Electronic Data Interchange (EDI) Solutions

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Electronic Claims Service (e-claims)

SPSI's claims service (e-claims) not only offers a comprehensive solution to electronically submit your claims to an extensive payor network, it also tracks each step of the process and provides flexible Internet-based reporting tools to manage your claims.
SPSI's objective is to provide an easy-to-use interface that offers a complete solution for editing, submitting and monitoring claims.
A major part of the SPSI's e-claims complete solution is its robust "Rules Engine" that can identify exceptions before they are submitted to the payor network. The "Rules Engine" identifies and reports claims exception early in the claim life cycle and provides the tools to quickly resolve the exception.

SPSI e-claims features:

SPSI accepts claims seamlessly from virtually any practice management system in most any format. (Claim Image, NSF, HIPAA)
SPSI only requires Internet Access with MS Internet Explorer.
Safe, secure HIPAA-compliant communications via the SPSI’s conduit
SPSI’s rules engine evaluates claims for missing or inconsistent data
The rules engine includes a comprehensive claim rules library
Clients can develop and add their own claim rules to the library
Claims not passing all the rules are posted to a claim exception (tickler) file with information to resolve the exception
"Clean" claims are formatted and communicated based on the varying requirements of individual payors
Claims are mailed to payors that do not accept claims electronically
Payor receipt confirmation and processing status are logged for each claim
Claim Activity History may be viewed anytime via the Internet
Reports can be configured to match your organization's workflow
Reports include cumulative and statistical reporting

Benefits

Faster claims turnaround
Better management tools through custom reports
Automated edit rules for claim accuracy
Periodic statistical reporting for analysis
Lower rejection and denial rates
Submission to over 550 payors (and growing)
Customizable rules for checking data
Secure and HIPAA-complaint communications
Claim search, tracking and status via the Internet
SPSI responsible for all payor changes
No hardware cost, monthly service or connection fee, only a minimal claim fee. Pay only for what you use