Encore’s Electronic Data Interchange (EDI) Process provides quick and easy repricing

July 2006

Encore has an EDI outbound process that is available to payers and insurance companies that have groups that are covered through the Encore Health Network.

The EDI outbound process is available to payers that have claims re-priced internally by Encore. The claims that are received from providers either electronically or by paper are able to be transmitted to the payer in an EDI outbound format after being re-priced.

This process allows the payer to eliminate the mail time of receiving re-priced claims and having to open and sort the claims when received. The EDI outbound process allows the payer to download the information directly into their claim processing system. The following is an excerpt from a phone conversation with Ron Lawlor of Group Administrators, a TPA Encore works with:

• “I wish all of our EDI connections were like Encore’s”
• “You guys are doing a great job and are extremely easy to work with…”
• “This EDI connection inbound and outbound has made a world of a difference with our Encore business and I wanted to make sure you knew that…”

There are payers currently using this process, and we continue to implement new payers on a monthly basis. The IT personnel at Encore will work with the payer’s IT personnel to implement this process. The time frame for implementation is usually 2-4 weeks depending on the amount of testing that is required. If you have payers that are interested in this process please have them contact their client service representative for additional information.