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Claim Processing / Claim Status

Claim Processing

Our Claim Processing Services provide immediate responses so you can detect claim errors, reduce the risk of compliance issues and ensure accurate reimbursement before claims are submitted to Payers. Real-time processing and pre-adjudication for all claims. Accept real-time and batch inputs. Receive real-time responses integrated into your workflow prior to submission. Our Claim Processing Service supports both provider claims (professional claims) and hospital claims (Institutional claims).

Clinical Coding Verification Service – Best of breed clinical claims scrubbing in real-time. Receive responses in standard X12 response format or human readable reports. Configurable filters invoke on per claim basis, based on procedure codes, total charges, provider and payer.

Level I – Includes real-time HIPAA validation, payer edits, delivery to payer, acknowledgement and payer status.

Level II – Includes Level I plus Clinical Coding Verification Services (CCVS) which provides clinical scrubbing including National Coverage Determinations (NCDs); Correct Coding Initiative (CCI) and Medical Necessity edits.

Integration & Reporting – Many formats and integration methods are available for claims and responses; all levels include robust web-based reporting and query capabilities.

  • Increase collections and receive full, accurate payment
  • Capture missing procedure codes and additional revenue
  • Accelerate cash flow
  • Cut costs by reducing rejections which reduces your staff’s time to rework claims
  • Verify eligibility prior to claim submission
  • Ensure payment accuracy, timing and reconciliation
  • Detect claim errors, rejections and potential denial issues prior to submission
  • Reduce compliance risk by reducing your exposure
  • Easy to use and understand responses
  • Define your own views, workflows and reporting
  • Define your own business rules as part of your workflow
  • No system changes – We can work with your existing systems and vendors or carry your transactions

Claim Status

Automate request and response for claim follow up. Flexible inputs and outputs for easy integration with your systems. Validate and track claims through their entire life cycle. Receive everything that the payers store and HIPAA supports including HIPAA claim status codes, rejection reasons and paid date. Also supports manual input or launch a transactions from and existing record.

  • Reduce phone calls
  • Improve billing accuracy
  • Cut costs


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About the free trial

We offer new provider accounts a 14 day trial period for the Payer Gatewayplus application. After you complete the online enrollment process and your account is approved, you will gain access to the Payer Gatewayplus application and begin your free 14 day trial.

This trial includes up to 300 transactions, including Medicare for 14 days. Try it out to make sure that our Payer Gatewayplus will meet your needs and expectations before you are charged anything.