OVERVIEW OF PAPERLESS ELECTRONIC CLAIM PROCESSING SYSTEM

The Electronic Claim System was designed to convert Providers who are still filing paper claims into EDI Electronic Filers. It also creates a paperless environment for Payers and Providers and reduces claim handling costs including postage. Benefits to the Payers are that they receive all claims electronically thereby eliminating the need to open mail and to scan, process and store paper claims. The major benefit to Providers is to be HIPAA compliant and an Electronic Filer. Furthermore, they can expect payment in less time.

Providers no longer have to mail claims to Payers eliminating postage costs. Instead, Providers electronically submit claims to DIS via a unique EDI transmission program developed by DIS. Electronic claims are batch controlled for processing. Claims are adjudicated for validity and accuracy of data and ICD 9 and CPT codes and for HIPAA compliance. Payer’s custom edits can also be applied. All clerical functions including return of rejected claims are handled by the system which results in clean claims for submission to Payers.

Processed claims are transmitted directly to Payers as Electronic Claims via ANSI 837 software through a clearinghouse or DIRECT to a Payer’s system in a custom format thereby eliminating any clearinghouse charges. The software we use for transmission is comparable to software used by Clearing Houses. We are able to access most Payers nationwide or can customize any Payer for direct filing.

Payers and Providers can elect to receive an image file of all claims processed for Search and Retrieval purposes. We provide all necessary software or can index and format images to a Payer’s or Provider’s system.

BENEFITS TO PAYERS

• Eliminates mailroom handling, scanning, processing, and storage of paper claims.
• Receive HIPAA compliant and adjudicated claims electronically.
• Minimize rejected claims.
• The system returns rejected claims to Providers with reasons for rejection. All errors are resolved by direct communication with the Provider eliminating the need for Payor to Provider contact for error corrections.
• Payer can become paperless using our search & retrieval system.
• Images of all claims processed are transmitted to Payers. Daily reports of claims received and processed or rejected are submitted to Payers and Providers.
• Processed CLEAN claims are submitted to Payers via 837 software or through a Clearing House or custom format direct to Payer.

BENEFITS TO PROVIDERS

• Electronic claims are paid in less time than mailed claims.
• No changes are required by the Provider in the way they currently handle paper claims.
• No investment required - claims are submitted electronically via a unique method developed by DIS - eliminating postage charges.
• Providers can become paperless.
• Provider becomes HIPAA compliant - minimizing claim rejects.
• Rejected claims are returned to Providers with reason for rejection.
• Claims are scrubbed and adjudicated and submitted to Payers with HIPAA acceptable codes.
• Providers can optionally submit ALL claims to ALL PAYER'S using the Electronic Claim System.