Electronic Data Interchange (EDI)

Electronic Data Interchange (EDI) is an innovative digital communication tool that is used to deliver data from a provider to a payer. In order to be eligible to submit electronic claims to an insurance company, providers must complete EDI enrollment. 

Some payers require EDI enrollment in order for providers to submit electronic claims or complete EDI transactions. In other words, until your organization has completed all necessary registration processes, you will be unable to submit electronic claims to that insurance agency. 

While some organizations allow for the exchange of paper claims, they are quickly becoming outdated. The industry as a whole is transitioning to digital claims management. Many payers are requiring the completion of EDI enrollment for providers to be able to submit claims at all. 

In a perfect world, providers would only have to complete one form and distribute it to all payers, but this is not the case. Providers work with dozens of insurance companies who each have their own list of demands. 

EDI enrollment can quickly become overwhelming to a healthcare organization that works with more than one or two payers. Each insurance company has differing procedures and requirements to qualify for EDI. This triples the workload for your team when it comes time to enroll and maintain that relationship

Careeo is the perfect choice for providers looking to join forces with an experienced clearinghouse

What is ERA & EFT?

Electronic Remittance Advice (ERA) allows providers to receive their Explanations of Payment (EOP) electronically, as well as provide the benefit of automatically posting payments to a patient’s account.

Electronic funds transfer (EFT) transmits funds for claims payments directly from a health plan into your bank account

Eliminate Checks and Paper EOBs to Accelerate Payments

  • Get funds fast with direct deposit
  • Streamline reconciliation and posting
  • Receive electronic EOBs in HIPAA-compliant files
  • Reduce costs and improve cash flow
  • Eliminate the risk of lost or stolen checks
  • Easily and securely view payment information online

Provider Portal

The Provider Portal is a quick resource that allows Providers convenient access to member and claim information. The portal is designed to provide access to: Claim and Payment status as well as a member’s benefits and eligibility.

It is a real-time access to many payers through portal. It’s ideal for direct data entry, from eligibility to authorizations to filing claims, and getting remittances (EOB).