CompuClaim’s cloud based healthcare EDI division provides the software and services needed to assure efficient, reliable and secure electronic networks among the providers of healthcare services, private insurance companies and government programs. The company brings state-of-the-art electronic solutions that include eligibility verification, claim capture and processing, adjudication and informatics. CompuClaim’s cloud based platform results in increased efficiency and reduced operating costs. Our Information technology innovations encourage strategic collaborations and mutually beneficial partnerships throughout the healtcare industry.

CompuClaim also designs and builds application specific healthcare EDI transaction Web portals for providers across the U.S. Our Web portals drive efficiencies and cost savings to all healthcare industry stakeholders.

With a HIPAA-driven approach to healthcare EDI transactions, we specialize in translating and processing high-volume eligibility and claim transactions in a secured environment. Our EDI services connect with multiple Medicaid, Medicare and commercial payers. Our custom portal applications back end into CompuClaim’s automated claims clearinghouse that allows the receipt of electronic medical claims in industry standard formats required by HIPAA, ANSI X12 837. In addition to the requirements of HIPAA CompuClaim’s EDI solutions can apply payer specific validation criteria which may apply to various lines of business.

Let us build your healthcare business portal that leverages our expertise, systems, and partner connectivity for your EDI solution needs. Our service-focused business model drives down the cost of health care transaction processing for payers and providers alike.

Eligibility Gateway

  • Batch Medicare, Medicaid, and commercial eligibility

  • Live technical support

Claims Gateway

  • X12N transaction clearing and translation

  • Reporting services

  • Online remittance advice/EOBs

  • Live technical support

  • Web data exchange

  • Transaction management tools

A client’s claims are submitted via a secure, custom designed, Web portal connection through the Internet. This means that the data is encrypted during transmission from the sender to the receiver and privacy and security are maintained. Claims are imported and the submitters receive both industry standard acknowledgements and easily understood reports detailing claim errors. After being imported by CompuClaim’s clearinghouse, claims are sorted by payer and outbound claim files are created. The outbound claim files contain only those claims that have passed validation. Transmission of the outbound claim files directly to receiving payers can be automated.

CompuClaim’s custom Web-based claim processing Portals can be used in a number of different ways. Third Party Administrators can use it to receive claims on behalf of multiple payers. Billing services can use the software to act as a hub from their billing systems to large industry clearinghouses while sending claims to large volume payers directly. Independent Practice Associations can use the software to pass all of their claims through a central location for re-pricing and managed care contract compliance. Practice management software vendors may run their own clearinghouses as a value added service for their existing clients. Each portal application is designed to accept any file format from any data source, including all Web-based IEP systems and any Student Information Systems.

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