Get paid encounters accepted the first time.
transSend TRACE, the Transaction Reconciliation and Claim Encounter Submission Engine, manages paid encounter submission and reconciliation for health plans. Encounters are loaded, held and prepared in TRACE until they are ready to go out to the CMS Encounter Data Processing System (EDPS), a state, or another agency, and every response that comes back is matched to the encounter it belongs to.
Nothing goes out until it is ready.
Paid encounter data is loaded into TRACE and stays there while business rules, look-ups and compliance checks run against it. The plan decides when a batch is released, and TRACE exports and transmits it to the outbound receiver.
The point of holding the data is leverage. Corrections made in TRACE before submission cost a rules change. The same corrections made after a rejection cost a resubmission cycle with the receiver.
Your rules, applied before submission.
Every receiver wants the data a little differently, and the gap between what a plan's system holds and what the receiver expects is where first-pass rates go to die. TRACE closes that gap with edits and transformations the plan defines, run alongside compliance checking.
Member and provider look-ups
Values missing from the encounter or held differently in the plan’s system are resolved against the source of truth as the encounter is prepared.
Identifier mapping
A health plan NPI or Tax ID can be mapped to the state Medicaid ID the receiver expects, so an identifier mismatch is not what gets the encounter rejected.
Custom edits the plan supplies
Any rule the plan provides can be applied as part of preparation. The rules belong to the plan, not to an inflexible product configuration.
Compliance checking
Compliance validation runs alongside the custom edits, so structural problems and business problems are both caught in the same pass, before submission.
Every response finds its encounter.
Response files are loaded back into TRACE and matched to the outbound encounter that produced them, so a submission is not finished when it is sent. It is finished when its final status is known.
Match and categorize
Each response is associated with the outbound encounter it answers and categorized as a pass or a fail against compliance and business rules.
Route to the team that owns it
A reject or denial can be mapped to the department that can actually fix it, whether that is Enrollment, Provider Relations or Claims, rather than landing in one undifferentiated queue.
Transaction IDs tracked
Receiver transaction IDs are captured on the way back in. For a VOID or REPLACE resubmission, the response ID (ICDN) is populated on the outbound encounter automatically, with nobody keying it across.
Standard response files, and the ones that are not.
TRACE loads the standard response transactions and custom formats alike, so a receiver with its own file layout does not have to be handled outside the system. Chart review records are supported both linked to an encounter and unlinked.
Metrics you can act on, and a record you can defend.
The TRACE interface carries the metrics and the complete audit trail together. Success rates and reject reasons tell you where the problem is, and the activity history for each claim tells you exactly what happened to it, in plain English rather than in raw segments.
Tell us your reject reasons and we will tell you what TRACE would catch.
Most encounter rejects cluster into a handful of causes, and most of those are fixable before submission. A short conversation about what your receivers send back is usually enough to tell whether TRACE is the right answer for your plan.
Talk to our team →Let's talk about your HIPAA transactions.
Thirty years in healthcare EDI, on both sides of the claim. Tell us what you're running and we'll tell you honestly whether we fit.
Software for healthcare payers and the providers who bill them, since 1996. Simplifying HIPAA eCommerce.
Frederick, MD 21701
(301) 815-5220