Paragon 21

Electronic Claim Processing

Allow providers to submit claims electronically and assess them automatically

Electronic Data Interchange (or EDI) allows providers to submit claims electronically to a clearinghouse (such as HICAPS or IBA Health Point) where they are electronically transmitted to each Fund. Funds then have the option to assess the claims on-line or automatically. Automatic assessment allows claims to be assessed with little or no assessor intervention.

Significant Strengths

Supports on-line, batch, or electronically entered claims.

Supports two different methods of assessment – on-line or automatic.

Supports a large number of system and user-defined edits in the automatic assessment process.

Eliminates assessor intervention on many claims.

Processes a series of management reports that indicate the results of all automatically assessed claims.

Registers all claims prior to processing.