X -Link Electronic Data Interchange (EDI) will automatically transfer patient demographic, insurance, billing, and claim information from the PMS to the EDI Receiver.  X -Link EDI is an All-Payer solution which allows you to pick which claims to send directly to the insurance carrier (if available in your area), or to YOUR choice of clearinghouse.  Most practice management systems do not allow your choice of clearinghouses and/or don't allow claims directly to the insurance carrier.  X -Link EDI circumvents this by connecting natively to the PMS database and sends HIPAA ANSI X12N 837 compliant transactions to a large choice of EDI Receivers.

Electronic Claims Processing is a process by which practices and hospitals can send their insurance claims via Electronic Data Interchange (EDI) to the insurance carriers.  The benefits of EDI include faster claims reimbursement, electronic claims error checking (called claim edits), reduced paperwork, increase productivity, and happier office personnel.

Key Benefits

• Scrubs Claims to Ensure Compliance
• Tracks Claim Status
• Automatically Posts Remittance Advice

What Is Electronic Claims Processing?

Electronic Claims Processing is the method by which you send claims to the insurance carrier electronically instead of by paper. 

With electronic claims, you send the claims via Electronic Data Interchange (EDI).  Using a modem or an existing internet connection, you send claims either directly to the insurance carrier, or to a central processing center, commonly called a clearinghouse.  Clearinghouses send claims to several insurance carriers for you.  Many larger insurance carriers, including Medicare, Medicaid, and Blue Cross / Blue Shield have created connectivity to send claims directly to them, without sending claims to a clearinghouse first. 

Electronic claims provide many benefits that paper claims do not, including:

Error Checking Most clearinghouses and many direct claims processing payers offer front end edits.  These check the entire claim file for errors and immediately reject claims for data entry mistakes, missing information, invalid information, etc.  Most paper claims are processed by an overworked employee of the insurance carrier.  They will typically stop processing a claim when they find the first rejection.  Front End edits on EDI claims check the entire claim file and provide all rejections.  X -Link EDI has these same edits directly in our software, so you can fix the problems even before sending the claims.

Faster Reimbursement.  Paper claims take at least a week to simply get from your office to the payer.  With EDI claims, they send immediately.  Most carriers delay payment on paper claims.  Medicare delays payment a minimum of 28 days for paper claims, only 14 days for Electronic Claims.  Rejections will dramatically increase the payment delay for paper claims.  EDI Claim rejections could be resolved within minutes of transmitting the initial batch.

Immediate Claim Rejection.  With paper claims, you must mail the claim and then wait for the response.  This can often take weeks.  With Electronic Claims, you transmit the claim file in a few seconds and typically get an immediate response from the front end edits.  

Higher Reimbursement Rates.  Because you are sending 3+ times the information with Electronic Claims vs. Paper, you are much more likely to have the claim accepted.  Payers also have reduced overhead costs for electronic claims, so they are motivated to process EDI claims more quickly than paper claims.  They want ALL providers to send Electronic Claims.

Increased Productivity.  Most offices spend hours each day handling paper claims.  You have to verify the data is correct, print the claims, check again to make sure they printed correctly, print envelope labels, sort the claims and insert them into envelopes, seal the envelopes, and then drop them off.  With electronic claims, you save all of that time by simply sending the claim in few clicks of the mouse.  A few seconds later, you find out if the claims were accepted or rejected, and why they were rejected. 

Reduced Paperwork.  Most medical offices are swimming in paperwork.  Paper claims just add to these piles.  Help reduce paperwork by getting a 1 page summary report of all claims sent in one day, instead of a copy of the claims.

X -Link EDI provides the power of choice - allowing you to pick your PMS and your choice of clearinghouse or direct payer, in seamless interfacing.  This ensures you can choose the right option for your office, even if there is only 1 factory solution.  X -Link EDI also offers true Claims Management, Claims Status Response, Electronic Remittance Advice, and Benefits Management.  Additionally, it offers many front-end pre-edits and claims scrubbing, prior to sending the claims.

Notes on X-Link EDI