837 EDI Exports
Large claims processors and health care providers use EDI to exchange claim data between systems. When capturing claim data from paper forms with OCR, the extracted data needs to be imported into your claims processing system. Since these systems all support the 837 EDI file format, this is a convenient way to integrate OCR data capture with your claims process without having to build additional data imports. 837 EDI files come in three different flavors: 837-Ql / 837P / Professional Heath Care Claim (HCFA-1500 / CMS-1500) 837-Q2 / 837D / Dental Health Care Claim (J430 / ADA-2012) 837-Q3 / 837I / Institutional Health Care Claim (UB-04 / CMS-1450)
The insurance claims process can be complex and time consuming.
Perform all of your claims processing faster and more accurately with the cutting-edge technology of our software:
The leading innovative data management solution.
Before a claim is submitted, a number of technical protocols and industry standards must be met for insurance claims to be delivered expediently and accurately between medical practice and payer. Our software makes it simple:
Once imported (copied or scanned), the expedited claims capture process begins:
Once the form is scanned, our software uses Optical Character Recognition (OCR) to recognize machine printed data from scanned images, as well as Intelligent Character Recognition (ICR) that can read hand printed data to electronically isolate and record information provided in the different fields, transferring and filling that information. This includes all information on the form, such as:
- Billing provider information
- Patient identification and information
- Services information
- Health plan information
- Insurance information
- Account information
- Billing charges
- Creation date
- Diagnosis codes
- Submission data
2. Our software checks for errors, then flags and prioritizes those errors.
Our software checks for errors, then flags and prioritizes those errors by low confidence fields for easy verification or correction. Low confidence areas are highlighted for fast review.
3. Edit or verify the recorded information.
You can review and edit all the data automatically recorded from the form.
4. Export and store your claim.
You can review and edit all the data automatically recorded from the form.
Improve your Clean Claim Rate (CCR)!
Implement the medical industry best Denial Prevention mechanisms.
Clean Claim Rate (CCR)
In healthcare revenue cycle management, the Clean Claim Rate (CCR) is a critical metric for assessing billing efficiency and operational effectiveness. This key performance indicator (KPI) serves as a foundational measure of an organization’s ability to submit claims that comply with payer requirements and facilitate timely reimbursement.
Given the increasing pressure on healthcare providers to optimize revenue cycle performance while sustaining high-quality patient care, a strategic focus on improving the Clean Claim Rate has become essential.
The Clean Claim Rate is defined as the percentage of claims that are accepted and reimbursed upon initial submission, without being subject to rejections, denials, or requests for additional documentation. In practice, these “clean” claims progress seamlessly through the billing lifecycle, enabling prompt and predictable payment.
An acceptable clean claim rate is 80%. However, to ensure high quality and accuracy, a benchmark of 90% or higher is ideal. A CCR below 80% results in lost revenue.
A key factor in this equation is the manual “touch rate” (manual data entry) which contributes to the 29% rejection rate seen in current industry data. This makes it nearly impossible to achieve a 90% CCR when claims are entered manually.
Denial Proof your healthcare claims management.
