Case Study: Children’s Community Health Plan achieves 99% EDI approval, saves $65K/year and retains $100K+ in reimbursements with Astera Software’s EDIConnect

CCHP Automates EDI Processes for Higher Healthcare Claims Reimbursements

Children’s Community Health Plan (CCHP) is a non-profit HMO affiliated with Children’s Wisconsin that manages care for 140,000 members across 28 counties. To maintain Medicaid certification and capitation rates it must meet a 95% state EDI encounter acceptance rate, but errors in encounter files from TPAs led to roughly 5% rejections (~85,000 claims) and time-consuming manual corrections that threatened compliance and required extra staffing.

CCHP implemented Astera Centerprise with EDIConnect to automate parsing, validation and correction of EDI 837 encounters. The new process reduced per-file correction from about 3 hours to 5 minutes, eliminated the need for an extra hire (saving $65,000/year), recovered roughly $26,000/year in manual-effort costs, raised approval rates to 97–99%, and helped retain over $100,000 annually in claims reimbursements.

Children's Community Health Plan

Amanda Moede

Health Plan Data Analyst