Electronic Claims Submission



E-Claims, SPSI's web-based claims service offers a comprehensive solution to electronically submit your claims to an extensive payer network. E-Claims provides a detailed reportable audit trail; tracking each step of the process establishing the foundation for flexible Internet-based reporting tools necessary to manage your claims.

SPSI's objective with E-Claims is to provide an easy-to-use interface that offers a complete solution for editing, submitting, and monitoring claims.

A major part of the SPSI's E-Claims complete solution is its robust "Rules Engine" that can identify exceptions before they are submitted to the payer network. The "Rules Engine" identifies and reports claims exception early in the claim life cycle and provides the tools to resolve the exception quickly.

E-Claims FeaturesSPSI
  • Accepts claims seamlessly from virtually any practice management system in most any format. (Claim Image, NSF, HIPAA)
  • Only requires Internet Access with MS Internet Explorer.
  • Safe, secure HIPAA-compliant communications via the SPSI's conduit.
  • SPSI's rules engine evaluates claims for missing or inconsistent data.
  • The rules engine includes a comprehensive claim rules library.
  • Clients can develop and add their own claim rules to the library.
  • Claims not meeting all the rules are included in workflow with information to resolve the exception.
  • "Clean" claims are formatted and communicated based on the varying requirements of individual payers.
  • Claims mailed to payers that do not accept claims electronically.
  • Payer receipt confirmation and processing status reported for each claim.
  • Claim Activity History available anytime via the Internet.
  • Reports are customizable to follow your organization's workflow.
  • Reports include cumulative and statistical reporting.
E-Claims BenefitsSPSI
  • Faster claims turnaround; reduction in Days of Accounts Receivable.
  • Better management tools through custom reports.
  • Prompt identification of carrier issues for faster resolution.
  • Automated edit rules for claim accuracy.
  • Periodic statistical reporting for analysis.
  • Lower rejection and denial rates.
  • Submission to over 550 payers (and growing).
  • Customizable rules for checking data.
  • Secure and HIPAA-complaint communications.
  • Claim search, tracking, and status via the Internet.
  • SPSI responsible for all payer changes.
  • No hardware cost, monthly service or connection fee, only a minimal claim fee. Pay only for what you use.
E-Claims Data FlowSPSI

Your Practice Management System

Claims Output File

SPSI Network

SPSI Mapping Engine

SPSI Rules Engine

SPSI Payer Translator

Payer Network

Customizable Web-based Reports

Southwestern Provider Services, Inc.

2350 Airport Freeway, Suite 410, Bedford, TX 76022

817-684-8500 - Office