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ValiData Claims Processing

ValiData Claims Processing Software

ValiData is a robust Medial Claim Data preprocessing software solution designed to maximize the speed and efficiency of auto adjudication. Using superior logic and functionality, the system matches claims to provider and eligibility databases. The software also validates CPT and ICD9 codes, generates the DRG as well as executes an unlimited number of custom claims rules. Preprocessing EDI with ValiData before loading into your claims payment system gets claims through your system four to six times faster and with greater accuracy. Consequently, fewer people are required to do the same amount of work.

Primary features include:

Provider matching - Superior logic yields improved provider selection compared to other claims payment systems. Manual matches are easier, too.

Eligibility matching - Using logic similar to that used for provider matching, eligibility matching is virtually automatic.

ValiData codes - CPT, ICD9 and modifiers are validated with standard and custom codes.

Quirks - Easily create and uniformly apply custom rules for claims. Write rules for Plan, Enrollment, Billing, Utilization Review, and Provider, and configure them to be permanent or temporary.

HSA - Audit and load NCPDP pharmacy claims into your claims payment system, eliminating the need for TPAs to call on BPMs for claims reports. Pharmacy co-pays are automatically integrated with deductible and out-of-pocket data, allowing the insured access to aggregate information from a single source.

DRG grouper and verification - Integrated MicroDyn application allows automatic identification of claims that fall outside of standards.

Database cleansing - Improved efficiency by automatically identifying the top providers, eligibility, etc. causing the most rejects. Create custom reports with Crystal Reports to better manage your process.

System Advantages:

ValiData is a comprehensive EDI scrubbing software package designed by a TPA for TPA's. The primary objective of the software is to validate and format your EDI in order to maximize the auto adjudication of your claims payment system. Because it is fast, it will save hours of labor every day. The following are the most important advantages that ValiData can provide today's TPA:

  • Improves claim processing speed and accuracy
  • Nightly data extracts for near real-time eligibility and provider data
  • Greatly reduces training time
  • Allows unlimited custom claims rules ("Quirks")
  • Built-in intelligence for matching provider, eligibility, ICD9 and CPT4 codes
  • Flexible and scalable
  • SQL Server based
  • ASP model eliminates the need for new hardware and support
  • 10 years in production


Contact us to learn more about our software solutions or for a free consultation