Start your project today+1-510-404-8049

Improved Claiming & Remittance Transaction Sets

Our enterprise integrated EDI solution tuned performance and recovered the revenue of hospital clients.

About Client

Our client is a leading healthcare service provider that has associated with multiple hospitals, private and commercial payers to distribute revenue & recovery solutions. The provider has a prodigious and vigilant team that handles transactions and challenges related to them. The client's team has to deal with millions of EDI 835 and EDI 837 transaction sets while maintaining the data quality. In order to maintain the quality of data and seamless flow of the transaction sets - the team has to make rigorous deep analysis to underline the root cause of any underpayments and denials. Their core service is to deliver recovery and prevention support for current and ongoing recoveries for their clients.

edi-a3logics

The Real Challenge

Handling non-uniformed abundance of transactions is challenging in itself. Especially when you have crucial data, that of patient's, there remains no room for error. Regardless of the robust and experienced team, our client struggled to monitor and manage EDI 835 and EDI 837. Additionally, the healthcare solution support provider had suffered complaints regarding X12 EDI data quality.

The real challenge was the unrevealed and unspecified count of transactions in a single EDI file. They can expect one transaction to innumerable transactions that need to be handled immediately.

After uncovering the transactions, the data within has been analyzed in detail. The so-called parsing process consumes a lot of time of our client's team, exhausting them completely. As only after deep analysis, the data was considered to be utilized.

The client has a collective of data science and intelligent tools ingrained with unique algorithms that help them achieve the task. However, the process has become old and slow, which made further processes slower. It also impacted the scalability of the process, which parallelly impacted the business.

Another major problem is complying with the upheaval market needs and the affordable care act. The act dictates the change in the payer responsibility, higher deductible plans, complex and stringent collection process.

The government reimbursement rules also fluctuates, which impacts the ability of the healthcare systems to capture revenue and receive full value. In short, the revenue recovery process has become complex for hospitals to manage delivery inaccuracy leading to look for assistance or outsource their solutions

Our Solution

To deal with the challenges, our client needed a robust yet flexible solution. They wanted a solution that could comply with the changing rules & regulations and handle endless data transactions without fracturing the system.

After a thorough analysis of their legacy system, we prepared a detailed report dictating the changes required to make their process seamless and agile. We also mentioned the cloning of interfaces to accelerate the new customer's onboarding. We initiated an EDI integrated fully engineered solution that accurately and efficiently delivered high-performance requirements, including parser.

edi-a3logics

Avail benefits of EDI with expert services

Highlights

A3logics solution for EDI 835/837 is crafted with an incremental approach to automate the X12 transaction files, following ANSI standards for faster and smarter business output.

Accelerating Revenue Cycle

A3logics proactive attitude towards treating problems enables them to build the futuristic solution. Organizations can take advantage of the trends and technology, such as intelligent alerts to reduce the delays in processing.

Flexibility While Creating Direct Connections

A3logics seamless solutions enable organizations or care providers to easily transmit claims and remittances to reach their destinations quickly, accurately, and securely with the help of APIs and other tools that also leverage industry-leading compliance and security.

Leverage Current Technology

A3logics keeps its teams and solutions upgraded that match the current market needs. Hence in today's EDI solutions, you will get quick configurable edits, cloud-based, digitized transactions - blockchain, AI & more.

Quick Search Options

A3logics empowers businesses with agility with its flexible search feature so that they can retrieve a batch number, payer identity, patient's name, and current transaction status instant access to even the last 15 months of data as well as export data through multiple options.

Quick Employee Onboarding

The automated interface integrated by A3logics gave them high-performance. The team could clone the interface template as well as mold it as necessary while quickly implementing them to onboard new customers.

Extended Connectivity

With the help of an intelligent Healthcare Network, our healthcare support provider was able to perform edits and customizations, thereby sending clean claims without rerouting. Secure Network integrated with VAN can allow organizations to seamlessly transmit electronic claims and remittance advice while handling any change.

Standardization

A3logics adheres to all EDI transaction standards supporting all formats of files for uninterrupted edits. Our robust EDI platform allows providers to securely submit electronic claim attachments via ASC X12 275 transactions and receive batch image and ASC X12275 index files, requests and manage through any online portal.

Comprehensive Approach

A3logics advanced solutions are furnished for intelligent claim routing, improve auto-adjudication rates, and electronic imaging for electronic claims. We strive to deter administrative burden and meet your business needs effortlessly. By eliminating pending and rejected claims, fewer delays in the revenue cycle, and more consistent adjudication, organizations can improve communication and drive results.

Additional Benefits of A3logics Integrated Solution

Healthcare Support provider was able to accentuate its business, while providing -

  • Reinforcement through positive reviews from peers in the industry.
  • The team of A3logics offers a tactical solution for generating X12 output for the requisite business segment automatically.
  • The strategic approach can render existing real-time data, allow dynamic test scenarios, analyze & find the variance, and bulk file creation for business scenarios.
  • The Web UI offered clear operational insight to monitor, log, audit, and report transactions while identifying the health of their interfaces.

Here Are The Numbers That Speak of Our EDI 835 & EDI 837 Outsourcing Solutions

  • 95% of the cost per document was reduced.

  • 100% medication location identification in just 10 mins.

  • 0 documentation errors were reported within a year

  • 50% enhanced business cycles resulted in faster marketing.

Tools & Technology

  • JSON

  • SQL

  • XML

  • MongoDB

  • ASCII files

  • EDIFACT

  • .NET

  • Cloud

Summary

The collaboration of the healthcare provider with A3logics for outsourcing EDI 835/837 solution rendered successful production and validation of the engine integrated solution surpassing their legacy system for transaction parser. The accuracy and performance they were able to achieve were immeasurable.

Our solutions allowed them to clone and implement tweaked solutions of their own, allowing them to achieve speed and efficiency followed by an agile development approach.

With the support of the A3logics engineered team, the client could make a rapid transition successfully. If you are looking to scale your business as our client and want to integrate a future-proof engine solution, please feel free to inbox us to provide you with optimum support.