Problem Statement

When claim files move between Epic and a downstream submission system, files or claims can be dropped in transit, and a claim that never makes it out is revenue that silently goes unbilled with nothing on a workqueue to flag it. The only reliable check is to balance the electronic and paper claim files between the two systems, confirming the counts and totals Epic sent match what MBMS received. Done manually, this balancing is tedious and easy to defer, which is exactly when a submission gap slips through.

Automation Solution

This automation reconciles electronic and paper claim files between Epic and MBMS to confirm balanced submission counts and totals.