EDI Claims Payment Processing

Automated Payment Processing – Designed for Medical Practice Group Business Unit Autonomy

ReMedics streamlines the payment process of all paper and electronic remittance, significantly enhanced using one of our custom integration and business process outsourcing strategies — connecting to your existing Practice Management System and Clearing Houses.

In systems that support electronic uploading of remittance data, our proprietary payment processing technology automatically checks the data for accuracy, system errors and missing information that can delay payment. In most cases, we can identify the information required to quickly validate a claim by viewing the EOB and/or correspondence indexed in our system.

For systems that don’t support electronic upload or lack EDI automation, ReMedics fully outsourced payment processing solution provides comprehensive paper to 835 conversion services, as well as conversion to HIPAA-standard remark codes for payers. We utilize Key from Image (KFI) workflow and Artificial Intelligence (AI) technologies to process your paper EOBs, downloaded to our secure, web-based portal and document management system. 

Payment Posting and Reconciliation

We work with your banking institutions through both retail and wholesale lockbox(es) for payment consolidation and document capture of paper remittances. Once processed, ReMedics provides normalized 835 files for direct integration to your Practice Management System(s) in a multi-submitter, single receiver environment. Reconciliation of all lockbox/remittances is completed through ReMedics Treasury Reconciliation solution whereby your bank deposits are segmented by division or business unit,

Payment Validation & Remittance Splitting

ReMedics ensures that correct information is applied to patient accounting systems by cleansing data prior to upload. A configurable rules-based engine scrubs payment (ANSI 835) data before it is submitted to the Line of Business (LOB) system and allows exceptions to be worked in an on-line tool for correction and re-submission. Co-mingled remittance transactions can be automatically split using client-defined criteria and associated with the appropriate practice management system while maintaining batch integrity. Regardless of how the original data was captured, by applying these rules, data integrity is improved resulting in fewer items to be worked as downstream exceptions.

Medical Practice Group Payment Processing Benefits

  • Business Process Outsourcing (BPO) solution for fully outsourced payment processing solution
  • Seamlessly integrated with existing Practice Management Systems (PMS) and other Line of Business Systems 
  • Leverage existing line of business core application investments
  • Integrated processes and centralized location for all payments, denials and reimbursements
  • EDI and paper-based claim capture with rules-based validation automatically identifies missing data
  • Receive ERA files for all payors/providers, including those that only provide paper
  • Normalize 835 & 837 data across payors and providers
  • Ability to support system specific data requirements
  • Capture of all denial codes, zero pays, comments and other transactions
  • Automated transaction validation, payment posting and data repair
  • Staff is only handling exception errors when necessary
  • Reduced staffing costs and timely secondary billing
  • Supports multi-submitter, single receiver practice aggregation business model
  • Bank deposits segmented by division, balanced, and reconciled daily at divisional and enterprise level
  • Maintain practice group/business unit autonomy