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The expEDIum Claims Portal is a web based secure Claims Processing solution that has a variety of features including web based secure account access and high performing backend expEDIum Claims Portal Components that are powered by our proprietary expEDIum X12N Thin Engine and expEDIum Validation Engine.
This solution is an optimal way to allow Clearinghouses, Billing Services, Hospitals and Practices to connect to one or more Payers or Clearinghouses directly and make the claim life cycle management more efficient and predictable.
This solution supports a handful of legacy formats and can be extended to support additional formats on a need basis. The solution works with HCFA/UB04 forms and can be customized to work with any other standard/non-standard healthcare forms.
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The main features of expEDIum Claims Portal solution v6.0 are:
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| Key Features |
- Multiple account support, each account can be a Clearinghouse, a Billing Service Bureau, a Practice or a claim operator.
- Legacy file format support.
- Batch uploads and processing.
- Patient Demographics Capture and lookup.
- Primary and Secondary billing.
- ICD-9, CPT, HCPCS code lookups and validation.
- Taxonomy code lookup.
- UPIN lookup from custom URLs.
- Exhaustive payer list and lookups.
- Standard healthcare form based L1, L2, L3 validation and scrubbing.
- Rule based automated and manual routing/creation of Electronic or Paper claims.
- Printing of HCFA/UB04 Paper claims.
- Multiple Trading Partner Profiles/Multiple Payers.
- Creation of Payer Ready Electronic EDI claims.
- Processing and claim level reconciliation of delayed payer reports - both standard (such as TA1, 997, 277U, 824, 864) and non-standard reports
- Account specific ERA/EOB creation
- Patient Statements
- Claim History
- Admin dashboard showing a summary from the system
- Data Archival of aged batches and claims.
- Customizable data edits and business rules.
- Reports module to create customized reports in PDF, CSV or HTML formats.
- Message based communication with users from Portal Administrator.
- Realtime and batch level Eligibility Enquiry/Response.
- Production driven, High performance solution.
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| Client side access |
- Web based secure provider/client/operator access.
- Account Password expiry.
- Provider side reports viewing and downloading.
- Provider side upload of legacy format files.
- Provider side claim scrubbing.
- ERA/EOB auto / manul posting and reconciliation.
- Currently deployed to handling specialities such as General, Chiropractic, Podiatry, Physical Therapy and Ambulance claims, capable of handling any specialty claims without any changes (or with minimal edits). Please contact us with any specific requests.
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| Automated Payer Connectivity |
- Extensible Payer Edits module.
- PGP and ZIP with password support.
- Direct Payer connectivity and multiple payer support.
- Standard Secure transportation mechanisms such as SFTP, FTP over VPN and HTTPS.
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| Technology |
- Open database and standard Internet browser support.
- Needs an Application Servers such as JBoss, WebSphere and GlassFish.
- Platform independent, J2EE based scalable solution.
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Please request for a remote demo of our expEDIum Claims Portal solution.
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