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| The expEDIum BPO Services is a productized service that offers a combination of Healthcare transformation adapters, data editing, scrubbing tools and web based claims processing and medical solutions bundled along with consulting / programming services. These services help BPOs to create cleaner, payer ready claims, allow faster turnaround and provide complete claims processing and claims management solutions to their clients. This service increases the end-to-end productivity of healthcare BPOs, provides better HIPAA awareness, thus resulting in better revenue models. The data acceptance rate by the payers is increased using this service thus making the claim payment faster. |
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expEDIum Adapters – expEDIum Adapter suite consists of a range of off-the-shelf software products built using expEDIum X12N Engine and provide readymade transformation from a variety of legacy healthcare formats to HIPAA EDI.
This suite consists of a variety of adapters that transform legacy healthcare formats such as NSF 2.0, NSF 3.01, NSF 6.0, DMERC, 3.20D, HCFA Print Images and UB92 Print images and CSV files to payer ready equivalent HIPAA EDI formats. Support for any other standard or proprietary format can be added quickly on demand.
Healthcare BPOs can provide added value to their clients-by creating Payer Ready EDI data instead of an earlier stage “legacy” healthcare data - using the expEDIum Adapters.
These Adapters also have many additional features like multiple payer support, GAP file mechanism which can be used to fill in some missing information in the input legacy data so that the output EDI is complete. This allows the BPOs to enhance their client’s revenue stream by reducing the number of rejected claims and shortens the claim life cycle. |
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expEDIum Claim Scrubber – The expEDIum Claim Scrubber is a desktop application that can be used to enter, manage, scrub and validate claim data using an open database.
This tool creates HIPAA compatible EDI claims from HCFA 1500, UB92 and Dental form based data. In addition, it allows validation and scrubbing of the claim data using the proprietary expEDIum validation engine and creation of complete error free payer ready claims. Batch printing on standard HCFA/UB92/UB04 form and batch EDI creation is available. Practice and Payer specific filters are available.
Using this product Healthcare BPOs can provide appreciable value addition to their clients by reporting HIPAA validation errors, correction of errors and filtering out errors claims before transmission to payer thereby reducing the cost incurred due to rejection of claims. The data entry process is also simplified as claims can be imported into the database directly from a print image file or CSV file. This tool can be used to generate paper claims also using the “Print” module. |
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expEDIum Claims Portal – The expEDIum Claims Portal(eCP) is a web based Claims Processing solution that has a variety of features including web based account access and a sophisticated high performing backend expEDIum Claims Portal Components that are powered by iTech’s proprietary expEDIum X12N Thin Engine and expEDIum Validation Engine.
The eCP supports a handful of legacy formats and can be extended to support additional formats on a need basis. The solution works with HCFA/UB92/UB04 forms and can be customized to work with any other standard/non-standard healthcare forms. It has many features like EDI creation, claim and status tracking, scrubbing and validation, variety of lookups, reports module, payer edits, patient demographics capture and secondary claim support.
Healthcare BPOs can use this as a claims processing hub and add a lot of value to their claims processing and claims management services. This solution is suitable for processing of larger volume of claims and for automated data enrichment, payer specific validations. The system is capable of handling over tens of thousands of claims per day with 20 to 30 operators using the system processing claims.
This solution provides access via the web and is scalable hence Healthcare BPOs can use this to establish secure connections with their clients - like Billing services, Clearinghouses , Hospitals and Practices and Payers - and provide a variety of services using the features mentioned above. |
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Consulting / Programming Services - We also offer software development services as part of our expEDIum “Pure Play" offering where we can build custom solutions for Healthcare BPOs. The solution created may not use any of our expEDIum Product suite or components. The IPR of the software created can either be shared or be entirely with the clients.
This service would rigorously follow standard software development methodologies, tools and cover the whole software development life cycle including post delivery support and maintenance of solution code base. This service would typically start with a vision of a solution being proposed followed by a detailed requirements document. |
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You can request for a copy of our BPO Case Study brochure from our Evaluation request page.
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