Connect with payers
Simplify payer integration with a single platform
Each payer operates with its own set of standards, protocols, and data formats, making it difficult to establish and maintain efficient connections. Without direct payer connections, you can face delays in claims processing, increased administrative burdens, and potential revenue losses.
Redox simplifies the integration process by enabling you to connect with multiple payers through a single, standardized interface. When your payer connections are powered by Redox, you can manage claims, eligibility verifications, and other revenue cycle management tasks with greater efficiency and fewer resources.
Our interoperability platform ensures that your payer connections are not only established quickly, but also maintained with the highest level of reliability and performance. This means fewer delays, reduced operational costs, and more time for you to focus on developing and deploying the solutions your customers are asking for.
Case study
By connecting providers and payers with advanced technology and custom-built solutions, we’re reducing administrative burdens and expediting care delivery. Whether you're implementing AI-driven tools or developing in-house solutions, Redox ensures seamless interoperability, so you can focus on patient care while we handle the complexity of data exchange.
How it works
Redox’s interoperability platform streamlines payer connectivity with a unified API that allows you to connect with multiple payers through a single interface. This API abstracts the complexities of different payer systems, reducing the need for custom-built integrations.
Our platform supports essential healthcare data standards, including X12 transactions, which are critical for claims processing, eligibility verification, and other payer interactions. Because Redox normalizes and translates your data, the information exchanged between your systems and payer systems is consistent and ready for immediate use, minimizing potential errors and discrepancies.
With Redox, you can manage all your payer connections through a centralized dashboard. This dashboard provides real-time insights into performance, claims status, and data flow, giving you complete control over your revenue cycle management processes.
Typical data flows
Claims adjudication
Submit claims to payers
Request coverage eligibility status to avoid costly claim denials
Retrieve patient information, such as diagnoses, procedures, and medications, to support accurate claim submissions
Monitor claim status and listen for adjudication updates to track progress
Automate the submission of claims to reduce administrative workload
Patient eligibility
Retrieve patient demographics and insurance ID to ensure accurate eligibility checks
Monitor updates from payers to stay informed about any changes in patient coverage
Automate eligibility checks to streamline workflows and reduce administrative burden
Prior authorization
Listen for new orders to ensure timely processing
Request coverage eligibility status to avoid costly claim denials
Retrieve necessary patient data, including diagnostic results, medication lists, and other relevant documents to support prior authorization
Automate the submission and management of prior authorization to enhance efficiency