Technology

  • JSON

  • C

  • C++

  • Java

  • C#

  • Visual Basic

  • SQL

  • XML

  • ASCII files

  • EDIFACT

  • .NET

  • Cloud

Clearinghouse Benefits from A3logics Claim

Clearinghouse client, after integrating EDI claim processing architecture they were able to -

  • Quickly set up connection methodologies to meet legacy client's needs.
  • Reduce the resources requirement and cost while onboarding more partners & managing volumes of transactions.
  • Self-service automated facility to distribute interface requirements.
  • Complete message testing and validation before customers go live.
  • Configure & define the organization's data format, communication methods, and rules with trading partners.
  • Send Asynchronous follow-ups to systems to testify & verify inbound transaction flow.

Summary

Over 18 years, A3logics successfully implemented a plethora of EDI integration regardless of industry and standards suitable for business needs.

Through these years, A3logics could demonstrate value to their customers through integrated engineering solutions that are future-ready.

A3logics has a refined and skilled team with result-oriented methodologies to configure, test and deploy process orchestrations, thereby paving the way to success.

If you wish to modernize your existing EDI claim processing architecture, A3logics is always ready with a substantial solution that complies with your business standards and culture. Along with EDI solutions, A3logics has an unparalleled range of services that you can look upon. So, if you are keen on learning more, you can inbox us right away.