Electronic Data Interchange (EDI) Solutions

EDI Solutions Home   Electronic Claims Service   Eligibility Checking

EDI from the Provider’s Point of View

Southwestern Provider Services specializes in helping the provider manage insurance claims by leveraging the power of Internet. SPSI provides the electronic communication conduit and audit trail to effectively manage the provider-payor relationship from the point of claim submission through remittance posting.

SPSI EDI Services

Electronic Claims Submission

• For virtually any Practice Management System
• Submission to over 550 payors
• Automatic editing of all claims for accuracy
• User customizable edits for unique requirements to trap exceptions prior to claim submission
• Claims tracking and status 24 hours a day
• Easy claims searching
• Statistical reporting by selectable time or divisions

Eligibility Checking

• Individual eligibility and benefits checking
• Eligibility checking by your appointment list
• Eligibility checking in batch format
• All eligibility specifics maintained in the audit trail

Remittance Posting

• Retrieval of Electronic Remittances from Payors
• Remittance posted to provider’s patient account
• Remittance (Online EOB) included in the audit trail

Authorization/Referral (in development)

• Authorization/Referral requesting and verification
• Authorization/Referral included in the audit trail

Benefits

• Faster claims turnaround
• Automated claims verification
• Customizable claims editing
• Audit trail of all claim activities
• Customizable reporting as defined by provider
• Easy claim searching via the Internet

SPSI Completes
the Claims Information Loop
For Providers

Provider's Internet Connection

SPSI

Payor Network

HIPAA Compliant
All internet communications use Strong (128-bit) encryption and conform to HIPAA regulations.

Implementation Requirements
Internet Access with MS Internet Explorer 5.0 with “Strong Encryption” installed