providers to submit claims electronically and assess them
Data Interchange (or EDI) allows providers to submit claims
electronically to a clearinghouse (such as HICAPS or IBA
where they are electronically transmitted to each Fund.Funds then have the option to assess the claims on-line
or automatically.Automatic assessment allows claims to be assessed with
little or no assessor intervention.
on-line, batch, or electronically entered claims.
two different methods of assessment – on-line or automatic.
a large number of system and user-defined edits in the automatic
assessor intervention on many claims.
a series of management reports that indicate the results of
all automatically assessed claims.