The submission of an eligibility request to a clearinghouse is a complicated process. It takes an expert to understand the nuance of a 270 request/271 response and how the submission data informs the response of the target Payer.
Enhanced Eligibility makes that interaction simpler by providing common pre and post processing rules that augment the submitted transaction and the returned response.
Healthcare data is not consistent across providers, facilities, and patients and the 270/271 EDI contracts exposed by payers do not follow the specification to the letter. If your organization faces unknown or incomplete patient data, or requires automation to increase your eligibility response rate, you will benefit from the Enhanced Eligibility API.
Yes, at its core, our engine interfaces directly with the clearinghouse. If you have scenarios that require enhanced processing, and some scenarios that don't, the Enhanced Eligibility API can accommodate the needs of your organization.
The backbone of our product is the integration with the Medical Network interface to the clearinghouse. Click here for more information.
Updated 2 months ago