HIPAA Compliant Electronic Data Interchange (EDI)
e3 Informatics can help you implement, configure and test
- 837P Professional Claims
- 837I Institutional Claims
- 835 Claim Payments and Denials
- 820 Member Premium Payment
- 834 Member Enrollment and Maintenance
- 270/271 Member Eligibility Request and Response
- 276/277 Claim Status Request and Response
- 278 Services Review and Authorization
- 999 Transaction Set Acknowledgment
- 277CA Claim Acknowledgment
- 5010 Compliance
Medicaid Managed Care
e3 Informatics can help you analyze
- 1915(b) and (c) waiver readiness
- Service and authorization trends
- Trends by specific parameters, such as demographics and diagnoses
- High cost services and high cost consumers
- Outpatient claims, inpatient claims, emergency room claims
- Paid claims and denials
- Eligibility/Member months
- Per member per month premiums (PMPM)
- Incurred but not reported claim trends (IBNR)
- 820/834 eligibility reconciliation
