263411 - Billing Clearinghouse Services

2026-11-03

rovide an Electronic Submission of Medical Documentation System that supports the electronic transmission of healthcare claims and remittance information between ADPH and various payers . The system must comply with all federal and State Electronic Data Interchange ( EDI ) standards and support integration with ADPH billing applications . The following categories describe the scope of required services : 1 . Claim Submission & Processing The supplier shall provide an automated platform capable of processing , validating , and submitting healthcare claims to a variety of payer types , including Medicaid and commercial insurers . • Support both batch and real - time claim submissions . • Perform pre - submission validation and edit checks to ensure claim accuracy . • Provide detailed error reports for rejected claims . • Allow resubmission of corrected claims through the same interface . 2 . File Transfer Service A transfer tool that allows you to send and receive 837 and 835 files . • Submit , edits , and receive claims and remittances for Medicare , Medicaid , and commercial insurances . • View a snap shot of all the transmissions • Provide immediate snap shot of 837 responses received by Medicare 3 . Medicare Analytics Track claims in Medicare system throughout their life cycle , report claim status , financial suspense status . • Compare revenue cycle metrics against the nationally published standards . • Track key financial indicators and trend data over a rolling 12 - month view . • Options to review and analyze Medicare data .

Alabama

2026-03-27