Claims Processing

The network uses FHIR and distributed ledger technology for payer-to-payer interoperability, prior authorization and more.

Health insurance companies increasingly face challenges in capturing and collecting revenue. Save time and money and prevent provider conflicts by addressing claim errors before payment.

The No Surprises Act and the Transparency in Coverage Rule have brought new requirements for insurers. Deadlines for compliance are fast approaching, but we have the support and guidance you need. 

"Traditional risk-adjustment solutions have rapidly outgrown their retrospective-only payer use cases," Edifecs' CEO said.

In the 2022 plan year, new requirements for improving healthcare cost transparency and encouraging consumer engagement will take effect. Here's what you need to know about the new NSA member ID and Advanced EOB requirements.

The companies say they will use artificial intelligence and machine learning to digitize healthcare claims and improve the accuracy and timeliness of the process.

Aetna says it wrongly denied requests to cover fertility treatments for certain individuals and that it would rectify its mistake.

The Data Aggregator Validation program is aimed at ensuring the validity of clinical data and saving provider organizations time and money.

Two examples: It obtains denial information three to 14 days faster, and it has seen a 20% reduction in the number of employees supporting insurance-claims status workflows.

The new capability is aimed at employer-sponsored plans, building  on existing initiatives for UHC Medicare and Medicaid beneficiaries.