PAYOR SOLUTIONS

For payors and those with self-administered health plans, HealthSmart Information Systems offer complete Electronic Data Interchange (EDI) Clearinghouse services. HealthSmart Information Systems offers significant operating efficiencies to the healthcare industry through a range of solutions that streamline electronic claims processing. Our services facilitate "clean claims," resulting in reduced administrative costs for you and improved customer service with your providers.

HealthSmart Information Systems offers both batch and real-time transactions, including all payor-to-provider transactions addressed in the final HIPAA regulations:

  • Claim and encounter submission
  • Claim status inquiry and response
  • Eligibility inquiry and response
  • Review/Inquiry/Response request
  • Electronic Remittance Advice (ERA) delivery
Ongoing and Comprehensive Support

HealthSmart understands the importance of continuing the relationship with our customers after the implementation process is complete. Our experienced EDI staff will help you:

  • Increase electronic claim volumes
  • Reduce administrative costs
  • Reduce support issues regarding eligibility, claim status, ERAs, and referral and authorization requests
Scanning and Optical Character Recognition

We specialize in providing full front-end claims management services, which includes Scanning and Optical Character Recognition (OCR) services. Our processes include multi-level verification and editing to ensure clean claims. Once clean claims are achieved, we provide the electronic claim images online via a secured Electronic Claim Mailbox (ECM). Your mailbox includes a scanned image of each original claim as well as an EDI export of the claims in the requested format. Features of our Scanning and OCR services include:

  • High volume scanning and data capture of paper claims (UB-92 & HCFA-1500)
  • Industry leading editing procedures
  • Data validation by highly skilled staff
  • EDI export of claim claim into requested electronic format (ANSI, NSF, etc.).
  • Online access to claim images via secure website
Complete Mailroom Services

We offer complete mailroom services, so your claims can be mailed to us by the client or we can create a unique PO Box enabling providers to mail paper claims directly to us. We will perform the necessary mailroom services prior to scanning.

Contact us today to find out more about HealthSmart's seamless process from a paper claim to a clean electronic claim and into a client’s claim system. Put HealthSmart's experience and knowledge to work for you today.