Erf Pp
description
Transcript of Erf Pp
Electronic Response File Reader
Takes you…
Response File Reader• Allows the user to read and translate a variety of
EDI formats including:
– 835- Health Care Claim Payment/ Advice– 271- Eligibility, Coverage or Benefit Information– 277- Health Care Claim Status Notification– 820- Premium Payment for Insurance Products– 834- Benefit Enrollment and Maintenance– 837- Health Care Claims– 997- Functional Acknowledgement File
• Will save valuable staff time
• Used all across the country in both payer and provider organizations
• Actively manage your EDI files!
• This demonstration will be primarily dealing with an 835 remittance file, but our ERF Reader will function in the same way regardless of the format of EDI file
To get started simply click the File> Open tab and select the EDI file that you want to analyze
User can pull out useful information at a quick glance with our summary data
File summary provides data about the selected EDI file
Grid Summary provides an overview of all information currently in the GRID
Information at the Remit Level appears here such as payee, check amount, check date, etc.
Summaries can be collapsed for better grid viewing
Quickly filter data to show only payments, pended claims, and/or
denialsCan sort any column to quickly find needed data by clicking the column
heading (asc. or desc.)
Over 50 customizable data fields that can be removed from/ added to grid as needed
Every column can be moved, expanded, or contracted for the layout that best suits your needs
Find function allows user to lookup specific data in any column on the grid
Advanced Find feature allows user to search by individual
Column, as well as usesearch parameters
You can also produce a traditional style Paper Remit (EoB)
Payers can adjudicate health care claims a number of different ways.
For example, some payers adjudicate claim information on a claim basis, some adjudicate at
a procedure level (line item detail level).
The Reader from EMS allows you to view your remittance in either of these manners.
Let’s look at a page from Traditional Paper Remit (EoB)
835 Claim View vs. Detail View
The claim header information, plus the totals for the whole claim – regardless of the number of
individual procedure lines that may be included on the claim.
CLAIM VIEW
One Line Per Claim
Let’s look at a page from Traditional Paper Remit (EoB)
835 Claim View vs. Detail View
Detail View shows each and every detail line that is provided, along with procedures, charges, adjustments, allowances, and payments by line (if provided)
DETAIL VIEW
Each Detail Line in the
835 File is Shown on its
own line in the Reader Grid
Can take desired data (all the denials in this example) and export the report into Excel or in a tab-delimited form- also note that the grid summary information has changed
User can easily print reports as needed also
A sample printout
997 Capabilities
Our reader has the ability to read and interpret 997 files and give you the status of a given claim
997 capabilities
When paired with an 837 file our 997 format can tell you if, and where, errors exist in the coding when present
For more information feel free to call us at 716-626-3310
To download a full-functioning demo of the reader visit our website: www.emscorp.biz