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expEDIum Claims Portal

The expEDIum Claims Portal is a web based secure Claims Processing solution that has a variety of features including provider side web based secure access and high performing backend expEDIum Claims Portal Components.

Manufacturer - iTech Workshop Private Limited
Model # - Saas 7.0
Submitted By - iTech Workshop Private Limited (Owner)
Category - Software : Medical Software : Claims Processing

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Specifications

Medical Software :   Web Based, SaaS
Payer Connectivity :   Direct, Multiple
ERA/EOB Posting :   Automated
Claims Processing :   Automated
Healthcare Claims :   HCFA, CMS-1500, UB-04
Codes :   ICD-9, CPT, HCPCS,ICD-10
Electronic EDI claims :   v4010A1 ,v5010

Details

The expEDIum Claims Portal is a web based secure Claims Processing solution that has a variety of features including provider side web based secure access and high performing backend expEDIum Claims Portal Components.

This solution is an optimal way to allow Practices, IPAs, Clearinghouses, Billing Services and Hospitals to connect to one or more Payers or Clearinghouses directly and make the claim life cycle visible across the spectrum and make the claim management more efficient and predictable.

This solution supports a handful of legacy formats and can be extended to support additional formats on a need basis. The solution works with HCFA/UB04 forms and can be customized to work with any other standard/non-standard healthcare forms.

Key Features

* Multiple account support, each account can be a Practice, a Billing Service Bureau, a Clearinghouse or a claim operator
* Automated population of provider data from account setup to create complete claims
* Multiple healthcare file format support (legacy formats such as NSF, TNSF, HCFA Print Image, HCFA CSV and 837P, HL7, XML)
* Batch uploads and processing
* Patient Demographics capture and lookup
* Primary and Secondary billing, Automatic population of COB data on Secondary claims
* ICD-9, CPT, HCPCS code lookups and validation (ICD-10 support will be available soon)
* Taxonomy code lookup
* UPIN lookup from custom URLs
* Standard healthcare form based L1, L2, L3 validation and scrubbing
* Rule based automated and manual routing/creation of Electronic or Paper claims
* Exhaustive payer list, lookups and Payer ID validation
* Multiple Trading Partner Profiles/Multiple Carriers
* Printing of Paper claims on stationary
* Automated creation of Payer Ready Electronic EDI claims (currenly v4010A1 is supported, v5010 support will be available soon)
* Automated processing and claim level reconciliation of delayed payer reports - both standard (such as TA1, 997, 277U, 824, 864, 835) and non-standard reports
* Account specific ERA/EOB creation
* Patient Statements [as an option]
* Claim History
* Data Archival of aged batches, claims and other data
* Customizable data edits, payer edits and business rules
* Message based communication with users from Portal Administrator
* Customizable Admin dashboard showing a summary from the system
* Customizable Reports module to create reports in PDF or CSV formats
* Secure Web services interface with SSL authentication and encrypted login for integration with web based EMR systems
* Near Real-time and batch level Eligibility Enquiry/Response
* Production driven, High performance, scalable solution

Client side access

* Web based secure provider/client/operator access
* Account Password expiry
* Customizable Reports module to create reports in PDF or CSV formats
* Provider side uploads of different healthcare format files (supported formats listed above)
* Provider side claim scrubbing
* ERA/EOB automatic/manual posting and reconciliation
* Creation of ERA/EOB from posted batches
* Currently deployed to handle specialties such as General, Chiropractic, Podiatry, Physical Therapy and Ambulance claims, capable of handling any specialty claims without any changes (or with minimal edits). Please contact us with any specific requests

Automated Payer Connectivity

* Automated upload of HIPAA compliant, payer ready claims to configured payers and clearinghouses
* Automated download of payer side reports including TA1, 997, 277U, 824, 864, 835 and non-standard reports
* PGP (RSA & Diffie-Hellman) and ZIP with password support
* Standard secure transportation mechanisms such as SFTP and FTP (FTP over VPN, HTTPS and Dialup will be available soon)

Technology

* Platform independent, J2EE based scalable solution
* Needs an Application Server such as JBoss, Websphere or Glassfish
* Uses PostgreSQL, a robust and reliable open-source relational database system, portable to other DBMS
* Tested in OS platforms like Windows 2003 Server, Solaris and Linux distributions such as Redhat, Fedora, Debian and Ubuntu

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