CCHP Processes Health Claims EDI files in an Automated, Error-Free, Agile Manner
Children’s Community Health Plan (CCHP) is a non-profit Health Maintenance Organization (HMO). It coordinates health care services for over 140,000 adults and children across 28 counties through the state of Wisconsin’s Department of Health Services BadgerCare Plus (Medicaid) program and Together with CCHP (commercial) plans.
Before Astera EDIConnect, it took data analysts a great deal of time to scrutinize the claims submitted via EDI files, called encounters, manually. Sometimes, a single transaction document took about 3 hours to eliminate errors and ensure compliance with the state department’s standards. CCHP wanted to increase the accuracy and quality of data in EDI files sent to the Wisconsin Department of Health Services and automate the process to ensure higher approval rates for maximum claim reimbursements.
To streamline the process, CCHP has built an end-to-end EDI correction system that only takes a few clicks to remove errors from the encounters with Astera EDIConnect. Since the process now involves less intervention from the data reporting team, it saves about 5 week’s worth of manual coding and reviewing efforts to resolve errors.