rovide an Electronic Submission of Medical Documentation System that supports the electronic transmission of healthcare claims and remittance information between ADPH and various payers. The system must comply with all federal and State Electronic Data Interchange (EDI) standards and support integration with ADPH billing applications. The following categories describe the scope of required services: 1. Claim Submission & Processing The supplier shall provide an automated platform capable of processing, validating, and submitting healthcare claims to a variety of payer types, including Medicaid and commercial insurers. • Support both batch and real-time claim submissions. • Perform pre-submission validation and edit checks to ensure claim accuracy. • Provide detailed error reports for rejected claims. • Allow resubmission of corrected claims through the same interface. 2. File Transfer Service A transfer tool that allows you to send and receive 837 and 835 files. • Submit, edits, and receive claims and remittances for Medicare, Medicaid, and commercial insurances. • View a snap shot of all the transmissions • Provide immediate snap shot of 837 responses received by Medicare 3. Medicare Analytics Track claims in Medicare system throughout their life cycle, report claim status, financial suspense status. • Compare revenue cycle metrics against the nationally published standards. • Track key financial indicators and trend data over a rolling 12-month view. • Options to review and analyze Medicare data.
