©2018 by Switch RCM, LLC

EDI Transaction Processing

Process

Process healthcare EDI transactions with us including

  • Claims submission

  • Solicited claim status inquiry

  • Enhanced claim status response

  • Electronic remittance advice (ERA)

As a provider, if you are paying for claims, solicited claim status or ERA transactions, you are likely paying too much money. Billing systems that are now capable of producing clean claims, combined with increased payor-clearinghouse exclusivity, have changed the EDI market in a way that should benefit the provider financially. But in large part it hasn't. We can help you realize those savings, often 50% or more of what you are paying for your current EDI solution.

Cost savings

  • We only deal in electronic transactions and do not provide a traditional clearinghouse application/website/program for four reasons:

  1. Claims today are cleaner than ever coming out of the billing system, so fewer modifications are necessary​

  2. Errors on claims should be corrected at the source (in the EHR/PMS/billing system) and not in the clearinghouse

  3. The valuable reporting data in your claims, status and remittance transactions are tied directly into Switch RCM's analytics platforms and linked with the data from your billing system

  4. If you don't need a clearinghouse application for claim editing or reporting, then you shouldn't have to pay for a clearinghouse application

Electronic claim submission

  • Most payors offer a claims submission gateway with no transaction fees, so why are you getting charged for the transactions?

  • We submit through the most direct, cost-effective route with complete transparency because you are the submitter

  • Our support fees are our only source of revenue; we take no clearinghouse or payor kickbacks

  • No directional bias that comes from selling claims to other clearinghouses

Unlimited claim status

  • Like claims there is almost always a way for a provider to get solicited claim status responses with no transaction fees, so why are you paying for every transaction?

  • Transaction-based pricing models force you to either limit the amount of status you do or stick you with a huge bill

  • The power of claim status is in volume - checking claims early, often and until remittance is received

  • We want you to use claim status, so we provide unlimited claim status for a reasonable, flat rate.

Enhanced claim status

  • There are variations in how payors provide status for claims that are in-process, pended for more information or investigation, and those awaiting a remittance adjudication cycle

  • We understand the processing and payment timelines, as well as the different code combinations that the individual payors use and we normalize and classify status transactions into our own proprietary status grouping to ensure that claims are appropriately classified no matter which payor is billed

  • If your billing system supports it, we can also pass back claim status updates at both the claim and charge level, to automate claim acceptance, the routing of rejected claims to staff and prioritization and automation of work

Staff time savings

  • Don't limit yourself to your clearinghouse's functionality and integrations

  • Leverage the advances in payor online systems that allow for uploading documentation, online appeal submission, and quick claim and payment status

  • We'll guide you to the best place to get information and give your staff the ability to log an update that flows back to your core billing system

Budget Stability

  • No nickel-and-diming based on transaction volume or participation status

  • You pay for support, functionality, reporting and server space, not transactions

  • Pay the same amount every month

Unlimited ERAs

  • Just like claims and claim status these transactions - when available - are almost always available free to providers, so why are you paying for them?