Erf Pp


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An overview of our market leading EDI translation and analytic tool

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Erf Pp

  1. 1. Electronic Response File Reader Takes you…
  2. 2. Response File Reader <ul><li>Allows the user to read and translate a variety of EDI formats including: </li></ul><ul><ul><li>835- Health Care Claim Payment/ Advice </li></ul></ul><ul><ul><li>271- Eligibility, Coverage or Benefit Information </li></ul></ul><ul><ul><li>277- Health Care Claim Status Notification </li></ul></ul><ul><ul><li>820- Premium Payment for Insurance Products </li></ul></ul><ul><ul><li>834- Benefit Enrollment and Maintenance </li></ul></ul><ul><ul><li>837- Health Care Claims </li></ul></ul><ul><ul><li>997- Functional Acknowledgement File </li></ul></ul>
  3. 3. <ul><li>Will save valuable staff time </li></ul><ul><li>Used all across the country in both payer and provider organizations </li></ul><ul><li>Actively manage your EDI files! </li></ul>
  4. 4. <ul><li>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 </li></ul>
  5. 5. To get started simply click the File> Open tab and select the EDI file that you want to analyze
  6. 6. 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.
  7. 7. Summaries can be collapsed for better grid viewing Quickly filter data to show only payments, pended claims, and/or denials Can sort any column to quickly find needed data by clicking the column heading (asc. or desc.)
  8. 8. 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
  9. 9. 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 use search parameters
  10. 10. You can also produce a traditional style Paper Remit (EoB)
  11. 11. 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.
  12. 12. Let’s look at a page from Traditional Paper Remit (EoB) 835 Claim View vs. Detail View CLAIM 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. One Line Per Claim
  13. 13. Let’s look at a page from Traditional Paper Remit (EoB) 835 Claim View vs. Detail View 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) Each Detail Line in the 835 File is Shown on its own line in the Reader Grid
  14. 14. 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
  15. 15. A sample printout
  16. 16. 997 Capabilities Our reader has the ability to read and interpret 997 files and give you the status of a given claim
  17. 17. 997 capabilities When paired with an 837 file our 997 format can tell you if, and where, errors exist in the coding when present
  18. 18. <ul><li>For more information feel free to call us at 716-626-3310 </li></ul><ul><li>To download a full-functioning demo of the reader visit our website: </li></ul>