EDGE Medical Services Private Network

benefit portal

Claim Resolution Services

PORTAL TO CLEARINGHOUSE TOOLS

VERIFY ELEGIBILITY: This link takes provider or biller to the EDGE clearinghouse log-in screen. after logging in, click elegibility tab on upper right of menu. A new window opens. on left menu, click new elegibility and follow prompts. Benefits will be available within seconds. this screen will catalog all benefits in a uniform table.

VIEW CLAIM TRACKING AND MANAGEMENT: Our software provides complete tracking from claim submission through claim adjudication, and can be used to:

•Provide proof of timely filing to payers.

•Identify and track rejected or denied claims along with the reason for rejection/denial

•Identify claims “missing in action” or “lost” by the payer.

•Perform electronic claim status inquiries to payers.

•Monitor follow-up by your billing staff — errors corrected, errors overridden, completion of follow-up items, etc.

The view claim feature displays all payer responses for a claim, from claim submission through adjudication in easy to understand messages.

Staff assignments and notes for follow-up can be added as needed. These can either be done on an individual claim basis or to groups of claims with a single entry.

ELECTRONIC REMITTANCE ADVICE: Our electronic remittance advice (ERA) downloads 835 files to your practice management/billing system for auto posting. Or they can be printed or viewed on-line. When 835 files are processed, EDGE software can automatically load claim adjudication information into your claim history as the “final” event in the claim lifecycle process. This information can then be used for individual claim tracking and for analyses of payer payment patterns.

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