15 Ways EDI Sumo Delivers Superior EDI Management to Health Insurance
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In today's fast-paced healthcare landscape, efficiency and compliance are non-negotiables. Health insurance providers have a lot on their shoulders, from managing the administrative tasks associated with verifying coverage, processing claims, making payments, and providing support to both healthcare providers and patients. Whew.
Enter EDI Sumo, the powerhouse solution designed to streamline operations and ensure regulatory adherence while providing unparalleled visibility and control over critical data.
Let's take a closer look at the key features that make EDI Sumo an indispensable tool for health insurance payers.
Data Management and Standardization
- Standardization and Centralization: EDI Sumo standardizes files into one format and centralizes them in a single location, simplifying data management and ensuring consistency across departments.
- Comprehensive File Handling: EDI Sumo handles all file types and formats, including on-the-fly decryption, file formats like X12, positional, CSV, tab delimited, and various file types such as Enrollments, Claims, 835s, and more.
Monitoring and Issue Resolution
3. Real-Time Monitoring: With real-time transaction monitoring, organizations can proactively identify and resolve issues as they arise, minimizing disruptions and ensuring smooth operations.
Operational Efficiency and Productivity
4. Operational Efficiency: By automating manual tasks and providing comprehensive data analysis and reporting capabilities, EDI Sumo improves operational efficiency and productivity, allowing organizations to focus on other crucial aspects of the business.
5. Departmental Visibility: EDI Sumo provides each department with visibility into their data, including Enrollment, Claims, and Customer Service, empowering teams to make informed decisions and meet service level agreements (SLAs).
6. Customer Service Portal: EDI Sumo allows representatives to quickly retrieve subscriber information, including demographics, coverage details, and contact information. Additionally, team members have access to claims data, processing details, and payment history as well as member arrival dates and eligibility spans. Powerful information to have at the ready when speaking with a subscriber on the phone!
Compliance and Accountability
7. HIPAA Compliance Tracking: EDI Sumo includes HIPAA compliance tracking features, ensuring regulatory adherence and safeguarding sensitive patient information.
8. SLA and PG Tracking: Organizations can track SLAs and PGs to ensure accountability and meet service level agreements effectively.
Electronic Data Interchange
9. Trading Partner Management Module: EDI Sumo offers a module for managing trading partners and their unique requirements.
10. EDI Sumo seamlessly integrates with multiple EDI translators and claims management systems, providing visibility into EDI translation reports and ERP error reports.
Security and Control
11. User Access Control: User access can be limited by trading partner, document, and other parameters, ensuring data security and confidentiality.
12. Search and Export Capabilities: EDI Sumo offers robust search capabilities by filename, date, trading partner, status, and more, with the ability to export data and error information to Excel for further analysis.
13. EDI Sumo is entirely on the insurance company’s intranet, residing behind a login screen.
Performance and Insights
14. Scalability and Performance: EDI Sumo easily handles hundreds of thousands of files per month and very large files, ensuring scalability and optimal performance.
15. EDI Sumo displays historical data offering insights into each "hop" a file has taken.
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