PilotFish X12 EDI Case Studies Show the Power Delivered by PilotFish EDI Solutions

PilotFish’s specific EDI Software is being leveraged by payers, providers, software vendors, cloud services, exchanges and other entities using the X12 EDI standards. With PilotFish X12 EDI solutions, the multitude of challenges in X12 EDI integration experienced by companies across healthcare are met and defeated – legacy systems, broken processes, X12 data and EDI documents inherent variability, high volumes, new technologies, limited resources and more.

Browse through our PilotFish X12 EDI case studies.  With PilotFish, organizations easily leverage the benefits of EDI – as each case study demonstrates. You’ll see how the flexibility and scalability architected into PilotFish’s integration engine solutions allows us to adapt to any business document, environment or requirement and deliver every time. It also enables us to leverage new technologies to provide opportunities for greater operational efficiencies, gains in productivity and system performance.

PilotFish’s eiConsole for X12 EDI graphical Automated Interface Assembly Line process easily handles connecting Anything to Anything – including legacy systems and new technology that have been developed using different data models, designs or architecture. Going forward, reuse of interfaces is as simple as clone, tweak, test and go – a huge efficiency benefit.  PilotFish EDI solutions slash timelines for onboarding, implementations, updating, and maintenance. With PilotFish software’s ease of use and automation, business users can do up to 90% of X12 EDI configuration work thus reducing reliance on developers and freeing IT resources.

Importantly, PilotFish supports every major healthcare standard and source – EDI, NCPDP, HL7, CDA, FHIR, XML and data sources outside of healthcare. The PilotFish eiPlatform is compatible with all major databases, operating systems, data formats and communication protocols. That means there is only one software product to learn and employ for any information exchange.  Across an organization, interfaces will be consistent, addressing any use case, with savings flowing to the bottom line.

We invite you to let us help you accelerate the benefits of EDI while meeting its challenges.

Faster Claims Processing

PilotFish dramatically improved a client’s healthcare claims processing and payment remittances system by implementing their Integration Engine Solution suite. This system, which handles X12 EDI 835 and 837 transactions, boosted data handling, parsing, validation, and usability. As a result, processing times were cut from 14 hours to just 45 minutes—an improvement of over 1000%. This transformation not only increased operational efficiency but also created new revenue opportunities and expansion possibilities. EDI 835, EDI 837, Claims Processing, Payment Remittances >

Easy Migration from Sunsetted EDI Claims System

Deep expertise in EDI claims processing averted a crisis for this HMO and delivered fast, easy migration from a sunsetted EDI system. New compliance capacity arrived with PilotFish’s unique EDI SNIP Validation Processor. In this case study, discover how partnering with PilotFish modernized the payer’s EDI claims processing system and compliance infrastructure.
EDI 837, EDI 835, SNIP Types 1-7, Compliance, Claims Management >

EDI Workers’ Comp Claims System

Robust, modern EDI Integration Solution replaced current sunsetted EDI integration system end-to-end. The company gained advanced SNIP validation of types 1-7 with superior accuracy, efficiency, and scalability. Faster cost-effective closure of workers’ comp claims improved profit margins. See how top EDI technology and EDI expertise delivered.
EDI Workers’ Comp Claims System >

Healthcare Data Integration

Payers, providers and service partners struggle to navigate the disparate processes, standards and systems required to integrate social care, behavioral health care and medical care. Learn how a transformative leader moved forward to tame complexity and ensure seamless data interoperability.
HL7 FHIR, X12 EDI, Care Delivery, Claims >

Healthcare Claims Accuracy Solution and Payment Integrity

Extensible software, a forward-thinking approach, and the ability to run billions of claims across policies, networks and markets from one platform deliver lower costs and higher quality for healthcare payers. Learn about this new hybrid, cloud-based central platform aiming at all aspects of payment integrity – claims accuracy, eligibility and verification, prior authorization, pricing and plan optimization, and more.
HL7 FHIR and X12 EDI Integration > Core Capability for Claims Accuracy >

X12 EDI Specialty Health Insurance Integration

A leading organization that provides health services was experiencing rapid growth and planning to double its size over the next five years. Enhancing its data integration solution was critical to meeting growth projections, improving efficiencies, and reducing any potential risks to its high-volume information processing capabilities. Integrating X12 EDI data with the organization’s diverse plans and programs posed a unique set of challenges that had to be met.

In this case study, discover how by leveraging PilotFish’s integration solution with its specialized X12 EDI features the organization benefitted from robust data integration and accurate validation and was able to achieve its goals.
Benefit Management EDI Integration Solution >

Healthcare Revenue Recovery Solution

 “A chain is only as strong as its weakest link” applies to X12 EDI data integration and delivering revenue recovery solutions. This company’s processes using advanced data science tools got bogged down by a weak link – EDI data intake. Their home-grown parser just couldn’t handle ingesting millions of EDI 835 and EDI 837 transactions. PilotFish’s eiConsole for X12 and its built-in EDI parser surpassed the client’s home-grown parser across every metric. The big winners in this PilotFish-led revenue recovery automation process were the client’s hospital system customers.
See PilotFish in action >

EDI 834 and 837 Claims Integration

This full-service third-party benefits administrator is a leader in the self-funded employer benefit health and wellness plan space. The company provides employers with strategic benefits plan design, cost-effective benefits administration as well as reporting and analytic services. With PilotFish as a partner, they have been able to capitalize on plan, utilization and claims data to help their customers balance and control the costs of providing benefits. In this case study, discover how PilotFish’s Integration Engine solution and deep expertise in EDI healthcare data exchange helped them modernize their IT capabilities and reduce costs.
EDI 834 and 837 Claims Integration >

NCPDP Integration Solution

TPAs leverage NCPDP standards for information exchange to process and administer employee healthcare and pharmacy benefits and claims. In order to manage and drive down healthcare costs, employers turn to TPAs to create and administer employee benefits plans. Learn how this leading TPA implemented the PilotFish Integration Solution to automate and standardize processes vital to meeting their client demands and their own aggressive growth targets.
NCPDP Integration Solution >

Benefit Enrollment & Claims Processing

Strategic use of data and analytics by this leading Third-Party Administrator (TPA) is critical to delivering value and innovation to its growing employer client base seeking new ways to manage rising healthcare costs and improve employee health. See how PilotFish’s Healthcare Integration Solutions and its eiConsole for X12 EDI provide a competitive edge.
EDI 834 Integration >

Reporting & Analytics Integration

High performance delivered! With dominant position and market share in hospitals and practices throughout the United States, the client is focused on delivering a single source provider of financial, operational and quality metrics, coupled with proprietary, value-added analytical services. This massive big data integration challenge, a tough bake-off, and implementation proves the superiority of PilotFish Integration Engine Solutions.
Delivering Higher-Quality Analytics in Less Time with Less Staff >

Revenue Cycle Management Solutions

The client is a well-established clinical laboratory billing and collection company serving companies nationwide. The organization offers cloud-based solutions that enable their client laboratories to maximize profitability through optimization of the revenue cycle and reimbursement process. The client has had (and continues to enjoy) significant commercial interest in its services. However, many of its critical business processes remained manual. This intense requirement on human resources threatened to put a cap on their growth, due to an inability to keep up with demand. Read on to learn how the client leveraged PilotFish to initiate automation.
Achieving Claim Entry and Processing, End-to-End, in 7 minutes >

Payer Claims Clearinghouse Integration & HIE

Legacy system hangover, stressed resources and impatient customers are a cry for moving to a modern architecture and integration solution. Learn how a Healthcare Claims Clearinghouse and HIE challenged its new integration solution to re-engineer and transition its claims processing architecture in record time with no disruption to existing connections or increase in resources. A small internal team armed with the new tools and PilotFish support met every challenge. With newfound agility, the organization has responded efficiently to growth and increased transaction volumes.
Lean, Lightweight Healthcare Integration Leverage at Work >