For Payers

Payer Connection Solutions for Healthplans & TPA’s

Today, receiving insurance claims electronically represents one of the many known cost saving measures available to insurance companies. While the industry has spent years perfecting electronic solutions, the majority of claims continue to be transmitted by paper with no electronic feedback loop for handling problem claims.

Products/Services
EDI Network Services
Encounter Data
EDI Management
TrinEDI Portals

Tomorrow, the industry has the opportunity to leverage HIPAA as a means to realize the promised benefits of standard transactions. This includes not only claim submission, but, pre-determination of benefits, claim status tracking, and electronic reimbursement. These benefits are dependent on a physician’s office being connected to this electronic environment.  Payer Connection’s understanding of the process has captured hundreds of organizations wanting to adopt our vision and strategy for HIPAA implementation.

Payer Connection has uniquely brought together the technology and administrative healthcare industry expertise to apply electronic transactions for automating critical business areas such as:

  • Claim Submission

Secure electronic claim transmissions with translation from legacy formats to HIPAA standards for Professional, Dental, and Institutional formats.

  • Business-Based Claim Editing 

Reducing the number of claims delivered in error by implementing Payer specific rules and edits, user defined code crosswalks, and a user intervention workflow application to correct pended claims before and after submission.

  • Automated Claim Status Tracking

Delivers updated claim status information for tracking and managing Payer requests for additional information, providing faster notification of rejects for non-eligible patients, and resubmission processing to correct pended claims.

Payer Connection works closely with Payers to develop a targeted effort directed towards transitioning their physician networks to the standard formats. We base our success on the ability to achieve higher utilization of transactions while reducing call volumes for benefit questions, pended claims, and requests for additional information. Our integrated transaction approach eliminates Payer concerns over typical pricing packages and delivers a measurable return on investment. The benefits are:

  • Customized Payer Edits

Receive cleaner claims with real-time business edits that achieve higher electronic adjudication, with on-line correction and response to your requests for additional information.

  • Flat Rate Pricing

Create predictable expense and tracking of value created by utilization of electronic transactions without risking volatile fees that add additional administrative overhead.

  • Reduce Administrative Costs

Communicate electronically with your providers on pended claims that need additional information for processing, lowering your costs for mailing requests.

Payer Connection packages its services to fit the need of the organizations we serve, big or small. For large Payers who have already invested and are satisfied with their front-end capture and handling of electronic claims, we provide immediate value by delivering claims from our existing client base. For small and even large Payers who cannot justify the expense or have not realized the benefits of outsourcing part of the trading partner process, Payer Connection delivers the following services.

  • HIPAA EDI Hub

Provides the capability of sending/receiving HIPAA EDI transactions with your trading partners. Handles receipt of transactions, creation and delivery of functional acknowledgements, and reformats data to the specification of internal legacy systems. By building custom business rules, problem claims can be handled before they get stuck in the mix of other claims.

  • Co/Full-Branded Services

Payer Connections communication technology integrates seamlessly into any Web Intranet or E-Commerce site. We provide the complete set of management tools with your logo and color scheme displayed prominently in the surrounding frame. This Branded effort is a strategic and powerful way to achieve not only HIPAA transaction compliance, but a truly functional system to be used by internal staff as well as external Trading Partners.

  • Full Integration

Some Payers may prefer to fully customize the Payer Connection EDI Hub. We deliver the framework to build a proprietary healthcare dashboard. The framework provides the system architecture, data model, role-based and privilege based security, and an extensive knowledge base to achieve your branding strategy and business needs.

Call us to discuss your needs today.