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Professional EDI Claims System(PECS)

  • General Product Information
      Is your office staff still shuffling HCFAs in and out of filing cabinets every time one of your patients comes in for an office visit? Are you still looking up HCPCS codes in those massive books to make sure you're typing them into the forms correctly? When it's time to close the books at the end of the month are you calling all the insurance companies and asking them to give you claims statuses and rush your payment? We can solve all this for you by getting your paper claims system converted to an easy, affordable electronic claims system that's HIPAA-compliant. Our PECS (Professional EDI Claims System) takes the HCFA-1500 forms you're familiar with and puts it on the screen ... but instead of having to print the forms, stick them in the mail, and then wait for the insurance companies to send you your remittance advices, PECS sends an 837 (the HIPAA-compliant electronic file) directly to the insurance companies of your choice with an amazing array of automation:
  • Technical overview
      The Professional EDI Claims System(PECS) is an electronic claims management and 837 Professional EDI claim generation system.The claims generation module of PECS is an EDI engine that generate a HIPAA-compliant 837 Professional claims file that can be submitted to an insurance company for payment. The system comes complete with a datebase engine between the two distinguishing modules complete with audit table for history of claims. User is only assigned the appropriate functionality based on a predetermined security level further enhancing HIPAA security policies and procedures. Some of the additional functionality of PECS is as follows:
    • User security(Functionality is controlled by an Administrator)
    • Patient Database
    • List of procedures codes (CPT codes) from AMA
    • List of insurance companies
    • PGP creation (Public and Private Key Pair)
    • PGP file encryption
    • Diagnosis codes
    • National Provider Identifier (NPI)
    • Claims Audit
    • and more features you would expect from a much more expensive EDI claims system...
  • Modules
    • HCFA GUI Module
        The HCFA GUI implementations is an simulated electronic version of HCFA/CMS 1500 paper claim form. This module contain the information entered by the user to create a a medical claim and the transfer of that information into the back-end database for persistent storage. The system administration assign security rights to a user depending on system setup of functionality. The main entry point of PECS is through the HCFA GUI module
      Main functionality of the HCFA GUI modules
      • Add Patient
        • Add/Modify/Delete Patient Information
      • Create Claims
      • List Claims
      • Create Claims
      • Administrator Menu
        • Add/Modify/Delete User
        • Add/Modify/Delete Provider/Supplier
        • Add/Modify/Delete Facility
        • Add/Modify/Delete Payer
    • EDI 837 Professional Claims Generation Module
        The EDI Generation module is responsible for the generation of the HIPAA- compliant 837 Professional EDI claims files which contains all of the HIPAA and EDI rules.
      Main functionality of EDI 837 Professional Claims Generation modules
      • Create EDI
      • PGP Encrypt EDI File
        • Generate Key
        • Encrypt File
      • Connect To Payer
        • Send File
        • PickUp File