5010 X12 Administrative Transaction Sets
RHIOnet accepts web-based requests from providers and generates a standard request routed to the appropriate host system.
Eligibility and Plan Benefits
RHIOnet can deliver a much deeper level of detail than simple yes/no eligibility, allowing for the collection of co-pays and deductibles at the point of care. This feature alone has one RHIOnet customer realizing an additional $120,000/month ($1.4 million/year) in previously uncollected revenue.
Through RHIOnet’s Direct Connect, multiple files can be uploaded for an eligibility status check before patients arrive. RHIOnet can send eligibility requests in either Real Time as single transactions that require an immediate response or in Batch Mode. In batch mode, they are grouped together in large quantities and processed en-masse; the responses are not instantly returned. The results of a transaction processed in batch mode will be completed for the next business day.
Claim Status Inquiry and Response
This transaction allows providers to inquire about a claim status and receive a response from payers
Payer Claims Inquiry and Response
This transaction allows users to ask for additional claims information, upload files, labs, and ask additional questions
Referral Requests and Response
This x12 transaction allows providers to request referrals from outside entities.