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Payor Solutions

Services for Insurance Payors, Bill Review Firms & Employer Groups

WorkCompEDI is the national leader in the workers’ compensation, auto and personal injury / no-fault EDI clearinghouse services, representing over 2,100 Payors, Bill Review companies, and employers as their EDI Gateway of choice. We offer robust electronic EDI aggregation and validation management services that increase efficiency through unparalleled flexibility and intelligent transaction pre-adjudication services.

Our highly flexible connectivity philosophies help our customers reduce administrative expenses and improve payment processing turnaround timelines with nearly no change to their back-end operations.  With nearly three decades of EDI Gateway processing experience, WorkCompEDI is able to transform data collection and pre-processing into business intelligence and enhanced performance.

Service Brochures

Managed EDI GatewayA single point of connectivity to the entire workers compensation, auto and personal injury markets for a Payor or Bill Review firm client simplifies inbound requests for electronic delivery of data without tremendous overhead or resources.

  • WorkCompEDI accepts transactions from large and small submitters to help ensure the highest level of access and EDI submission rates.
  • WorkCompEDI supports nearly any/all data formats and connectivity methods to simplify connectivity for submitters ensuring adoption.
  • Existing inter-connectivity to competing work comp clearinghouses (Jopari, Ingenix, P2Plink/Helios) ensures submitters have options when choosing to submit EDI.
  • Leader in practice management software / EMR vendor integrations, helping accelerate adoption of EDI by submitters through lower adoption adjustment requirements.
  • Ongoing adjustments and compliance with jurisdictional and EDI requirements are handled by WorkCompEDI without effect to customers.

Unlimited Pre-AdjudicationAs the pioneer of real-time transaction processing, WorkCompEDI’s technology infrastructure allows for nearly unlimited ways to scrub and validate inbound billing data without added costs to customers (you only pay for bills you receive – filtered and rejected bills are not charged).

  • WorkCompEDI works in a consultative manner with customers to build the most efficient “pre-adjudication” processes without taxing internal resources or systems.
  • Claim indexing (hosted or direct API connectivity to backend systems) ensures inbound bills have valid claim numbers.
  • State specific rules and edits ensure bills are scrubbed and complete, providing cleaner bills to receiver and instant notification to submitters.
  • Vendor matching logic provides workflow routing of bills to appropriate receiving parties.

News_Payor copyOCR/Paper-to-EDI/Printing services (full mailroom management and image processing) and document management and workflow software (SaaS hosted or deployed) that seamlessly connect with our EDI clearinghouse systems provide a fully integrated operational outsource option for clients.

Custom Engineering SolutionsAfter decades of experience providing services in the EDI industry, our company has developed advanced tools and systems that are now available for customers to private label, including TroubleTicket™ (robust internal and external ticketing support system), SalesDesk™ (sales CRM management system), HelpDesk™ (customer CRM management system), IMSLink™ (hosted image management and workflow system), and D&NDA-Lite® (real-time dental adjudication system coupled with our leading member, provider, group/admin and broker web portal systems).

Our Process

Explaining the complexities of how clearinghouses work is overwhelming, let alone describing how an implementation process would take place.  However a picture says a thousand words and WorkCompEDI allows its customers the highest level of flexibility to ensure a seamless implementation with existing workflow and operational processes.  The General Implementation Outline diagram to the right gives a top-level view of what an implementation with WorkCompEDI would look like, and the approximate time it would take to complete.

Standard implementations can be completed in as little as 3 days and can take up to 90 days (depending on the level of resources and attention a customer gives to the process).  Our firm assigns a dedicated operations representative to support your firm during the process and we even handle coordination between multiple vendors and third-parties to ensure the process is painless. The key implementation phases include:

  • Proposal and contracts — Negotiate terms, pricing, and establish a timeline
  • Kick-off conference call / meeting — Exchange specifications and documentation
  • Development and functional testing
  • Training and marketing plan rollout
  • Ongoing metric monitoring and reporting

WorkCompEDI staff have been performing technical EDI implementations for over 25+ years, and bring an extreme level of technical competence to the process.

WCE-Workflow-Small

WorkCompEDI supports compliant use of American National Standards Institute (ANSI) Accredited Standards Committee (ASC) X12N Health Care Insurance standard transactions, custom transaction formats, business-to-business (B2B) integrations, and robust workflow electronic data interchanges.

At WorkCompEDI, we consider the confidentiality and integrity of protected health information one of our highest priorities. We fully support and are compliant with the Health Insurance Portability and Accountability Act (HIPAA), HITECH, and all state jurisdictional requirements so we can remain at the forefront of regulatory compliance initiatives.
WorkCompEDI has been EHNAC HNAP accredited, and is actively working towards attaining its HITRUST and SOC2 certifications in 2017.

Call our dedicated staff today to learn more about the many ways our firm is already helping thousands of Payors and Bill Review companies achieve operational nirvana. Call us at (800) 297-6909 or email us at info@workcompedi.com.

Products & Services

User friendly informatics portal for flexible submitter transaction intelligence and metrics reporting.

Allows receivers (employers / insurance plans) to accept EDI billing from submitters via WorkCompEDI’s clearinghouse, then be able to see the bills received through a secure web-interface in order to determine which bills need to be sent to multiple different bill review companies for processing, and which bills can be paid directly (avoiding the high cost of bill review services for non-essential or low cost billings).v

Flexible OCR/image-to-EDI conversion service that extracts data from paper bills (and other standardized inbound documents), and provides extracted data in any format for auto-posting into billing systems. Complex workflow systems help inter-department processing by controlling the routing of transactions to appropriate staff. Enhanced central monitoring capabilities help maintain proper timelines and departmental workload assignments to ensure compliance with internal (and external) best practices.

We offer printing and mailing services at our service bureau. We can print, fold, stuff, and mail any quantity of information return forms. Our prices (including postage and handling) are the most competitive in the industry.

EDI processing for group health claims provides a single vendor partnership for all EDI needs.

Non-technical EDI processing service can be offered to submitters as a simplified non-technical EDI submission method.

COMING SOON – turnkey service providing single-point of provider payment services, including EFT/ACH, Pre-paid debit cards, and check & EOB printing services.

COMING SOON – pharmacy benefit management (PBM) services for employers and Payors in the workers compensation industry.