EDI & Encounter Management
Capabilities

Seamless EDI communication between various entities like Payer, Provider, TPA, PBM in the Healthcare continuum is of paramount importance to the effective delivery of member service. Payer industries often face challenges in integrating various transaction sets that are integral for seamless delivery. 

Infinite’s EDI platform offers seamless integration of various entities within the Healthcare ecosystem. It is HIPAA compliant microservices-based healthcare platform to process healthcare industry standards -EDI, HL7, and SMART on FHIR Integrations and non-EDI transactions. Cloud-based, lightweight, and containerized architecture makes it easy to implement simplifying the infrastructure complexities and maximizing the usage of infrastructure thru auto-scaling also ensuring high-availability.

Key highlights of the platform:

  • Encounter Management.
  • Eligibility and Enrollment Management.
  • Enables business process design and optimization.
  • Security and Privacy.
  • Lower Account Receivables.
  • Industry-standard Data Exchange.
  • Reduce Administrative Expenses.
  • Clinical Integration and Decision Support. 
  • Faster Information Exchange.
  • Interoperability.
  • Cloud-based and Containerized Architecture.
  • Real-time/Near real-time transaction process.
  • Next Generation Design.
  • Faster Resolution of Submission Errors.
  • Compliance Management.
Experience
  • 20+ Payer Clients.
  • Expertise on Medicaid, Medicare, Dual, Commercial, and Marketplace LOBs.
  • Impact: 80M Patient Lives.
  • 90%+ clean claims processing in the first pass of adjudication.
  • 10+ Solution Platforms across digital transformation including Hosted EDI platform with integration across the Health ecosystem.

Features:

  • Intake of inbound Encounters with L1-L7 Validations + Custom rules and edits / by state.
  • Acceptance and Rejection with 999 ( partial or full).
  • Generate Outbound Encounter data/file from Claims Systems or DW/Staging ODS.
  • End to End Encounter Tracking.
  • Hold, fix, or discard/regenerate error encounters.
  • Match Outbound encounter edits to inbound.
  • Keep up to the states' validation edits changes (proactively update).
  • Load Response from the state (EVR, 999, 277CA, 835, txt reports).
  • Trading Partner Setup.
  • Add Custom Validations by state.
  • Inbuilt data checks for Code sets.
  • NPI , PECOS, Provider Taxonomy checks.
Capabilities

What we offer

Claim and Encounter Manager

Claims and Encounter Management system is built on Enterprise Transaction manager platform to generate, validate, send, receive and reconcile 837 I/P/D transactions. It is fast, highly configurable and scalable architecture enables processing more than half a million claims a day, increasing the auto-adjudication rates and reducing claim denials.

Eligibility and Enrollment Manager

Eligibility Management system is built on Enterprise Transaction manager platform to streamline and automate the enrollment lifecycle. It’s highly scalable, API based architecture enables processing millions of enrollment records within a very short period thereby significantly enhancing Eligibility load and coverage turnaround time.

Communication and Collaboration

Enhance collaboration with numerous providers and vendors, and the shared services approach reduces redundancies and includes predictable pricing, allowing for higher volumes of transactions, including eligibility, and claim status.

Predictive Analytics

Predictive analytics with real-time dashboard reporting and analytics, to enhance the ability to plan for future demand as eligible populations grow and shrink, easing budget restrictions.

Inbound and Outbound Transactions Support

Complete EDI solution to integrate any EDI and non-EDI transaction across Payers, providers and clearing houses. Implement 834, 837, 820, 835, 271, 270, 275 and 278 transactions. Pre integrated with leading claims systems like Qnxt, HealthEdge, Facets and others.

Workflow Automation

Workflow Automation to simplify workflows, decreases paperwork and reduces waste.

Omni-Channel Service

Connect provider and payer systems through their preferred channel (SFTP, web based Direct Data Entry, Secure Private network, mobile phones or tablets) making communication easier and the exchange of information more secured, timely and accurate.

Patient Provider Payer (P3)/ REAP Platform

Integration of Patient, Provider, Member & Health Plan data in near real-time bi-directional manner using Interoperability Hub – FHIR API Integration.Drive PHM campaigns through our platform engagement.Patient outreach / digital engagement using platform outreach for decreased MLR. Population Risk Assessment & Stratification, Care Coordination & Management and Effective Member Engagement.

Zyter EDI Manager TM

EDI & Encounter Management

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