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Electronic Interchange with Payers

Since we host your data, we assume the responsibility for producing and transmitting your electronic claims, for receiving and posting your electronic remittance notifications, and for receiving and sending to your database front-end payer reports. With North Carolina practices, we have direct links with Medicare, Medicaid, and Blue Cross Blue Shield. For other payers and for practices outside North Carolina, claims, reports, and electronic remittance notifications are routed through Emdeon, the leading clearinghouse solution provider.

Payers report whether or not they have accepted (passed front-end edits) your claims for adjudication,  within hours of submission. We retrieve these reports from payers, copy them to your database, and register them in an unexamined payer report list. This list is one of many to-do Lists within the system. When you have examined the reports, you mark them as examined, causing them to disappear from your list.

We post not only electronic remittance basics, but also most other information provided by the payer, including crossover information, bank deposit numbers, payer-assigned claim numbers, DFI numbers, and so on.

Our electronic remittance posting process requires that information in the remittance advice match date of service, procedure code, patient name, policy number, etc., within your database. If the posting process fails to achieve an adequate match, which does happen occasionally, we provide you with another to-do list which makes it easy for you to isolate a problem remittance, fix it, and then re-run the automated posting process yourself, without resorting to manual payment posting. 

We generate secondary as well as primary electronic claims, which require full and complete COB information from the primary payer.

We personally serve as an intermediary between you and payers or Emdeon for especially difficult cases involving obscure EDI errors that payers or clearinghouses sometimes report. This is covered in your standard monthly fee.