Payer & Claims Data Integration
Every payer sends a slightly different file, on a slightly different schedule, with a slightly different definition of the same field. Most organizations reconcile that by hand, in spreadsheets, a quarter late.
DAX normalizes claims across every payer in your book into one model — with lag and completeness stated openly rather than hidden behind a dashboard.
What we process
X12 transaction sets
- 837P professional claims
- 837I institutional claims
- 835 remittance advice
- 834 enrollment and maintenance
- 270/271 eligibility inquiry and response
Government & payer files
- CMS CCLF files for MSSP and ACO REACH
- Medicare Advantage encounter and premium files
- Commercial payer claims extracts
- Medicaid managed care files
- Payer-specific gap and quality files
Membership & attribution
- Eligibility spans and coverage history
- Attribution and alignment logic by contract
- Member-to-patient identity resolution
- Panel assignment and PCP relationships
- Retro-attribution and churn handling
Claims normalization
- One claims model across every payer
- Header and line-level reconciliation
- Adjustment, void, and replacement handling
- Place of service and revenue code alignment
- Allowed, paid, and billed amount standardization
Completeness & lag
- Claims lag curves by payer and service type
- Incurred-but-not-reported estimation inputs
- Run-out windows applied per contract
- Completeness flags surfaced to every downstream report
Risk & reconciliation
- HCC capture from claims diagnosis history
- Risk score inputs by model year
- Payer reconciliation against internal records
- Variance tracking and persistent exception tables
From raw payer file to contract action
- Payer file
- Claims normalization
- Attribution & eligibility
- Completeness & lag
- Utilization, risk & contract performance
Utilization visibility
Admissions, ED visits, SNF days, and specialist patterns measured on normalized claims rather than on whichever portal a payer gave you.
Patient prioritization
Cost, utilization, and risk history combined so care teams work the patients most likely to affect the contract.
Attribution you can defend
Who is attributed, under which contract, for which months — reproducible from source files rather than asserted by a vendor.
Risk adjustment
Claims-based condition history against clinical documentation, showing recapture opportunities and unsupported codes side by side.
Provider performance
Cost and utilization by provider and site, adjusted for attribution and risk, with drill-down to the underlying claim lines.
Contract performance
Trended performance against benchmarks with the lag caveats stated explicitly, early enough in the year to act on.
All of it lands in a foundation your organization owns. The applications that read it — DAX's, your existing tools, or something your team builds — stay interchangeable.
How many payer feeds are you reconciling by hand?
Tell us which payers, which file types, and where the numbers stop agreeing. Claims normalization is usually the fastest part of the foundation to show value.