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As the leader in large healthcare databases, System13 works with state agencies and individual health care facilities to assist them in the process of collecting, cleaning, and ultimately publishing medical claim data sets. In order to produce the highest quality medical data, we maintain a vast array of current lookups for diagnosis and procedure codes, value and condition codes, occurrence codes, physician licenses/NPI's and much more. We run multiple grouper products across our client base, and typically perform over 200 validations for every claim processed. Our validations and reports are fully customizable to meet your needs.


System13 maintains a comprehensive set of medical data readers, interpreters, and data conversion utilities.  We read electronic claims in multiple formats and routinely convert data between formats for clients. ...

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Medical data comes in all shapes and sizes. Very large facilities may upload 100,000+ claims in one file, while many smaller facilities may struggle to complete data entry for just a handful of claims, System13 implements ultra high speed multi-threaded processing for the big data sets, and intuitive help features and great support for the smaller locations.

  • We Can Use Your Existing Data Capture Models:  Many state agencies are already collecting claim data. System13 can work with any procedures you already have in place. This helps state agencies make a smooth transition, keeps the impact to your facilities to a minimum, and provides a way to reduce costs.

  • Data Capture Options:  For state agencies who are not yet collecting claim data, System13 can present multiple options and help you create an effective solution to collect your claims, state-wide. We currently read multiple data formats including ANSI-837, XML, CSV, XLSX, text report parsing and more. Some states require all facilities to use one format, while others allow multiple formats. System13 can support both of these approaches.

  • Data Conversion:  Numerous individual facilities contract with us just for our conversion services alone.  This can be a very cost effective solution, saving smaller facilities from the need to hire programmers or upgrade in-house systems. Our conversion utilities are also useful to state agencies as an option to consider when planning a state-wide data collection process.

  • Crosswalk Updates:  We offer services to maintain and use crosswalk tables for multi-record updates. This is often a great convenience for facilities that are struggling with internal software upgrades or system migrations. In these situations it is common for facilities to experience data mapping issues that they are unable to resolve before an impending deadline. We can assist by fixing data quickly from a spreadsheet if needed.

  • Data Entry Tools:  Many smaller facilities often do not have sophisticated data systems. System13 offers web-based data entry tools for cases where electronic data submission is not feasible.

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Accurate and meaningful data is our focus at System13. There's a lot to consider here. The "who, when, why, where, and how much" all play into the final results. ...

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Capturing and cleaning medical data is no simple task. The whole process relies on a solid backbone of constantly updated lookup tables. From there, we start by working with the state agency to define the end goal, and then we map the data capture and validations that will be needed to get there.


We will discuss the accuracy of:

  • Diagnosis and Procedure codes  (in addition to current lookups, we also maintain older values for referrence)

  • Claim elements  (PCN, MRN, admit type/source/hour, discharge status, bill type, etc)

  • Physician information  (doctor names are a moving target, but System13 has several methods to help improve this data)

  • Date validations  (statement dates, admit, discharge, birth, procedure, occurrence, value, etc)

  • Demographics  (gender, ethnicity, age, location)

  • UB-04 fields  (revenue and HCPCS codes, charges, units, etc)

  • CMS 1500 Form Indicators  (payer types, patient condition and work indicators, modifiers/pointers, etc)

  • Many more  (medical claim data elements number in the hundreds)

Meaningful Data:

There are cases where highly accurate data is not actually meaningful. For example, a facility may populate all "race codes" with a value of "U" or "9" which means "unknown". While this is not an error, it is also intended to be used sparingly. System13 can discover and aggressively pursue data corrections in situations like this.

Complete Data:

System13 performs continuous statistical analysis to ensure all of your facilities are submitting all of their claims. We quickly discover locations with "lower than normal" claim counts and notify them ASAP.  We want to give the facilities notice as early as possible so they will have time to both submit and correct their claims.

What About Calculated Fields:

Items like "length of stay" and  "age at discharge" are common calculations we perform. System13 can assign "Emergency Department" indicators based on procedure code lists, and perform rules to compress charges by rolling-up same or similar revenue codes. We support complex readmission transfer logic for many clients, and we maintain several routines to discover and remove duplicate records. These are just a few of the custom calculations we create.

Our Validations Rules:

  • Customizable Per Client  System13 maintains separate validation rules for each client. You can design your own validation rules and/or choose from our existing rule sets. We will offer advice to help you create effective validation rules from our decades of processing experience.

  • Include Comprehensive Reports  All processing will result in detailed analysis and error reports being sent back to the facility contact. This information highlights problem areas to help the facility effectively focus their efforts.

  • Correction Options Are Flexible  System13 offers online Real-Time correction tools, and/or resubmission of entire batches to all users.

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System13's help desk is staffed by the very programmers who design and maintain your applications. We customize the level of support desired to fit within your budgetary constraints. Continue reading to view the scope of activities and personnel that we support. ...

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Our help desk receives multiple requests every day. We are privileged to respond to a wide range of issues, from the common password and account assistance requests, to very complex claim data formatting questions. System13 currently supports over 1500 facilities in multiple states, and several state agencies. State agencies typically work with System13 to design a hybrid solution that offers resources from the state agency website in addition to System13's offerings and phone support.

Our help-desk staff and system meets your needs, and meets the needs of your users:

  • One-click email instructions for common support needs.

  • Custom one-click training procedures and manual attachments.

  • Built-in "Find Person" features to immediately locate a caller and their data.

  • Staffed by programmers, all of whom have authored complex health data parsing processes.

  • One-click buttons enable our programmers to open user submission files in a text editor for immediate support.

  • Customizable auto-emailings to assist facilities with reminders of impending deadlines.

  • Issue management, escalation, prioritization, and reassignment to ensure all issues are tracked and resolved.

  • Data analysis queries to call our attention to data issues that may be getting overlooked by facilities.

  • High call answer rate, over 96% of all calls are answered directly instead of voice mail.

Website Helps and Features:

  • Our online claim correction tools will flag errors in red for quick identification.

  • The process of correcting claims is simplified with intuitive drop-down lookups.

  • Short video helps are incorporated at context sensitive locations to assist new users.

Well Organized Documentation:  System13 compiles client specific materials into a well organized presentation to assist users that need to download submission schedules, data formatting specifications, rules, field structure lists, validation logic, and more.


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The end goal is the creation of highly accurate and complete medical data sets for research, sale, and/or redistribution by the state agency. From simple raw data, to complex solutions that include reports and analysis tools, read on to discover our approach to your final packaged solution. ...

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Our purpose and commitment is to provide you with a clean and accurate final data set. This is most commonly a "quarterly" data set. System13 produces this as a last step after all data has been collected, processed, corrected, and finally packaged for shipment. State agencies commonly pursue these data sets for research, distribution, and/or resale purposes.

Common Final Data Set Options:

  • Grouper Processing  Many agencies will coordinate with System13 to run popular grouper products over the final data.

  • Calculated Fields  System13 often includes calculated fields in completed data sets

  • Charge Categorization  It is common to present charges rolled up into categories defined by the state agency

  • Distribution Options  Data can be distributed via hard media or secure download

  • Analysis Reports and Tools  System13 can include reports and analysis tools, along with the final data, back to the state agency, or even individual facilities depending on how the agency would like to have final data packaged for distribution.

We will work within your deadlines, and even help you find ways to shorten the time-frames to arrive at your distribution data. System13 is currently processing over eight million claims per quarter for multiple agencies, and we have never missed a deadline! Our multi-threaded approach to processing ensures the highest through-put speed and the elimination of holdups from our end. You can leverage our high speed Real-Time processing to shorten your submission schedule, and reduce your overall time to final distribution data.

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