EDI Experts

Health Benefit Capitation, Coordination of benefits, Referral management, Authorization management

MCSI has vast experience with standard and non-standard EDI transactions.

EXPERIENCE

  • Real-Time or Batch
  • Inbound/Outbound and Complex Client driven Chaining
  • Data Scrubbing
  • Hierarchical Search Rules
  • Trading Partner and Format Management
  • Rejections and Acknowledgements

ELECTRONIC DATA EXCHANGES:

  • Enrollment data and verification
  • Claims submission (Medical, Dental, Pharmacy, etc.)
  • Accumulator information
  • Payment remittance advice
  • Transaction acceptance
  • Referrals and authorization
  • Premium payments
  • ACH/Credit card transactions
  • Provider Network Rosters

HIPAA EDI TRANSACTIONS :

  • 270 - Eligibility Request
  • 271 - Eligibility Response
  • 276 - Claim Status Request
  • 277 - Claim Status Response
  • 278 - Claim Review Request
  • 278 - Claim Review Response
  • 834 – Enrollment
  • 835 - Claim Payment
  • 837 - Professional Claim
  • 837 - Dental Claim
  • 837 - Institutional Claim
  • 997/999 - Acknowledgement