edi insight
Claim Visibility, From Submission to Paid
Complete Claim Visibility
View each claim’s current status, complete history, payer responses, filing dates, and payment activity from one connected record.
Workflow & Task Manager
Create and assign follow-up tasks, organize staff responsibilities, and automatically update worklists as claims move through the revenue cycle.
ERA & Denial Management
Review paid and denied transactions, group denials by reason, assign follow-up work, and view payment details and allowed amounts.
Claim Scrub & Eligibility
Catch claim errors before submission, verify patient coverage, and reduce preventable rejections caused by inaccurate or incomplete information.
1. Submit Electronic Claims
2. Catch Submission Issues
3. Review Payer Responses
Claims move from the practice-management system into the clearinghouse for formatting, review, and transmission.
Claim-scrubbing tools identify missing, invalid, or inconsistent information that could prevent a claim from being accepted.
Track acknowledgments, rejections, and other responses to understand whether each claim was accepted for processing.
4. Monitor Payments and Denials
5. Assign Follow-Up Work
6. Preserve the Claim History
Review ERA activity, payment details, adjustment information, and denial reasons from the claim record.
Create tasks, organize worklists, and direct unresolved claims to the appropriate staff member.
Maintain a searchable audit trail of submissions, responses, payments, denials, notes, and follow-up activity.
Submission Is Only the Beginning
Sending a claim does not mean it has been accepted, adjudicated, or paid. EDI Insight helps billing teams identify where each claim stopped, understand what happened, and determine the next action required.
Denied
The payer accepted and adjudicated the claim but declined payment for all or part of the billed services. The denial must be reviewed to determine whether the claim should be corrected, appealed, or otherwise followed up on.
Invalid
The clearinghouse identified missing, inconsistent, or improperly formatted information before the claim was transmitted to the payer. The claim must be corrected before submission can continue.
Rejected
The claim reached the payer, but the payer did not accept it for adjudication. Rejections commonly result from eligibility or identification issues, such as an invalid member ID
CLEARINGHOUSE OPTIONS
Get More Visibility Into Every Claim
PSS supports EDI Insight users with setup, configuration, claim workflows, and ongoing assistance. For practices seeking a fully connected billing platform, Phoenix brings clearinghouse activity, follow-up, payments, and reporting into one system while preserving clearinghouse flexibility.