Healthcare Technology Featured Article

November 29, 2012

JDi Data Claims Manager Streamlines Medicare Compliance Process



In the insurance industry, filing a claim is only the beginning. JDi’s Data Claims Manager aims to help insurance adjusters and managers an easy to manage their claims and compliance forms from anywhere, especially with its new API.

“We pride ourselves on being active listeners when it comes to clients' needs in order to pursue an intuitive claims management system with creativity and passion to exceed expectations,” Cristian Landivar, a software engineer for JDi, said.

The package also offers a variety of compliance forms, including the MMSEA Section 111 Medicare Secondary Payer Mandatory Reporting form.

The package provides a Direct Data Entry (DDE) service through a Section 111 COB Secure Website (COBSW). Once logged in, a user can get to work immediately entering claims data, though this can be a tedious manual operation.

Alternatively, users can use the Electronic Data Interchange (EDI) feature to import and export data from other files automatically, as long as they are in a specific format.

Another option is to farm out the task of compliance to firms that specialize in this kind of work, such as Gould & Lamb.

To support third-party compliance agents, JDi has developed an API for its MMSEA Section 111 Medicare Secondary Payer Mandatory Reporting. This allows developers to directly interact with the server in order to send and retrieve data easily. It also interacts with Gold & Lamb’s own secure server. The API will allow clients to automate the process of entering claims, taking the drudgery out of the task.

“As the claim adjuster you enter the claim and claimant information in the Claims Manager® system once and forever,” a company blog post said. “The API is programmed to retrieve the required data from around the Claims Manager system, format the data in the specific file format, and submit the file to CMS or your agent. When the result file is ready from CMS or your agent, the API will pick it up from the designated secure server and process it neatly in the Claims Manager system, create error report for you to follow up when necessary.”




Edited by Rich Steeves




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