May 2010 Newsletter
Sometimes It's the Stuff You Don't See
It is easy to see a beneficial change or an enhancement that makes your job easier when it’s in a product or service that you see or use every day. Xpeditor, with its Xtensions, is a great example of a product suite that you use every day to get the job done. On a daily basis Xpeditor helps you process claims efficiently and makes sure those claims are clean and correct before they are sent to payers. Having claims “sent to payers” sounds much simpler than it is, considering that the claims you so carefully dealt with in Xpeditor must be handled and put into a HIPAA-compliant format for hundreds of payers (each of whom, of course, require claim files just a ‘little different’ from all the other payers). Meeting the payer requirements, getting the claims sent out on a timely basis, and processing an ever increasing amount of claims from our clients is sometimes a daunting task.
Sometimes it’s the stuff that you don’t see, behind the scenes, that makes all the difference to your bottom line. We have a great group of people who, on a daily basis, diligently work to see your claims are processed and submitted to our many Trading Partners. Hank and Chuck—yes, they really do exist—make sure that claims get processed after Communicator runs by maintaining expertise in ANSI 837 output formats and the editing of claims. Our Transmissions team makes sure that our methods for getting the actual files to/from Trading Partners are state-of-the-art and timely, and that every file transfer is verified as successful. EDI Systems staff manages the interface between the claims coming out of Xpeditor and the rest of the clearinghouse processing system. That process has become a modern day claim switchboard, routing the claims to their appropriate places within Quadax. The entire team in our Network Services area maintains all of the hardware needed to manage the ocean of data in and out of the Quadax network to and from our Trading Partners. The effort these teams expend to ensure your data is correct, safe, and timely is critical, though you may never interact with them or see firsthand the work they do for you every day.
Currently, claims are handled in both a PC server and a HP mainframe environment. The latter has been the workhorse of our claims processing system for more than 30 years. As technology progresses, so do our systems. We are moving away from the HP mainframe world and completely into a PC server environment. To accomplish this task, new software had to be designed, written (using Visual Basic, SQL and other PC-oriented utilities), and purchased (Sterling Commerce – GIS Business Processing software). Quadax has been working on this new system for about a year now and has been running it in parallel with our production claims processing since the beginning of February 2010. The new process is designed to be database driven with regard to our Trading Partners, making new payer implementations easier then ever. The entire claim process is not only logged, but every file that is created/processed is archived for easier diagnosis of problems, should they arise.
We have also been doing time trials on the new system, and so far claims are being processed in one third of the time it was taking on the mainframe. What this means to you is even faster turnaround times with Trading Partners and better controls on the claims to ensure that everything you intend to send actually makes it to payers. Our goal is to be able to track every claim from Xpeditor to payer with dates and times documenting every step accordingly. This capability will not only allow you to know where your claims are and when they were processed, but will also give Quadax personnel the ability to track any problems with payer files. The current plan is to fully implement the new system around the end of May for the UB claims. This new system also lays the groundwork for implementing a new ANSI mapping utility required for the mandated transition to ANSI 5010 transactions. Quadax is dedicated to using new technologies and software designs to make getting claims to their final destinations as timely and accurate as possible. Pay no attention to those people behind the curtain; they are just working their magic.