SIMS Interfaces

We provide a number of interfaces to and from external systems, including:

• Positive Pay and Bank Reconciliation: These interfaces are used to communicate with your bank electronically. SIMS Claims™ submits check data (check number, payee, amount, etc.) and receives the cleared dates and check status. The Positive Pay and Bank Reconciliation interfaces are used to reduce check fraud and improve internal controls.
• Bill Review: The Bill Review interface is used to submit claim and vendor information to your bill review company and import medical payments, including EOB information, into SIMS Claims™. Once imported, all the medical information is easily accessible in the payment and reporting modules.
• ISO ClaimSearch^®: Claims transmitted from SIMS Claims™ to the ISO ClaimSearch^® are processed and matched against millions of other claims in the database. If the system finds a match a report is returned and stored in SIMS Claims™ to help you identify patterns which may indicate fraudulent or suspicious activity or duplicate coverage.
• Accounts Payable: This interface is used when checks are not printed within SIMS Claims™. In that case, it exports approved payments to your accounts payable or check printing system. Once the checks are printed in the external system, SIMS Claims™ imports the check numbers and check dates and matches them with the corresponding payments.
• Claim: This interface is used to import claims submitted electronically from your claim intake provider. The same business rules used when creating new claims within SIMS Claims™ (coverage verification, auto-adjudication, etc.) are applied to this interface.
• Policy: This interface is used to import policy information into SIMS Claims™ to verify coverage and include policy information in Loss Run and other reports.
• Payment: SIMS Claims™ includes a number of payment interfaces to allow you to import electronic payments into the system.

Our interfaces can be modified and expanded based on the client's requests and are ready to read and write to a variety of formats including XML, flat files, Access, Excel and a number of OLE DB providers.