Claims Processing
Automated EDI claims processing for healthcare organizations — manage 837 and 835 transactions with full HIPAA compliance
Are your healthcare claims processing fees holding you back from profitability? Focused E-Commerce has developed an easy and inexpensive way to remove your dependency on a middle-tier claims clearinghouse. Using our Claims Portal application, your providers can submit healthcare claims directly to you in the correct EDI format, all without expensive recurring fees.
With our No Fees Claims Processing solution, your customers do not need to invest in a costly EDI for Healthcare integration. Using a web application, we build your business process and routing logic directly into the portal. Data validation and integrity is enforced by the software, ensuring that data received has been properly validated.
The No Fee Claims Portal ensures that you remain compliant with any changes in rules, policy and versions. Getting quality data into the Medicaid/Medicare system is vital for payment processing. Our easy to use and cost-effective EDI for Healthcare application allows you and your customers to not get bogged down in paperwork and errors.
We offer the best EDI for Healthcare services and have successfully implemented hundreds of B2B and EDI integration projects for customers of all types and sizes. With our Claims Portal EDI web application, we can help you realize the full potential that EDI and electronic claims processing brings to your business.
Our Claims Processing solution supports both 837P (Professional) and 837I (Institutional) claim formats, along with 835 Electronic Remittance Advice, 276/277 claim status transactions, and 999/TA1 acknowledgments. All formats comply with the latest HIPAA X12 implementation guides.
The denial management module automatically categorizes denials by reason code, identifies patterns across payers and providers, and provides guided workflows for appeals and resubmissions. It tracks your clean claim rate over time and suggests process improvements to reduce future denials.
Both. The system supports real-time claim submission for urgent or individual claims, as well as batch processing for high-volume scheduled submissions. You can configure submission modes and schedules by payer, facility, or claim type to match your operational needs.
The 835 module automatically parses incoming Electronic Remittance Advice documents, extracts payment and adjustment details, matches them to original claims, and posts payment data to your billing or accounting system. Exceptions like partial payments or unexpected denials are flagged for manual review.
Whether you need EDI for healthcare, supply chain, or ERP integration — our experts are here to guide you through every step of the implementation process