We are excited to announce Emdeon has acquired EquiClaim, a leading provider of post-payment healthcare claims audit and recovery services for commercial and government payers, from MultiPlan. EquiClaim’s programs enable Emdeon Payment Integrity Solutions to offer healthcare payers a more comprehensive suite of prospective and retrospective payment integrity services. EquiClaim’s offerings, now named Emdeon Audit and Recovery Services, are designed to provide credible and objective programs that help payers reimburse providers appropriately and provide a foundation for both parties to improve the payment process.
Emdeon now offers commercial and government payers:
• Robust payment integrity services with enhanced audit capabilities, enabling retrospective recoveries for improper payments
• Improved payment integrity through enhanced intelligence, for claims review in accordance with medical billing guidelines, contractual obligations and reimbursement rates and policies
• Recovery audit contractor (RAC) services, specifically for the government sector, in support of the program the Centers for Medicare and Medicaid Services (CMS) introduced in 2005 and recently rolled out to state Medicaid programs
• More tools to help reduce general and administrative costs, by improving the accuracy of the claims payment process and the recovery of improper payments
• Enriched, comprehensive payment integrity solutions that include both pre-adjudication validation (clinical code validation, provider verification, predictive and rules-based fraud detection software and analytics), as well as post-adjudication validation (special investigative unit services, post-payment audits for contract compliance, and hospital bill audit and diagnosis-related group (DRG) audit services
With this acquisition, Emdeon furthers its goal of helping payers make appropriate payments as well as working to make sure providers receive reimbursements from payers that meet negotiated, contracted rates.
How Emdeon Audit and Recovery Services Can Help with ICD-10 Transitions
CMS reports that mandated claims coding changes (from ICD-9 codes to new ICD-10 codes) will likely cost the health insurance industry more than $1 billion. CMS also anticipates an initial 10 percent increase in the number of claims rejected for improper coding.
Adding EquiClaim's capabilities to Emdeon's Payment Integrity Solutions offers Emdeon's payer customers more tools and expertise to help meet this regulatory-driven challenge. It also further positions Emdeon to help its government and commercial customers' initiatives promote cost-effective healthcare and reduce fraud, waste and abuse (FWA).
EquiClaim was one of the first subcontractors for CMS's RAC program. As mentioned above, CMS introduced the RAC program in 2005 and recently rolled it out to state Medicaid programs under Section 6411 of the Patient Protection and Affordable Care Act. The RAC program is a cost-containment effort intended to reduce improper payments within the Medicare and Medicaid programs. It also aims to identify process improvements that could reduce or eliminate future improper payments.
EquiClaim's capabilities give Emdeon more ways to help its payer customers resolve payment issues arising from increasingly complex provider contracts, reimbursement methodologies and claim payment policies. Emdeon’s end-to-end prospective and retrospective payment integrity solutions can help payers be more efficient and improve cash flow.
To discover more about Emdeon Payment Integrity Solutions, visit www.emdeon.com/paymentintegrity.
Emdeon Acquires EquiClaim to Expand its Payment Integrity Solutions Offering
Pre-Payment Fraud Detection and its Impact on the Bottom Line: A New Payment Integrity White Paper
The phrase, “An ounce of prevention is worth a pound of cure” aptly applies to a movement within the healthcare payment industry: Fraud, waste and abuse (FWA) prevention. Because of lean budgets and compelling cost analyses, payers are motivated to find payment integrity solutions that can identify FWA before paying erroneous claims. For optimal aberrance detection, consider adopting a proactive, preventive approach.
This white paper can help payers determine the best ways to protect themselves against FWA. It demonstrates the benefits of proactive, in-stream claims review and illuminates powerful preventive resources, to understand how to limit unnecessary claim payment, potentially saving significant time and money.
Specifically, this white paper details:
•How shifting to a pre-adjudication or pre-payment fraud detection solution can yield significant financial impact
•Characteristics of an effective pre-payment FWA management solution
•Organization, system and process implications of adopting a pre-payment FWA management solution
To read this white paper or to discover more about Emdeon Payment Integrity Solutions, visit www.emdeon.com/paymentintegrity.
Industry-leading education sessions from AHIP’s Institute 2011
Emdeon hosted several speaking sessions during America’s Health Insurance Plan’s (AHIP) Institute 2011 Conference June 15-17 in San Francisco. If you weren’t one of the more than 3,000 AHIP attendees, or if you missed one of Emdeon’s six in-booth speaking sessions, you can watch these presentations online.
Emdeon’s in-booth presentations included:
•Fraud, Waste and Abuse Prevention: An Industry Perspective, presented by: Louis Saccoccio, JD, Executive Director, National Healthcare Anti-Fraud Association (NHCAA) and Kelli Garvanian, Payment Integrity Solutions Consultant, Emdeon
•How to Save $9 Million Preventing Fraud, Waste and Abuse: A HealthMarkets Case Study, presented by: Taryn Risucci, Vice President, HealthMarkets
•The Next Generation Health Plan: Intentional Transformation, presented by: David Gallegos, SVP of Consulting, HTMS, an Emdeon company,
and Nancy Wise, VP of Planning and Strategy, HTMS, an Emdeon company
To learn more about these topics or to access other Emdeon presentations, including white papers and webinars, visit www.emdeon.com/ahip2011speakers.
Simplify Your Business with Two Bigger, Faster, Better Solutions from Emdeon
Have you ever seen a duck gliding on a lake? It's a serene image: As sunlight gleams on the duck's iridescent feathers, it skims smoothly and seamlessly on the glass-like water. Yet just underneath the surface, the duck's feet paddle quickly, furiously, relentlessly—in constant, concerted effort to keep moving forward. It takes tremendous work to look that effortless.
Emdeon is much like that duck; our systems work ceaselessly, and our people are endlessly innovating, creating bigger, faster and better ways to simplify the business of healthcare. As our partner, you enjoy the smooth reliability of the more than 100 solutions Emdeon offers. You can conduct business with seamless functionality because we're paddling nonstop to save you time, money and effort managing the revenue and payment cycle.
However, at Emdeon, "bigger, faster, better" is never enough. Our goal is to give you the services and support you need to lead. We are constantly improving, working to advance our existing solutions and pinpoint new ones, to enhance your ever-growing, ever-changing business. We're pleased to report the proverbial paddling has paid off once more in the form of two major innovations: Emdeon's data center additions and our new, best-in-class print technology.
Emdeon Data Centers
We invite you to look below the surface to get a glimpse of all that goes on— not only to maintain the single largest financial and administrative information exchange in the U.S. healthcare system—but also to take it to new heights.
Our data centers deftly, reliably and securely transmit an enormous number of information exchange points and transactions at any given minute, on any given day—such is the business of healthcare. Yet the volume of data exchanged is not nearly as impressive—or important—as what we can now do with this data.
Rather than keep data chained together through separate business rules and processes, as previously required, our technology now allows us to create data mash-ups, combining and aggregating data to make information more useful and nimble.
Here's a quick look at the advanced capabilities this technology can enable.
For payers:
•Decrease call center and other operational costs by minimizing errors or omissions in provider claims
•Detect potential insurance fraud before claims payment
•Offer providers preventive patient care messages using the patient’s medical and pharmacy histories
•Eliminate pounds of paper received by mail or fax
For providers:
•Get paid faster—using electronic claims that are auto-corrected and/or enriched with eligibility data to increase auto-adjudication rates
•Receive remittance advice or payment estimates within seconds of filing an electronic claim
•Easily obtain comprehensive, accurate patient medical and prescription histories
•Monitor patients’ adherence to disease management protocols during defined periods
In bringing the new data centers online, we have streamlined many of our business processes, reducing the potential for human error. Automating these processes allows us to more accurately measure performance and anticipate issues before they become a problem. Already we have seen a steady decrease of calls at our call center and increased customer satisfaction.
Our new, massive data centers are "state-of-the-art" in every sense, exchanging data at lightning speed to eliminate downtime and increase productivity. With hundreds of miles between them, these facilities are redundant yet independent, to ensure all data is secure, safe and accessible—without interruption.
These centers feature:
•55,000 square feet, with 2,000 servers
•Two petabytes of storage (That’s 2,000 terabytes!)
•20+ load balancers (10+ redundant clusters)
•900 Microsoft Windows servers
•350 IBM AIX Unix servers
•500+ VMWare virtual guests
•450 databases
•100 percent growth potential
Unparalleled Printing Advancements
We have introduced the Pitney Bowes® IntelliJet™ 30 printing system, for the next generation in on-demand printing technology and patient communication production. As one of only three such systems in the world, Pitney Bowes IntelliJet™ takes the idea of "fast, high-quality printing" to stratospheric levels. With amazing 120x600 dpi output at 1,380 pages per minute, there is virtually no limit to what providers can create, design and produce for patient communication.
This new printing technology offers:
•Advanced print quality for razor sharp, vibrant patient statements
•Full-color, two-sided statements with exceptional resolution—1200 x 600 dpi
•Print rates of 1,380 pages per minute (400 feet of paper per minute)
With this new capability, Emdeon ExpressBill is more responsive than ever, and can produce patient statements quickly, regardless of quantity. We can also easily update the statement design and content and print statements on demand—eliminating costs and waste associated with traditional methods.
In addition, patient statements now enter the mail significantly sooner than before, through logical presorting that combines postal codes before printing, eliminating USPS sorting delays. Emdeon can print batched statements in full color—pre-sorting them—so statements hit the mail immediately upon completion. Statements mailed sooner often lead to faster payment.
At Emdeon, we know we are doing our job when you see "the duck gliding across the water" and you don’t have to worry what’s required to keep things moving. With these exciting changes, Emdeon has made it possible for you to go about your business more easily, while we keep "paddling" to our next innovative solution.
To discover more about Emdeon’s innovations and for a video tour, please visit www.emdeon.com/innovation.
HIPAA Simplified Update
We are pleased to announce Emdeon has met requirements of the Electronic Healthcare Network Accreditation Commission's 5010 Readiness Assessment Program. Emdeon scored 100 percent, further demonstrating our ongoing commitment to help ensure HIPAA 5010 compliance.
In addition to this recognition, Emdeon continues to help our payer partners and submitters successfully migrate to the X12 5010 and NCPDP D.0 versions of HIPAA transaction standards. We have updated our gap analysis documents to include the recent 5010 Errata changes and have enhanced our 5010 systems and products to support these changes. Errata versions of the gap analysis documents are available at the HIPAA Simplified website under 'Downloads'.
We strive to provide updated and accurate information for HIPAA 5010 readiness. Answers to the most commonly asked questions about HIPAA 5010 are below.
Q. How is Emdeon preparing for HIPAA 5010 testing?
A. Emdeon is testing and implementing 5010 standards with submitters and payers. The late release of the Errata changes to the 5010 transaction standards further constricted the already narrow 5010 testing and conversion window. Nevertheless, Emdeon has initiated submitter and payer testing on all 5010 transactions, as you can see in the list below.
Q. Which Errata tests are being conducted?
A.
•837 Professional claims
•837 Institutional claims
•837 Dental claims
•835 ERAs
•270/271 Eligibility verification
Emdeon is also testing with submitters and payers the Final Rule version for HIPAA X12 transactions the Errata revisions did not include:
•276/277 Claim Status
•278 Referral/Authorization
Emdeon's guiding principles for the 5010 program are to sponsor a rational, orderly and realistic transition while protecting provider cash flow and successful payer EDI penetration.
Q. What is the timeline of events?
A. Emdeon is committed to supporting 5010 standard transactions on all of its products and services prior to the compliance date (January 1, 2012). Emdeon is in 5010 production with early implementer submitters and payers and is also in 5010 testing with many of our trading partners.
Q. Where can I find additional HIPAA 5010 information?
A. Emdeon has created a valuable resource, HIPAA Simplified, that is available to all industry stakeholders at www.hipaasimplified.com. HIPAA Simplified is a one-stop, online resource that features gap analysis, business-level documentation, webinars, transition timelines and customer testing information.
Thank you for trusting Emdeon as your information source for HIPAA readiness. We work diligently to deliver solutions that help our submitters and payers seamlessly meet industry regulations.
