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Claims Processing and Editing for Health Plans, TPAs and Government Payers

Veredi understands the complex issues surrounding payer adjudication. Minimizing wasteful time and money adjudicating claims with errors is critical to the efficiency and bottom line of your organization. Payor837 is a robust, scalable, high speed yet easy-to-implement rules engine designed to meet the ever changing requirements of your environment and the healthcare industry.

Payor837 Features:
  • All industry code sets and procedures – CPT/HCPCS/ICD9, diagnoses, CCI, LMRP, revenue            codes, DRG, occurrence codes, value codes, treatment codes, etc. – are fully supported and          automatically updated as revisions are announced
  • Edits can be customized on any field to meet specific needs without software programming            or expensive professional services
  • Supports 837P (professional), 837I (institutional) and 837D (dental) claims
  • Implemented on a local server or via ASP allowing fast integration
  • Rules engine runs at blazing speed without sacrificing accuracy

  • Payor837 Advantages:
  • Rapidly and precisely identify and eliminate incorrect and incomplete claims before they                enter adjudication processing
  • Significantly increase first-pass adjudication rates and reduce re-submissions
  • Decrease suspense processing
  • Decrease false accept processing and losses
  • Provide immediate and explicit feedback to improve provider behavior and relations
  • Focus knowledge workers on critical business activities

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