EDI Workflow Management
With NEXUS, Green Light’s Workflow Optimization Engine, Payers gain full control of their EDI workflow management. NEXUS eliminates the challenges associated with EDI transaction management and improves savings outcomes. NEXUS enables Claims Payers to seamlessly manage and exchange data with multiple trading partners through a single exchange point. This centralization affords Claims Payers the ability to optimize outcomes through a logic-based decision engine, all while maintaining full control of their EDI workflow.
NEXUS is a powerful business tool designed to streamline EDI implementations and increase savings opportunities for our Clients. Using our rules-based system to establish a client workflow, NEXUS is configured to automate distribution and workflow management based on the defined workflow, all which is configurable at the individual employer level. Clients can easily modify their existing workflows and seamlessly integrate any vendor organization that is a Green Light trading partner.
Examples of variables that distribution rules can be established on, include the following:
-
Geography
-
Diagnosis Related Group
-
Tax Identification Number
-
Billed Charges
-
Diagnosis Codes
-
Claim Type
-
Date of Service
-
Provider Specialty
-
Procedure Codes
Our robust technology is complimented by our decades of experience working with PPO networks and managing the transfer of the associated transaction sets. Our network and vendor partnerships continue to grow and are effectively limitless, giving our clients streamlined access to a growing number of trading partners. We continually seek to identify network solutions that can add value and efficiency to our Clients cost management programs.
Our value proposition is uniquely positioned in the market. Green Light is not a traditional “aggregator” or “reseller” of cost management services. Traditional aggregators tend to recommend networks where they have significant interests in margin, the difference in the price they pay for network access versus the price they sell the network access. Instead, Green Light is a technology provider that bases recommended distribution decisions on projected net savings, in keeping with our mission to optimize savings outcomes and help employer health plan dollars go further.