Solutions for Payers

Payer Enterprise Platform

The Payer Enterprise Platform (PEP) provides an end-to-end RCM experience for providers and payers. Through our payer-facing, HIPAA-compliant, EDI gateway solution, Payspan enables payers to consolidate and manage their inbound and outbound transaction streams at a single connection point.

PEP differentiating characteristics include:

  • Complete adjudication Payer Enterprise Platform (PEP)
    • EDI Gateway & Clearinghouse
      • Supports all X12 HIPAA compliant EDI transaction types
      • Configurable SNIP 1 – 7 validation rules
      • Custom payer validation rules
      • Clinical validation rules (ex. CCI edits, additional fees apply)
      • Hosted Eligibility and Claim Status (additional fees apply)
        • Enables CAQH Core Phase II compliance
      • Advanced or custom translation, mapping and routing
      • Web portal for transaction-level reporting
  • Paper-to-electronic (P2E)
  • Direct data entry (DDE)
  • EFT PaymentsCAQH Core Phase III ERA / EFT compliant
    • ACH/EFT and Virtual Card
  • Print payments
    • Payspan Direct print output or third-party options
    • Payment portals
    • Provider
      • Self-service enrollment, payment search and reporting
    • Payer
      • UI for payer support, operations and treasury management
    • Multi-payer architecture
    • Ease of provider enrollment facilitated online via the Payspan Provider Portal
    • EFT with email payment notification complete with correlating payment and claim detail
    • ERA in the form of a remittance advice via online presentment and a downloadable 835
    • Online self-service portals for providers and Payspan Admin Users
    • Ability to search and retrieve payment and associated claim detail for up to 24 months

Learn more about Payer Enterprise Platform