Streamline EDI processing and reduce costly denials
SmartEDI helps payers and third-party administrators streamline EDI processing and reduce costly denials by applying advanced edits and validations before reaching the payer. This improves first-pass rates and operational efficiency across medical and dental transactions.
Help enhance EDI workflows
SmartEDI helps to:
- Increase first-pass adjudication rates by enabling CCI edits, custom EDI validation and advanced edits, including the ability to validate claims against patient coverage information
- Identify denial trends through EDI analytics capabilities via a user-friendly payer research portal, allowing you to better educate and partner with your providers
- Reduce administrative waste across a health plan’s claims, operations, network management and EDI departments
- Process transactions faster across many claim systems and business lines with advanced transaction routing
Navigate claims quickly and accurately
Enable high-quality, effective transaction management.
Simplified transactional workflows
Route transaction data to the appropriate processing path to streamline workflows, even with multiple claims systems and lines of business.
Advanced claims edits and routing
Apply advanced claims edits directly to submitters to catch errors upfront so claims are cleaner when routed for processing.
Payer research portal
Our payer portal provides analytics, warnings and alerts. The portal also highlights rejection details in an EDI or paper claim view.
Reduced administrative waste
Reduce administrative waste stemming from low first-pass rates and claim rework from incorrect outings across multiple adjudication systems.
SmartEDI FAQ
SmartEDI is designed for health plans and other payer organizations. It supports front-end claims editing by helping identify issues before adjudication.
SmartEDI operates before adjudication. It helps identify claim issues early in the workflow so corrections can be made before additional downstream processing.
SmartEDI adds payer-specific edits and routing logic. A clearinghouse typically focuses on connectivity, format conversion and basic transaction validation.
SmartEDI supports front-end claims workflows that depend on accurate submissions and early issue detection. It’s especially relevant where cleaner intake and routing can improve efficiency.
Claims editing is the process of reviewing claims for errors or missing information. It helps identify issues early so claims can be corrected before they move further into processing.
Front-end claims editing is claim review before adjudication. It helps identify submission issues early, which can reduce rework and support smoother claims processing.
Front-end claims editing can help reduce rework by identifying errors and missing information earlier. This gives issues a chance to be addressed before claims move further downstream.
A clean claim is a claim submitted with the required information in the correct format. Clean claims are easier to process and can help reduce delays and administrative rework.
A claim rejection usually happens before adjudication because a claim has errors or missing data. A claim denial typically happens later when the claim does not meet payment or coverage requirements.
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