XeoRules™ Transform drives the translation of claims, responses, member enrollment and provider contract data between legislated industry layouts and proprietary formats. Any data that enters the system or is generated during the use of the system can be output to satisfy reporting or 3rd Party application requirements.

XeoRules™ Transform is where powerful Front End Edits are applied for the payer and documented in the payer’s EDI Companion Guides. XeoHealth EDI Subject Matter staff assist the payer EDI staff in creating EDI Companion Guides and submitting the guides to ASC X12 for proper approval and attestation. The Front End Edits keep only clean claim data entering the adjudication system, providing providers with immediate feedback on business edits via the 277 Claim Acknowledgment transaction and providing an improved claims cycle management system. XeoHealth follows implementation guidance based on Technical Report (TR2) or reference model as published from the standards body ASC X12. 

XeoRules™ Transform is the interface for accepting the file from provider and payer community alike. If required, it can be the “front door” for all file transfers for the payer’s claim, acknowledgment, attachment, and remittance advice with the provider community. It can also be the interface with third parties on behalf of the payer. This module can be utilized within the solution or it can interface with the payer’s existing EDI solution.