electronic-data-interchange-healthcare-insurance-edi

SIMPLIFIED MANUAL INTERVENTIONS IN HEALTHCARE EDI

Cost-effective HIPAA compliant X12 schema validating tool, SimplyEDI helps business users in health insurance industry to simplify manual interventions in complex Electronic Data Interchange (EDI) transactions to significantly reduce costs and improve customer net promoter score. It is primarily used in Claims Adjudication, Billing Reconciliation and Enrollment Inquiry. The business users can not only view the files in a human-readable format but can also create, edit, validate and reprocess them as required. SimplyEDI offers a user-friendly UI with a built-in parser and validator to validate the EDI files against the respective specifications. Time spent on manual interventions can be reduced by 80%-90% with SimplyEDI.

Supported Formats

SimplyEDI supports multiple EDI ASC X12 file formats used in the healthcare insurance domain such as:

820 Premium Payments

834 Benefit Enrollment and Maintenance

835 Health Care Claim Payment/Advice

837P Professional Health Care Claim

277 Health Care Information Status Notification Transaction Set

276 Health Care Claim Status Request

278 Health Care Services Review Information

270 Eligibility, Coverage or Benefit Inquiry

271 Eligibility, Coverage or Benefit Information

SimplyEDI has been architected on an open and extendible framework that can be easily configured to support many more EDI file formats that are used in various industries beyond healthcare.

Flexibility to search what you want and how you want

By using customized filters, SimplyEDI allows to drill down to specific files or transactions. The search can be conducted by filtering according to name, ID, control number, or any other element which is found in the EDI file. The filters can be configured to the needs easily. A task such as searching for a claim submission, an enrollment transaction or payment which takes 5-10 minutes on average can be accomplished in less than 10 seconds.

You don’t find the error, the error finds you.

On an intuitive user interface, erroneous files are self-identified. It pinpoints where the error exactly is in the file in a specific transaction segment and provides a description of the error, such as missing or incorrect data, as well as the expected, correct value for that segment. The time spent on editing and validating files and transactions can be reduced by 90%.