MiddleSolve/Provider Claims Manager for Payers is an enterprise level integration solution allowing health plans to offer secure electronic claims submission capabilities to all their member hospitals and practices. When legacy practice management and hospital information systems are unable to produce HIPAA compliant transaction formats, Provider Claims Manager offers a direct path to generating and distributing electronic claims with no impact to their existing applications.
Providers use a comprehensive user-friendly desktop portal to manage their claims throughout the submission process, with real-time functions for loading, reviewing, and editing claims online. Our integrated translation function supports a seamless data exchange with legacy systems, accepting existing print image or structured formats.
Health plans control the entire claims submission workflow using the Claims Manager Gateway, a central processing server for managing transaction activity. The Gateway offers claims validation and data augmentation features that can be configured based on individual providers and even specific line of business requirements. Providers receive immediate notification of any incomplete or incorrect claims while the help desk screens allow end-user inquiries to be quickly resolved by the plan. Data content formatting and bundling services provide flexible integration options with both front-end and adjudication systems.
MiddleSolve/Provider Claims Manager can be implemented on the health plan’s choice of industry standard servers, and deployed to providers in any combination of centrally managed, distributed, and desktop environments.
edisolve offers a complete turnkey installation including training and support packages, helping health plans quickly realize the increased efficiencies and cost savings through higher EDI adoption rates and the improved claims quality that Provider Claims Manager delivers.
