CHANNEL PARTNER CLAIMS &
PAYMENT MANAGEMENT
SOLUTIONS
Simplifying the Business of Healthcare
Claims & Payment
Management
Solutions provide end-to-end visibility into the
claims lifecycle
Emdeon leads the industry in clearinghouse and EDI solutions for
automated workflow that decreases the cost of electronic claims receipt
and pre-processing, reduces phone calls from providers and improves
your auto-adjudication rate. Our secure transmission platform and
HIPAA translations and formats offer you the best and most reliable
connectivity services available so that claims are processed correctly. Our
nationwide electronic network reach allows us to connect to any system
for all payer-to-provider HIPAA-mandated transactions. Faster
adjudication and shorter billing cycles result in increased cash flow for
providers. An Emdeon partnership offers the broadest payer connectivity
and helps eliminate time-consuming paper processes so providers can
focus their energy on their patients.
HIPAA simplified with Emdeon
As part of Emdeon’s commitment to guiding our clients through the
transition to HIPAA X12 Version 5010 standards, we have completed
a thorough gap analysis between versions 4010A and 5010, which we
are using to enhance all of our systems and products to support the
modified HIPAA transaction sets. We are on schedule to be well-ahead
of the January 2012 compliance date for the mandatory transition to
HIPAA X12 Version 5010 standards. We have several resources available
to assist our customers in the transition.
Provider Features
• Electronic claims submission with batch import or direct entry
• Claim attachments for Workers’ Compensation / Auto eBills
• Secondary claims processing
• Simplified tracking of claim submissions and assistance in identifying
rejected claims
• Instant and continuous claim status verification throughout the
reimbursement cycle
• Centralized online claims management tool empowering providers
for self-help
Provider Benefits
• Complete visibility throughout the claim lifecycle
• Improved first pass acceptance rates with visibility into
rejection trends
• Compliance with state mandates
• Identify claim submission trends or potential issues anytime,
anywhere via the mobile application
What are the advantages of an Emdeon partnership?
• One partner for all EDI services
• Single point of connectivity to over 1,200 national, regional and
government payers for claim submission and processing
• Online claim tracking to better support your providers
• Pre-adjudication logic applied to claims for increased first pass
acceptance rates
• High scalability and reliability for quick responses at any level
• Flexible file-type submission
• Seamless integration into existing systems and workflow
Why Wait?
Contact Us Today!
vendorsales@emdeon.com
At Emdeon, we’re here to help. To transform the way you run your healthcare business today, call us at 877.EMDEON.6 (877.363.3666) for a complimentary review.
03
Integrated Solutions
Whether you need a highly customizable integration into your applications or
just connectivity to our network, our integration solutions offer the most
flexibility to help you achieve the maximum results.
Claims Submission and Reporting
Managing billing to third-party payers is a critical function within the
healthcare revenue cycle. Emdeon offers the broadest claim processing
and management solutions and the largest number of connections to
commercial and government payers in the industry. Tracking claims
through every stage is made easier through powerful, flexible and
easy-to-use solutions.
Emdeon Direct Connect
Emdeon Direct Connect brings together our industry leading
clearinghouse and EDI solutions to reduce phone calls and improve auto
adjudication rates. Providers also receive network connection via the
HIPAA standard ANSI X12N format. Emdeon Direct Connect provides
network connection supporting claims and encounter submission (837),
electronic remittance advice (835), eligibility and benefits (270/271),
claim status (276/277), healthcare services review request and response
(278 X094), healthcare services review inquiry and response
(278 X059) and claim financial inquiries (277/835).
“Emdeon has exceeded my expectations
in providing us with the tools necessary to
meet our customers’ needs. We have
noticed a significant reduction in the
volume of support calls relating to
electronic submissions. Emdeon Vision for
Claim Management really simplifies the
claim tracking process. With the click of
a button, our providers can investigate
any claim they are interested in without
calling for support.”
– Robert I. Jandorf,
President
Software Unlimited, Inc.
Our innovative, award-winning reporting and analytics tool gives
Emdeon channel partners complete visibility into their clients’ claims filing
process. Emdeon VisionSM for Claim Management provides your
customer service staff with an end-to-end view into all claims from the
point of submission to Emdeon through payer adjudication. Additionally,
providers who submit claims through Emdeon also have access to
Emdeon Vision allowing them self-help. Claim summaries allow
providers to quickly scan all claims at a glance and hone in on specific
rejected claims that need attention. If needed, search for individual claims
in a variety of ways, including patient name, payer subscriber number or
date of service. Once rejected claims are identified, office staff can quickly
rework these claims to improve cash flow. With Emdeon support, you
and your providers all using the same claim management tool, problems
are resolved much faster.
Revenue and Reimbursement Analytics
Emdeon delivers automated batch screenings of patient account
information so users capture more revenue before and after patient
visits. This service leverages all available patient data to search for key
information in government programs and payer databases resulting in
increased revenue collection and reduced bad-debt write-offs for
improved provider profitability.
• Screens patients before and after visits
• Retroactively identifies insurance coverage
• Patient address verification
• Increases revenue
• Reduce instances of incorrect or missing data
Payment Management
Making remittances clear and understandable is the first step toward
making it truly useful. Emdeon Vision gives providers a 360° view of their
claims from submission to payment. It automates the translation of the
payer’s 835 codes into human-readable formats, eliminates paper
Explanation of Benefits (EOBs) and quickly provides expected payments
enabling secondary billing and expediting follow-up for denied claims.
Providers can use Emdeon Vision to link a specific claim back to the
Electronic Remittance Advice (ERA) or use the ERA search capability to
view all ERAs by date range. Additionally, providers can use their access
to Emdeon’s extensive payer network to automate the secondary billing
cycle for payers that offer ERA.
• User-friendly, web-based tools for viewing electronic and paper
remittances and payments
• Electronic deposit of claims payments to any bank
• Enables providers to reduce costs and improve efficiency by moving to
a paperless payment process
• Helps reduce errors in patient information
• Streamlines your providers’ revenue cycle processes
• Automated payment posting into any practice management system
• Batch or real-time submission options
• Secured each electronic transmission
• Decreases pre-processing costs
• Increases overall efficiency
• Exposes key claim rejection trends for correction
• Integrates into virtually any application
• Submit Workers’ Compensation and Auto-Medical Bill
attachments electronically
At Emdeon, we’re here to help. To transform the way you run your healthcare business today, call us at 877.EMDEON.6 (877.363.3666) for a complimentary review.
05
Denial Management
Emdeon provides powerful trend analysis tools which ultimately reveal
the cause of denials and underpayments. This insight enables valuable
decision support leading to denial prevention. Our denial management
tools drive efficiency into the follow-up process with configurable work
queues enabling staff to easily organize, prioritize and monitor denials and
underpayments, and allow the accurate reporting and viewing of the net
denied amounts. With this information providers can streamline the
denial management process by determining root causes, patterns and
process breakdowns responsible for denials and establish corrective steps
to prevent future revenue loss or delay.
• Create work queues tailored to specific employee knowledge
and expertise
• Access ERA historical database for trend analysis
• Receive audit log that tracks all actions taken on a remit
• Ensure compatibility with most HIS/PMS
• Identify causes of denials and underpayments
• Analyze vital billing department metrics quickly with
configurable dashboard
Private Labeled Solutions
Our private labeled wholesale solution offers customization with your
logo and color scheme, while providing a quick-to-market solution for all
HIPAA mandated real-time transactions. This solution eliminates the
need to program, update, and maintain ANSI X12 real-time transaction
formats, while providing payer specific return transactions.
Emdeon Office Suite
Accelerate revenue, simplify administration
Claims Submission and Reporting
The Emdeon Office Suite instantly connects to the largest network of
commercial and government payers in the industry to provide a wealth of
real-time patient information and health information exchange. Submitting
claims, including Workers’ Compensation eBills and automobile medical
claims and attachments is quick and easy with direct data entry and batch
upload options. Our innovative, award-winning reporting and analytics
tool gives your providers complete visibility and tracking capabilities from
At Emdeon, we’re here to help. To transform the way you run your healthcare business today, call us at 877.EMDEON.6 (877.363.3666) for a complimentary review.
the point of claim submission through adjudication. Claim summaries
allow office staff to quickly scan all claims at a glance and hone in on
specific rejected claims that need attention. If needed, search for individual
claims in a variety of ways, including patient name, payer subscriber
number or date of service. Once rejected claims are identified, office staff
can quickly rework these claims to improve cash flow.
• Anytime, anywhere web-based access
• Fast, easy end-to-end claim tracking
• Electronic claims submission with batch import or direct entry
• Claim attachments for Workers’ Compensation / Auto eBills
• Reduces errors and maximizes reimbursement rates
• Improves productivity through helpful automation
• Complies with state mandates
Payment Management
Revenue and profit are the lifeblood of any business and Emdeon
payment tools can help providers increase both, while improving
efficiency. Emdeon Office Suite delivers valuable electronic payment and
reconciliation processes that help providers eliminate paper checks and
simplify secondary claims. As a result, it can dramatically reduce expenses,
shorten the reimbursement cycle and streamline workflow. By increasing
efficiency it creates time for providers and staff to focus on reconciling
outstanding payment issues to capture otherwise lost revenue. Providers
can search, view or print remittances as needed. The centralized
reporting allows providers to obtain detailed information and trends on
all payment data. Electronically managing payments by amount and by
specific payer information can lead to a simpler, more efficient
reconciliation process that reduces the errors which commonly
slow down payment posting.
• User-friendly, web-based tools for viewing electronic and paper
remittances and payments
• Electronic deposit of claims payments to any bank
• Enables providers to reduce costs and improve efficiency by moving to
a paperless payment process
• Helps reduce errors in patient information
• Streamlines your providers’ revenue cycle processes
• Automated payment posting into any practice management system
07
Providers who use Emdeon Vision
will also have access to their claim
reporting on their mobile smartphone.
Maximize Your Product
Offerings with Emdeon
Solutions
Connectivity. Simplicity. Innovation.
Control. Advantage.
Timely provider reimbursement and compliance is something
your clients look to you to deliver. This requires simple and
efficient payer interactions. Through Emdeon’s unique suite of
all payer services, you can offer your providers a comprehensive
solution to simplifying the entire revenue cycle. Emdeon is fully
committed to the success of our channel partners and providers.
Solutions that complement Emdeon’s Claims and Payment
solutions include:
• Eligibility and Benefits Verification
• Patient Statements
• Return Mail Management
• Patient Lockbox
• Patient Pay Online
• ePrescribing
• Lab orders and Results
• Direct Contracting
• Emdeon ON24/7 Support
• Direct Invoicing
Elevate your level of
business through an
Emdeon Channel
Partnership
When you partner with Emdeon you not only get the powerful,
flexible solutions today’s providers require, but you get them all
from a single source. As your business grows, Emdeon will be
there to show you the most innovative and valuable ways to
build your business. Our solutions can help by bringing together
end-to-end revenue cycle management, accurate clinical solutions
and valuable channel partner support tools into one source to
provide the consistency, reliability and accountability you expect
from a long-term business partner. Discover the benefits of a
partnership with Emdeon. Call today and start building a
competitive edge through the comprehensive support,
products and services that providers need to simplify the
business of healthcare.
We invite you to contact us and discover solutions that Simplify the Business of Healthcare
Emdeon is a leading provider of revenue and payment cycle solutions that connect
payers, providers and patients to improve healthcare business processes.
To learn more about our company, our services and our commitment to
improving healthcare, visit our website at www.emdeon.com.
© 2010 Emdeon Business Services LLC. All rights reserved.
EMDA1010304 rev 5.10
3055 Lebanon Pike, Suite 1000
Nashville, TN 37214 USA
877.EMDEON.6 (877.363.3666)