Electronic Response File Reader

Takes you…

Response File Reader• Allows the user to read and translate a variety of

EDI formats including:

– 835- Health Care Claim Payment/ Advice– 271- Eligibility, Coverage or Benefit Information– 277- Health Care Claim Status Notification– 820- Premium Payment for Insurance Products– 834- Benefit Enrollment and Maintenance– 837- Health Care Claims– 997- Functional Acknowledgement File

• Will save valuable staff time

• Used all across the country in both payer and provider organizations

• Actively manage your EDI files!

• This demonstration will be primarily dealing with an 835 remittance file, but our ERF Reader will function in the same way regardless of the format of EDI file

To get started simply click the File> Open tab and select the EDI file that you want to analyze

User can pull out useful information at a quick glance with our summary data

File summary provides data about the selected EDI file

Grid Summary provides an overview of all information currently in the GRID

Information at the Remit Level appears here such as payee, check amount, check date, etc.

Summaries can be collapsed for better grid viewing

Quickly filter data to show only payments, pended claims, and/or

denialsCan sort any column to quickly find needed data by clicking the column

heading (asc. or desc.)

Over 50 customizable data fields that can be removed from/ added to grid as needed

Every column can be moved, expanded, or contracted for the layout that best suits your needs

Find function allows user to lookup specific data in any column on the grid

Advanced Find feature allows user to search by individual

Column, as well as usesearch parameters

You can also produce a traditional style Paper Remit (EoB)

Payers can adjudicate health care claims a number of different ways.

For example, some payers adjudicate claim information on a claim basis, some adjudicate at

a procedure level (line item detail level).

The Reader from EMS allows you to view your remittance in either of these manners.

Let’s look at a page from Traditional Paper Remit (EoB)

835 Claim View vs. Detail View

The claim header information, plus the totals for the whole claim – regardless of the number of

individual procedure lines that may be included on the claim.

CLAIM VIEW

One Line Per Claim

Let’s look at a page from Traditional Paper Remit (EoB)

835 Claim View vs. Detail View

Detail View shows each and every detail line that is provided, along with procedures, charges, adjustments, allowances, and payments by line (if provided)

DETAIL VIEW

Each Detail Line in the

835 File is Shown on its

own line in the Reader Grid

Can take desired data (all the denials in this example) and export the report into Excel or in a tab-delimited form- also note that the grid summary information has changed

User can easily print reports as needed also

A sample printout

997 Capabilities

Our reader has the ability to read and interpret 997 files and give you the status of a given claim

997 capabilities

When paired with an 837 file our 997 format can tell you if, and where, errors exist in the coding when present

For more information feel free to call us at 716-626-3310

To download a full-functioning demo of the reader visit our website: www.emscorp.biz