• Thiruvanmiyur, Chennai 600 041, Tamilnadu, India.
  • +91 91766 47868
  • Cost

    Effective Solutions

  • On Time

    Project Delivery

  • Cost

    Effective Solutions

  • On Time

    Project Delivery

XML Submission

Home XML Submission

MULTIPLE RA XML CLAIM SUBMISSION (INSURANCE – HEALTHCARE)

Our System is used for Multiple Submission XML Claims & RA (Remittance Advice) XML Claims Submission for Insurance Team in Hospitals and Clinics. This System will automatically segregate the Multiple RA Claims into Accepted and Rejected Claims.

Benefits

  • Reduce the Claim Rejections
  • Increase the Payment and Turnover
  • Reduce the Manpower Usage Time
  • Simplify the resubmission process
  • Easy to identify the rejected claims for resubmission
  • Automated XML Submission system which avoids human errors
  • Editing the approved insurance amount since download in XL Format
  • To fill the system gap which exists in most of the HIS System

Objective

  • Our System will accept and submit a set of Submission & RA XML Files (Multiple Claims)
  • Our System will read multiple RA Claims XMLs and separate this into two XML files
    (i) Accepted XML File (ii) Rejected XML File
  • Analyzing the XML Data which is received from HIS
  • Our System will create a batch no. for each claim submission
  • When batch is created, XML and XL are generated and gets auto-downloaded
  • Our System provides the option (Success / Failed) to update based on the HIS Submission
    Success / Failure
  • Our System maintains all batches in a list with their Claim Ids detail under each batch
  • Our System will maintain the services (CPT Codes) under each claim under each Branch, each
    Insurance Provider (Branch, Insurance provider, Claim, Service)
  • Accepted / Rejected Claims are kept for each Claim Service
  • Claims under Successful Batch can be downloaded in XML or XL at any point of time

XML Handling

  • Upload Multiple RA XMLs
  • Validation of RA XML Files
  • Segregation of XML into Accepted and Rejected
  • Edit any Claim / Service Data of Paid Amount, Rejection Amount and Rejection Reason
  • Generation of XML for the selected Claims / Services for both Accepted and Rejection
  • Creation of Batch for the generated XML
  • Updation of Status (Success / Failed) to the created batch. If failed, batch will be removed and batch can be created again for the claims
  • List of Batches with their Claim Ids and Service Codes

Upload RA XML

  • It will act independently. All RA XMLs will be uploaded into our system manually by
    selecting the xml files
  • These XML will be received after Submission XML
  • This schema differs with Submission XML schema with some fields which contains patient’s insurance details along with Paid Amount and Balance Amount
  • When RA is received and uploaded, Accepted Claims are separated if Denial Code3 is ‘Null’ and Rejected Claims are separated if Denial Code is not Null
  • Some of the fields Validations of XML is done
  • Submission XML Data are to be stored in a separate Master / Detail Table
  • It will act independently. All RA XMLs shall be processed and generated as XML in our
    system

Edit XML Data

  • Display all the data of Submission XML & RA XML against each Claim ID / Service Code
  • Edit the existing claim service under any claim id
  • Editing of data is possible only with Paid Amount, Rejection Amount and Rejection Reason
  • Change Rejected Claim to Accepted Claim

Resubmission

  • Rejected Claim Services can be edited and resubmitted as RA XML

Batch Creation

  • Batch is created for both Accepted and Rejected Claim Services