Services

Payer EDI Services

Payer EDI Services leverages our broad healthcare technology network with extensive connectivity to expand your EDI transaction reach.

Payer electronic data interchange (EDI) transactions include eligibility verification and claims processing to help streamline operations, improve efficiency and reduce costs. Our modern network allows for more rapid implementation of new product features. Expanded network capacity improves scalability for any level of volume. We focus on network safety and follow best-in-class security practices. Our network offers secure solutions for every stage of the claims continuum.

Increased EDI accuracy

Claims go through pre-adjudication on first pass, which makes it less likely that they will be rejected or denied. This also helps to reduce the costs of administration.

Increased connectivity

Additional entry and end points within the healthcare ecosystem are provided to help streamline EDI communications and drive efficiency.

Expand EDI reach

Our vast, nationwide network provides extensive connectivity to expand your reach. We serve 7 out of 10 health plans and offer connectivity to 9 out of 10 U.S. hospitals. We process over 50 million transactions weekly and support more than 2,000 payer connections, and growing.

Medical Network bundles

  • Icon

    Batch claims

    Flexible and easy to implement, batch claims allows pre-adjudication claim validation initial editing and processing of submitted claims.

  • Icon

    Claims and ERA

    Complete the claims EDI cycle by combining our claims processing and electronic remit advice (ERA) functionality for a single point of connection for these core services.

  • Icon

    Eligibility, claims and claim status

    We can help improve your core EDI transactions. You can also work with us for eligibility transactions (directly or hosted), claims preprocessing and claim status. This can help lower administrative costs and give providers and submitters better access, nationwide.

  • Icon

    CORE EDI Services

    Our core EDI Services also include a full range of EDI clearinghouse services including batch Claims, electronic remit advice (ERA), real-time eligibility and claim status

  • Icon

    Payer Connectivity Services (add-on)

    Payer Connectivity Services provides enhanced claims administration, routing and first pass ajudication logic that consolidates EDI transactions into a single connection point.

  • Icon

    Hosted Payer Services (add-on)

    Hosted Payer Services offers real-time processing of eligibility requests (270/271) and claim status requests, (276/277) on behalf of the payer, where we host their data and provide the responses. 

Related resources
Learn more
FACT SHEET

Payer Connectivity Services

Payer Connectivity Services provides enhanced claims administration, routing and first-pass ajudication logic that consolidates EDI transactions into a single connection point.

Learn more
Learn more
FACT SHEET

Hosted Payer Services

Hosted Payer Services offers real-time processing of eligibility requests (270/271) and claim status requests (276/277), on behalf of the payer, where we host their data and provide the responses.

Learn more

Marketplace updates

Subscribe to The Spark

We're adding new products and services to rapidly expand our marketplace and the potential is huge. Be an early adopter and stay ahead of the trend with our bi-weekly e-updates.