Infrastructure Transition
Claim.MD dependency reduction path · MASE-native payer connectivity roadmap
Migration In Progress — Phase 1 of 4
⌘K
Native Rail Migration Readiness
Progress toward eliminating Claim.MD dependency across all 7 active payers
42%overall readiness
86% of today's traffic via Claim.MD
Phase 1: Infrastructure & Legal
60%
Phase 2: Payer Connectivity
29%
Phase 3: Enrollment Migration
0%
Phase 4: Production Cutover
0%
Cost Reduction Projection
Monthly Claim.MD Fee (Current)
@ $0.08 per transaction
Projected Native Cost
Infrastructure + ops only
Monthly Savings at Go-Live
88% cost reduction
Annual Savings Potential
Full native adoption
Migration Phases
Phase 1·Q1 2025
Infrastructure & Legal
In Progress
60%
ISV Certification with X12
BlockerPending — estimated 3 weeks
CMS EDI Enrollment (Medicare)
Completed Aug 2023
Trading Partner Agreement Templates
7 templates ready
Legal Entity HIPAA BAA Framework
BAA v2.1 in production
Security & Penetration Testing
Scheduled Feb 2025
Phase 2·Q2 2025
Payer Connectivity
Partial
29%
Medicare Direct API Connection
Live since Aug 2023
BCBS TPA Approved
Signed Sep 2024
Aetna TPA Under Review
14 days overdue
UHC TPA Submitted
Awaiting response — est. 10 days
Cigna — Requires Revision
BlockerISV cert + ISA/GS format issue
Medicaid State Agreement
Notarization required
Humana SFTP — Deferred Q1
Humana paused onboarding
Phase 3·Q3 2025
Enrollment Migration
Not Started
0%
Provider Enrollment Migration Tool
Depends on Phase 2 TPAs
ERA/EFT Re-enrollment for Direct Rails
Per-payer re-enrollment required
Companion Guide Integration Layer
7 companion guides to parse
Real-time 270/271 Direct Connect
Medicare live; 6 remaining
Phase 4·Q4 2025
Production Cutover
Not Started
0%
Parallel Run Period (30 days)
Both rails live simultaneously
Claim.MD Traffic Reduction Plan
Incremental cutover by payer
Native Rails Go-Live
Full production readiness
Post-migration Reconciliation Audit
30-day retrospective audit
Payer Migration Readiness Matrix
Manage TPAs | Payer | Current Route | TPA Status | Migration | Monthly Vol | Acceptance | Blockers | Next Action |
|---|---|---|---|---|---|---|---|
Blue Cross Blue Shield 00050 | Claim.MD | Approved | Pre-Planning | 14,820 | 97.3% | Clear | Monitor renewal date |
Aetna 60054 | Claim.MD | Under Review | In Progress | 11,340 | 96.1% | 1 blocker | Follow up with Aetna EDI team — 14 days overdue |
Cigna 62308 | Hybrid | Requires Revision | Testing | 9,210 | 94.5% | 2 blockers | Revise Section 4.2 and resubmit with updated ISV certification |
Medicare 00040 | Claim.MD | Live | Pre-Planning | 22,180 | 98.9% | Clear | Initiate renewal process — 7 months until expiry |
Medicaid 77002 | Batch EDI | Drafting | Not Ready | 8,950 | 91.2% | 3 blockers | Schedule notarization and obtain HIPAA cert |
UnitedHealthcare 87726 | Claim.MD | Submitted | In Progress | 18,640 | 96.8% | 1 blocker | Awaiting UHC response — est. 10 business days |
Humana 61101 | SFTP | Deferred | Pre-Planning | 7,280 | 95.3% | Clear | Re-engage in April 2025 when Humana resumes onboarding |
Recent Route Events
All claims CLM-2025-00185110:01 AM
Claim routed via Claim.MD to payer P003 (Cigna)
MASESUBMITTED TO CLAIMMD
CLM-2025-00185110:01 AM
999 acknowledgement received from Claim.MD — claim in transit to payer
ClaimMDCLAIMMD ACK RECEIVED
CLM-2025-00185007:45 AM
Claim flagged by rules engine — UHC Modifier 26/TC required
MASEMANUAL REVIEW TRIGGERED
CLM-2025-00184809:45 AM
Claim rejected by Aetna — CO-4: Service not covered
ClaimMDPAYER REJECTED
CLM-2025-00184709:00 AM
ERA 835 received from BCBS — payment of $638.40 posted
PayerPAYMENT POSTED
Key Migration Risks
ISV Certification Bottleneck
Critical
Without ISV certification, MASE cannot be a recognized independent submitter. Blocks all Phase 2 direct payer connections.
Est. resolution: 3–4 weeks
Cigna TPA Revision Required
High
Cigna rejected initial TPA — ISA/GS header format must be corrected and ISV cert docs included. 6-week re-engagement timeline.
Est. resolution: 6 weeks
Medicaid Notarization Requirement
High
Texas HHSC requires in-person notarization for state EDI agreement. Cannot be expedited digitally.
Est. resolution: Unknown
Routing Architecture: Current vs. Target State
Current State — Claim.MD Dependent
Provider Portal
MASE Rules Engine
MASE Rules Engine
Claim.MD API Adapter
Claim.MD API Adapter
Claim.MD Clearinghouse
Claim.MD Clearinghouse
Payer EDI Network
Payer EDI Network
ERA → Claim.MD → MASE
Single point of failure · Cost per transaction · SLA dependency
Target State — MASE Native Rails
Provider Portal
MASE Rules Engine
MASE Rules Engine
Routing Engine
Routing Engine
Native Payer API (TPA)
Routing Engine
Claim.MD (fallback only)
Native Payer API
ERA → Direct → MASE
Redundant routing · 88% cost reduction · Custom SLA enforcement