Features
Features- EDI claims move quickly and accurately to all participating business entities
- Claim recipient determined by client’s business rules
- Business rules are easily updated to reflect new network members (providers, payers, repricers)
- Timestamp receipt of every claim available to sender of claim
- Complete audit trail for every claim
- Single FTP site for receipt and transmission of claim files
Benefits
Benefits- EDI transmission eliminates errors, data or paper loss
- Claim turn-around-time is significantly reduced
- Claims move to auto-adjudication and payment much faster
- Costs of adjudication and handling are significantly reduced
- Reduced manual effort and associated administration costs
ClaimsBridge Routing Services evaluate each claim, based on the business rules of our clients, to determine each claim’s next recipient. The rules based routing engine handles complex flow paths efficiently with full tracking capabilities. The use of the routing service is largely transparent to ClaimsBridge clients but the benefits are significant.
Point-to-Point Routing
In the simplest case Routing Services receives a claim from a submitter (clearinghouse, PPO, provider) and then transmits it to the receiver (payer, PPO) for further processing.
Wrap Routing
Wrap routing is a rules-based structure that seamlessly adds wrap networks in the claims flow. Based on rules defined by the client (e.g. non-par) multiple or tiered networks can be routed to for processing before delivery to our clients.
Affiliation Routing
Affiliations of networks/PPOs offer one of the most complex claim routing challenges. By joining together, multiple PPOs create a larger and more competitive network solution for payers and employers. The ClaimsBridge router solves the complex affiliation claims flow using customizable business rules utilizing data such as subscriber eligibility or provider location.
