Payer Solution

We provide options not requirements.

Are administrative burdens impeding your potential?

Payers, health plans, IPAs, ACOs, MSOs, and similar organizations are routinely challenged by internal resource constraints and the limitations of vendors who are unresponsive to their changing needs and requirements. While administrative distractions have become an unwelcomed reality, payers must minimize the disturbance in order to be successful. Harnessing the potential of personalized EDI solutions offers much-needed benefits to payers—more seamless clinical data acquisition, increased compliance, greater control of workflow—which enable them to reduce costs and shift their attention to other priorities.

Approximately 31% of U.S. healthcare costs, or $496 billion, is spent on billing and insurance-related (BIR) expenses.

But did you know…?
Industry leaders believe this can be cut by 50% by increasing efficiency and diminishing burdensome overhead.

Managed Payer Gateway, SSI’s payer solution.

Expand and enhance your EDI transaction capabilities. SSI’s payer solution, Managed Payer Gateway, ensures all administrative and clinical data transactions are complete, accurate, and standardized to the edits, business rules, and system formats defined by each client. Leveraging a growing list of direct connections, we offer personalized services catered to users’ unique needs and nuances. Partner with us and we’ll become a part of your strategic planning team—an extension of your IT, Operations, and Clinical/Medical Management—to provide functions that enable you to reduce both clinical acquisition and EDI transaction costs.

Benefits

  • Establish a single connection to the U.S. healthcare ecosystem, for both administrative and clinical data, eliminating the need to maintain multiple connections independently
  • Simplify the claim standardization process and gain the ability to receive claims in any format, from any submitter (e.g., institutional, professional, and dental), clearinghouse, or billing company
  • Acquire clinical data, lab results, ADTs, EMRs, and more
  • Change edits and business rules on your timeline, usually within 24-48 hours of a request
  • Host transactions (Eligibility and Claim Status) within the solution when your systems are unable to generate HIPAA compliant transactions
  • Reduce paper volume with a system that works with your network to manage paper-to-electronic claim conversion or (P2E)
  • Monitor transaction performance for efficient and accurate routing
How It Works

It’s a never-ending battle to keep up with industry changes and coordinate with submitters to maintain compliance with your plan’s clean claim requirements. Managing both electronic and paper claim submissions requires the use of already limited resources, such as time and labor.

SSI Managed Payer Gateway removes the complexity from paper and EDI transaction processing by establishing a single, streamlined connection of all inbound transactions. Customized to clients’ individual business rules, edits and validations, the solution enables organizations to receive claims in the exact format necessary for their system to auto-adjudicate, regardless of the format in which they were submitted. Through personalization and dedicated support, users gain visibility with full transparency of transaction processing and reconciliation.