EDI Messaging
Achieve payment accuracy early in the value stream by shifting claim edits into the electronic data interchange (EDI) workflow.
Improve provider collaboration and satisfaction
Editing in EDI workflows provides early editing transparency that can lead to higher first-pass adjudication rates. Edits are provided via industry trading partners using the standard 277CA transaction, so there’s no change to existing claim workflows or technology.
Lower administrative costs
CES EDI Messaging notifies providers to self-repair claims before they enter a health plan’s system. Actionable claims feedback can help reduce the costs associated with appeals, resubmissions and manual rework.
Seamlessly introduce new policies and editing programs
Introduce incremental medical cost savings opportunities without the provider abrasion that is typically associated with traditional mid-adjudication claim editing.
Extend your editing capabilities
Claims Edit System
Solve editing challenges of all sizes.
Specialty Rx Analytic Suite
Implement specific edits for specialty medications.