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EDI
Electronic Data Interchange
exchange structured info
agreed…
EDI
Electronic Data Interchange
- exchange structured info
- agreed message standards
- minimum of human intervention
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Eligibility Verification
New Clients
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Identify client's payers
Register client with their payers, as needed
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Configuration
- Tax IDs (gen_rc files)
- NPI's Type 2 (provider table)
Turn Eligibility ON
- ced (ecs_rc)
- PCC EHR Permissions
- Test to make sure it works
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General Workflow
client submits an eligibility request
(Partner generates a 270 ANSI X12 formatted file and submits it to the Hub)
Hub
- listens for requests...
- receives the request
- validates the requests
- identifies where request needs to go
- rtelig file instructs how to format the 270 requests
- sends the request to the next entity (payer/etc)
Hub
- receives response from the entity
- sends the response to the client
Client
- response receive on client's server
- user sees the response (software makes it readable)
- user consumes the eligibility information and acts on it.
(sets elig statuses, notes, policy changes, etc)
Infrastructure
Vendors/Payers
- setup of new
- maintain established
- There are payers that cannot process eligibility requests
Clearinghouses
- setup of new
- maintain established
Vendor's/Payer's Clearinghouses
- setup of new
- maintain established
PCC Financial Hub
- setup of new connections
- maintain established
Standards
- setup of new standards
- maintain established standards
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Support
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User Error
- Policy info incomplete
- Pt Sex missing
Proactive
partnercron runs at night
- submits batches as needed
- submits RT requests for upcoming appointments
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We receive emails from the entities about connection interruptions/restoration that we would like to more automatically communicate to the client.
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