Company

ClaimEDIx © was incorporated in 2002 for the purpose of developing enterprise class software programs and solutions for the managed care community.

Through extensive research and hands on experience with our managed care organization partners, ClaimEDIx identified the following challenges that adversely impact the daily administration of managed health care and claims processes.

• Maximizing auto-repricing
• Billing and payment tracking
• Conversion of paper claims to electronic claims
• Managing multiple products and fees for services
• Identifying and correcting incomplete/inaccurate claims
• Compliance with Federal HIPAA EDI transaction requirements
• Billing PM/PM, % of savings, per transaction, flat fees for services
• Managing multiple networks PPO, EPO, HMO, Worker’s Compensation
• Imaging, archiving and retrieval of claims and pertinent data for analysis
• Accommodating multiple disparate fee schedules for a single provider
• Accommodating provider’s that desire to “opt out” of participation with a client, payer, carrier, broker
• Reporting the efficacy of the network(s) operations to clients, payers, brokers, stop loss carriers, and providers
• Centralizing all data accessed by all departments (claims, accounting, customer service, sales, and management)
• Relating claim submission to a participating provider, product, network, fee schedule, group, payer, and patient

With our more than 40 network partner’s input, we have developed products to meet these challenges, increase productivity and decrease the cost of administering a managed care organization.

In addition, our team of highly qualified solution developers can analyze, design and deliver custom solutions in any environment including web, client-server or n-tier.