EDI Autoclaim

EDI Autoclaim is a HIPAA-secure Medicaid billing system for the unique needs of Home and Community-Based Services.

Manage the complexity of Medicaid billing.

EDI Autoclaim is designed with built-in logic and robust controls to ensure fast and accurate billing, payment and reporting. Providers can submit claims the same day service is delivered and get paid faster, with fewer denied claims.

EDI Autoclaim handles billions of dollars in claims, but makes it look easy.

Get paid fast, the first time.
Every claim that gets created is ready to send error-free. EDI Autoclaim system logic and validation results in a 100% reduction in incomplete claims, invalid diagnosis codes, incorrect rates, and duplicate claim-related denials.

Manage cash flow in one system.
EDI Autoclaim features integrated double-entry bookkeeping that accounts for every penny with no extra steps. Powerful reporting helps you manage aging and track accounts receivable so you always know which claims are paid and which claims need follow up.

Medicaid billing done right with EDI Autoclaim.

Automation saves staff time.
With a simple workflow you can trust, EDI Autoclaim automates the steps that take your staff time. Process claims 60 times faster than keypunching manually with industrial-strength batch processing that submits thousands of claims at a time.

Easy interoperability with your existing tools.
Don’t throw away the tools you’ve already invested in for case management, EVV, electronic health records and more. EDI Autoclaim works with your existing tools to improve your billing workflow and shrink your accounts receivable.

Case Study

Tempus Unlimited depends on EDI Autoclaim to meet its growing Medicaid billing demand

EDI Autoclaim helped Tempus improve cash flow with automations that saved over 500 hours a year in staff overtime alone and helps them reconcile all claims to the penny each week.

What is EDI Autoclaim?

EDI Autoclaim is cloud-based and easily integrated with existing software and tools: it bolts right on for easy interoperability. With the unique needs of Home and Community-Based Services in mind, EDI Autoclaim is fully automated to save staff time and improve cash flow with no clearinghouse needed.

EDI Autoclaim is designed for high volume billing. The system manages the complexity of thousands or tens of thousands of claims a week, while managing down to the penny with dashboards and reports. For growing programs, EDI Autoclaim’s simple 3-step workflow scales easily and stays simple.

EDI Autoclaim is highly configurable and can accommodate changing rules and priorities. For example, the software is configured to know state-specific and payer-specific rules so your staff members don’t have to. It also meets referring provider mandates and various date span requirements that are state- and payer-dependent.

Features and Functionality

Bill fee-for-service, managed care and other payers with powerful electronic claiming, no clearinghouse needed
Produce batch electronic billing files, including 837i and 837p files
Automate claim scrubbing to prevent incomplete billing and collect more on your claims the first time
Import batch 835 electronic remittance files to instantly mark each claim as paid, denied or partially paid
Check Medicaid eligibility in batch with automated 270/271 and prevent claims for ineligible consumers
Depend on HIPAA-secure hosting that includes industry-leading security features
Manage aging with powerful reports and streamlined workflows
Track accounts receivable and aging by program, payer, consumer, and more
Track reason for denial, allowing for easy follow-up and re-billing
Produce pre-populated Forms CMS 1500 and UB-04
Add on batch rebill and other batch action features for more time savings

States and Payers

EDI Autoclaim bills any combination of state Medicaid Management Information Systems (MMIS), Managed Care Organizations (MCOs), Integrated Care Organizations (ICOs), Accountable Care Organizations (ACOs) and other payers.

EDI Autoclaim bills Medicaid programs in over 20 states and currently bills more than 40 MCOs across the country. Contact us to find out if your Medicaid program or MCO is on the list. We are adding new states and payers regularly to meet client needs.

EDI Autoclaim is used across the country and helps make new state billing requirements fast and easy.

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What our clients say about EDI Autoclaim

“By far, the biggest win with the new software is increased speed and time savings! We can queue up multiple functions at the same time and easily save over 500 hours in staff overtime compared to before.”

–EDI Autoclaim user in Massachusetts

"It’s been a pleasure working with you thus far and I have learned a lot from you. You have been awesome at training!"

–EDI Autoclaim user in Kentucky

"Using this software, I get to brag to our executive team about how it does exactly what you said it would and how we don’t have any problems. I love using this software."

–EDI Autoclaim user in Pennsylvania

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EDI Autoclaim can be used as a stand-alone system with your current tools or can be combined with Annkissam’s AFC Home, an Adult Family Care solution specifically for the Massachusetts program, or Dignyfi, our self-direction solution specialized for New York.