What factors influenced TRICARE North-Health Net Federal Services' decision to implement a hosted Health Services Review (278) transaction solution? You chose to partner with Emdeon for your hosted electronic 278 solution. How did you determine that Emdeon was a good fit? How has TRICARE North-Health Net Federal Services benefited by implementing electronic referrals and authorizations?
TRICARE North–Health Net Federal Services recently implemented Emdeon Hosted Health Service Review to help improve care management for consumers and providers. The added efficiencies from automating the historically manual and time-consuming process of receiving and responding to requests for referrals and authorizations are discussed in the following interview with TRICARE North–Health Net Federal Services’ Mark Sconce, EDI marketing representative and Jimmie K. Ramos, senior systems analyst.
[Mark Sconce:] A number of factors played a role, but essentially, we recognized the available savings for both providers and our health plan.
[Jimmie K. Ramos:] Improving information accuracy up front, early in the Referral and Authorization process, was also top priority for us because it impacts the entire downstream process. With paper requests, there are the obvious issues with legibility of individuals’ handwriting and key data that is often missing. The drawbacks associated with paper requests result in numerous callbacks or correspondence with providers in order to collect the necessary information.
[Mark Sconce:] We have a large provider population so Emdeon’s network of connected providers made them (Emdeon) a good fit….a one-stop-shop to roll-out the hosted electronic 278 to the largest possible number of providers.
[Jimmie K. Ramos:] Emdeon’s existing relationships with providers were definitely a factor in our decision. Since many providers currently submit claims to Emdeon, it’s a logical step for providers to move to an electronic 278.
From an IT perspective, Emdeon is close to plug and play. Emdeon eliminates providers’ needs to invest in technology solutions to communicate with payers securely; and they enable providers to engage in EDI at low cost, within a short time.
[Jimmie K. Ramos:] By migrating the Requests for Referral and Authorization to an electronic transaction, we’re able to offer improved service to our providers. By applying HIPAA EDI standards to the process, data is clearer, more concise and specific– effectively removing a layer of subjectivity. That can have a direct correlation to the quality of care a patient receives.
[Mark Sconce:] Absolutely. Efficiency and processing time have dramatically improved. Before we began accepting the Requests for Referrals and Authorizations electronically, we would receive requests via fax. Those would get processed, printed and sent for keying into the system, all before it even reached the analysts desk who can act upon them. With EDI, data goes directly to the analysts who need to work it. Providers can check the status online without ever picking up the phone.
For us, the turn-around time for processing and responding to hosted electronic requests has decreased dramatically and the entire process has become far more efficient.
To learn more about how Emdeon Hosted Referral and Authorizations can reduce costly, manual processes and simplify your business, contact Jay Ratcliffe, Director, Product Management at 707.527.0499.
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