Claims Processing Services
With extensive claims processing experience and a portfolio of industry-based solutions, Episource helps payers increase revenue, optimize productivity, and reduce expenses, while sharing critical electronic-based information. We specialize in providing consulting and knowledge management process solutions that address the unique needs of the healthcare payer markets.
Key Conversion Services Offered
- CMS-1500 and UB-04 Paper Claims into a standard EDI Stream (NSF 2.0 or ANSI 837)
- Superbills to a standard EDI Stream (NSF 2.0 or ANSI 837)
Benefits
- Eliminate Paper Claim Processing
- Increased Auto-Adjudication rates (as high as 95%)
- Ability to process custom Superbills capturing HCC Codes
- Submit up to 9 diagnosis codes per claim (only 4 codes available on paper CMS-1500 form)
- Lower Costs and Improve Claims turn-around-time
- View all claims through secure online Image Viewer
Physician Super bill Processing
Episource provides a new Payer service offering that enables us to convert Provider Superbills into EDI formats that are integrated with payer claims adjudication systems. This unique solution eases the burden on Providers to submit encounter data to MSOs, Health Plans, and IPAs, and provides Payers with the ability to adjudicate consistent and increased encounter data in order to capture additional details such as diagnosis codes that have a significant impact under the CMS Risk Adjustment Model.
