ZyWinElectronic Data Interchange - EDI

Electronic Data Interchange (EDI) is an all encompassing term for electronically communicating information, transmitting documents and sharing databases with insurance carriers, hospitals, pharmacies, medical libraries and others. Electronic medical billing has matured and now just one aspect of EDI, beginning October 16th 2003, all EDI communications are mandated to be HIPAA compliant. Beware! Don't be fooled. Some are offering HIPAA compliance as a service for translating non-HIPAA medical claims into a compliant format. This approach is very limited and many of the codes present in the current format will not translate or do not exist to be translated. This undoubtedly will result in claim rejections, which are costly. ZyWin does not use a translator; all interpretation is built directly into the programming code or accompanying databases.

The most common uses of HIPAA compliant EDI in the medical industry are for electronic claim submission, ANSI 835 EOB retrieval, claim status information, electronic patient records and inter-office/remote communications.

Electronic Claim Submission

ZyWin Advantages

                                HIPAA TRANSACTION SET CERTIFIED!

 Easy to use!

 HIPAA qualifier codes pre-loaded!

No testing! EDI formats are pre-approved with carriers.

No third-party translators!

 Functions are almost 100% automated!

 Save money!

 NO per claim fees for direct carriers!

 NO costly paper forms or mailing fees!

 Faster turnaround!

 Reduce receivables!

 Increase cash flow!

 Submit to HUNDREDS of carriers for FREE!

 Use with confidence!

 Approved by major carriiers

 Constantly updated for new regulations. (Updates available 24/7 via Web)

 Advanced technology!

 Retrieve Submission Analysis Reports electronically for incomplete/invalid claim rejections.

 Electronic EOBs - Retrieve EOBs (835) for Medicare and others using ZyWin APS (optional).

 Automatically post directly to patient accounts using ZyWin APS (optional).

 ZyWin ECS supports the fastest modem rates available today.

Medicare Carriers

ZyWin includes direct submission to CMS Contracted Medicare Intermediaries.

Blue Shield Carriers

ZyWin includes direct submission to the following Blue Shield Carriers (others are being added - call for specifics):

 Highmark/PA Blue Shield

 Blue Shield of Delaware


Highmark EDI Services also accepts claims for other carriers. 

 PA Blue Shield Private Claims

 Independence Blue Cross (IBC) Personal Choice

 Highmark Claims/Encounters

 Keystone Health Plan East/West/Central claims and encounters

 Keystone Health Plan East claims and encounters (An IBC company)

 Amerihealth - Delaware, New Jersey

 Clarity Vision

Emdeon Clearinghouse (formerly WebMD, Envoy, NEIC)

Emdeon provides electronic submission services to hundreds of participating carriers free of per claim fees! Additional non-participating carriers can be submitted for a nominal per claim fee.

Services available:

 FREE electronic claim submission to over 700 participating carriers.Submitting in HIPAA compliant format - ANSI 837 4010.A1

 Electronic submission to non-participating carriers for a nominal per claim fee.

 FREE AETNA/US HEALTHCARE and Cigna referral submission and retrieval.

 Electronic submission of patient bills to ExpressBill. They print and mail bills for you! 

Automated Posting System

The ZyWin Automated Posting System (APS) is one of the most powerful tools available today as insurance EOBs can be received electronically and posted in seconds! Please read the enclosed APS literature for more detailed information.

Automated Updates

Updates to the ZyWin program are retrieved via our secure website through the ZyUpdate software provided with the system. The advanced Auditron Updating System is available 24-hours a day enabling Users to:

 Automatically retrieve and perform system updates including new features and documentation!

 Perform updates according to their schedule!

 No waiting for updates!

Electronic Medical Records

ZyWin has been programmed to interface with Electronic Medical Records (EMR) packages. This enables automatic updating to occur from ZyWin to the EMR package. So as patient information is changed in ZyWin, it is automatically modified in the Electronic Medical Records program.

Please consult your ZyWin representative for latest availability and license fees.

Electronic Patient Billing

Patient billing can be done electronically through ExpressBill. The billing cycle is completed in ZyWin and the data sent to ExpressBill via direct modem link or through the Internet. Bills are printed and mailed within 24 hours. Please consult your ZyWin representative for latest fees regarding this service.

The cost benefit is derived in staff having much more time and energy to concentrate on the collection process, since the billing is done for them! The cost is only about a nickel per bill over doing it in house not considering labor expense!

 Hospital Links

Many hospitals provide the means for physicians to access patient information by modem. Contact us for further information for specific hospitals.

Inter-Office/Home Links

Interoffice connections and Provider home-to-office connections are old hat for ZyWin Users.  Just log into the office computer for complete access including print capabilities. This access can be Internet or direct dial.

Inquiry and Referral Products

Many Insurance Companies are providing electronic inquiry and referral products or services. These may be through direct links to the carriers or, more commonly now, via the Internet. Where available, information is imported into and sent from ZyWin. These programs allow access to information such as:

 Claim status.

 Fee schedule and limiting charge data.

 Procedure code information.

 Check / EOB information.

 Forms, policy, billing procedures & publications.

 Post Payment Review Requests.

 Provider Address & Telephone/Fax number changes.

 Patient enrollment/benefit information.

 Allowance information - including the provider's current charge, usual charge, fee schedule allowances & UCR allowances for procedure codes.

 Access to eligibility & benefit information.

 Ability to create/send/lookup/import referrals.

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