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Electronic
remittances provide for Electronic Data Interfaces (EDI) to the respective
third party payors and intermediaries which enable payments to be electronically
applied to the originating claims. In this manner, the system can automatically
adjudicate each claim on a contractual or on a service by service basis while
concurrently applying the contractual adjustments and posting the payment detail. Adjudication
precision to .004% accuracy is routinely achieved.
The process can selectively or automatically submit secondary coverage as a
result of the primary payment. Thus the clerical effort needed to enter
the payments, determine the contractual allowances, make any necessary ESRD
network adjusting entries, and enter adjustments for insignificant rounding
adjustments is virtually eliminated.
Secondary claims are automatically created and are available for immediate
submittal. As a byproduct of the electronic remittance application, cash flow
is improved through the elimination of the delay between entry and secondary
claims generation. This sophisticated tool provides a unique productivity
capability with a very high return on investment.
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Health Informatics
Intl
