Smarter Claims Processing

New Challenges for Claims Processing

Healthcare Insurance providers are facing many challenges adapting their in-house systems to comply with the new legislative requirements and infrastructures created by the 2014 Affordable Healthcare Act. Not only is there a shift to a value-based care delivery system, but the Affordable Healthcare Act and State Exchanges have introduced complex processes, communication protocols, and improved governance and management requirements.

In addition, the new ICD-10 coding requirements that will become effective on October 1, 2015 increase the level of complexity by changing the code formats and adding approximately 140,000 new procedure and diagnosis codes.

Identify Incorrect EDI 837 Claim Formats Before Submission

For healthcare insurance providers, the claim submission and management processes have always presented challenges, despite the standardization of the EDI 837 Claims format. To help healthcare insurance providers meet and overcome this challenge, Prolifics is working with an industry-leading healthcare claims transaction provider to give organizations the ability to identify, fix, and validate incorrectly formatted EDI 837 Claims transactions before they are submitted - with our Smarter Claims Processing solution.

The Prolifics Smarter Claims Processing solution for EDI 837 Claim transactions can be implemented in as little as 12 weeks, so healthcare insurance providers can realize the benefits of a better claim submission and management process in a fairly short amount of time.

Learn More About the Smarter Claims Processing

To find out more about the Prolifics Smarter Claims Processing, download the Smarter Claims Processing brochure or contact us at and discover how we help take the complexity out of the claim submission and management process.