For all payers who issue Medicare Part D Explanations of Benefits (EOBs): Did you know that Emdeon produces millions of EOBs to eligible Medicare Part D recipients each month?
Here at Emdeon, we have developed CMS form design requirement expertise, and are able to move quickly to change or update forms to meet new CMS form requirements at no additional charge. Because we produce millions of outgoing mail pieces every day, we are able to saturate zip codes and qualify for three- and five-digit pre-sort rates to ensure the lowest postage possible, given your mail mix. By utilizing both #10 and 6x9 envelopes, we obtain USPS pre-sort letter rates on mail up to 3.5 ounces.
Through our Client Access System, our web-based self-service payment management tool, our customers can manage these documents and access archived documents for up to ten years.
If you are still processing Medicare Part D EOBs in-house, Emdeon provides the experience, agility, and scale to the CMS-mandated process. Call us at 877.EMDEON.6 or send an email to us to request a complimentary cost analysis today!
Industry service alert: Attention Medicare Part D Payers
X-Ray Vision for your claim cycle
As you may have noticed in recent communications, Emdeon now offers an application that is more than just a claim tracking tool- Emdeon Vision for Claim Management delivers transparency and intelligence throughout the claim delivery cycle. This tool offers summarized and detailed claim data, claim image viewing, extensive reporting capabilities and more complete tracking of your claims at every step in the claim delivery cycle. In addition, recent product enhancements have integrated Emdeon Vision for Claim Management into multiple solutions across Emdeon’s suite of services. So now you have the ability to track your claims and get status updates on both paper and electronic claims!
Whether the claim was filed on paper or submitted electronically, Emdeon Vision provides complete visibility at each step along the way. Your service representatives will be able to see when the provider sent the claim, when Emdeon received the claim, when the claim was transferred to your adjudication system and, finally, when the provider received the electronic remittance advice acknowledging payment. Emdeon Vision even offers status and tracking information on claims routed for PPO repricing.
Have paper claims? Whether we have scanned your claims or you are scanning your own claims with Emdeon software, Emdeon Vision enables your customer service representatives to view online images of the claims as they were filed by the provider. You’ll even have the same great, end-to-end tracking on those scanned claims as you do on your EDI claims- all in one convenient, easy-to-use application.
Emdeon Vision really is like having X-Ray vision into your claim administration processes. Why wait? Start seeing through your entire claim cycle today.
Take a few minutes to view our quick tour video now and learn how Emdeon Vision can help you “know” your claim cycle.
Maintaining the affordability of the prescription drug benefit
Are you looking for ways to better control your drug expenditures?
Managing all or more of your prescription benefits in-house may be your best solution for lowering drug expenditures and optimizing clinical outcomes. By doing so, your organization can create a customized formulary; negotiate directly with manufacturers eliminating the middleman; develop your own pharmacy network and obtain timely data to identify trends and cost drivers.
Our Solution
Emdeon provides claims processing and other administration services for pharmacy payers and providers that are conducted online, in real-time, according to client benefit plan designs. Our Prescription Benefit Solutions allow our clients to directly manage more of their pharmacy benefits and provide a cost-effective alternative to an in-house pharmacy claims adjudication system. To learn how Emdeon can help you better manage your benefits and reduce drug expenditures, view the SelectRx Quick Tour or call 800.521.4548, ext. 3.
Achieve Savings Through Targeted EDI Growth
Like payers, providers understand that increasing automation and electronic transactions has a direct impact on their bottom line.
For payers, simply “turning on” electronic capability does not guarantee every provider will begin utilizing this capability. To truly create savings, sometimes a helping hand is needed to identify “paper-offenders,” that is, those providers still submitting paper claims. A targeted growth program focused on increasing electronic transaction volumes can help identify those providers and target them with specific messaging to educate and encourage their office staff on how to improve electronic submission rates.
“At Coventry, we saw clear, measurable increases in both EDI rates and our real-time transactions,” said Harry Fox, former Vice President of e-Commerce for Coventry Healthcare and current Vice President, Business Information Officer at Kaiser Permanente, speaking of Coventry’s Accelerated Growth Program with Emdeon. Over the last several years of the program, Coventry’s rate of electronic submission has risen from 39 percent to 71 percent. By increasing the usage of real-time eligibility and claim status inquiries through Emdeon, Coventry’s call center volumes have decreased by approximately 30 percent.
Claim data analysis and opportunity identification based on rejection rates and low provider utilization help establish goals and drive data-driven programs that increase the adoption of electronic transactions and reduce paper handling. Customized programs are tailored to fit individual payer needs. Coventry Health Care’s growth program, administered by Emdeon, included provider education seminars, direct telephone outreaches and targeted direct mail campaigns to providers.
According to Fox, Emdeon has “a group that understands the data, understands how to analyze that data and they are able to execute the growth strategy through sales and marketing.” Learn more on Emdeon’s approach to growing EDI volumes by clicking here.
Interested in learning about our new program to grow provider participation in Electronic Fund Transfer (EFT) reimbursement transactions? We now have a team dedicated to provider EFT enrollment outreach. Contact your account manager or give us a call at 877.EMDEON.6 to receive more information on this exciting new service!
Emdeon Commits to CAQH CORE Phase II Rules
Improving electronic administrative data exchanges
To demonstrate our commitment to improving administrative data exchanges, Emdeon has committed to complete a testing process by no later than the end of 2009 to certify that we can exchange electronic healthcare administrative data according to the CAQH Committee on Operating Rules for Information Exchange (CORE) new Phase II rules.
The voluntary business rules enhance interoperability between providers and payers; streamline eligibility, benefits and claim status transactions; and reduce the amount of time and resources providers dedicate to administrative functions. The Phase II rules cover requirements for electronic connectivity, patient identifiers, claim status and reporting of patient financial responsibility for an increased number of service codes included in the HIPAA standards. Phase II builds on the rules created by the initiative during its Phase I efforts, completed in 2006.
CAQH, a nonprofit alliance of health plans and trade associations working to streamline healthcare administration, launched CORE with the goal of enabling provider access to patient administrative information before or at the time of service using the electronic system of their choice. CORE rules are built upon existing standards, such as HIPAA. They are developed through a collaboration between more than 100 healthcare industry stakeholders as partners in a multi-phase rules development process. Participating health plans cover more than 130 million lives or more than 75 percent of the commercially insured plus Medicare and state-based Medicaid beneficiaries.
Emdeon joins more than 40 organizations that have committed to becoming Phase II rules certified or endorsing the rules.
Business Objects and SAP Recognize Emdeon's Innovations
Industry leaders admire Emdeon’s compelling business intelligence innovations
Business Objects, an SAP company and the world’s leader in Business Intelligence software, recently honored Emdeon with its competitive Business Intelligence Excellence Award for 2008, recognizing both Emdeon’s IT department and infrastructure as innovative through its use of successful business intelligence strategies in creating Emdeon Vision. This coveted award acknowledges Emdeon’s enhanced database infrastructure as well as its use of BusinessObjects XI, Business Objects’ intelligence platform, to increase productivity by significant proportions.
The Challenge
Emdeon, the leading processor of healthcare transactions in the United States, issues up to 800,000 text-based reports per day to healthcare providers and payers. According to Gene Boerger, Vice President of Advanced Business Reporting, “If a claim is sent electronically, we send text-based reports back to the healthcare providers to track the claims into Emdeon, out to the insurance company, and back to the provider. Our experience is that these reports are very difficult for the providers to handle.”
The Solution
“With Crystal Reports as a key component, we’ve developed an electronic solution that allows us to distribute information much more quickly and efficiently….providers can immediately view the status of any electronic claim in the process,” describes Boerger. According to Business Objects, customer feedback credits Emdeon’s innovative solution for the “successful transition from paper-based reporting to a more efficient and cost-effective Web-based delivery.”
Emdeon Customers Agree
MedePresence CEO Dave Dugan concurs: “Emdeon Vision will definitely drive down errors, while accelerating and automating support for us as your channel partner. Keep up the awesome work!” According to Boerger, “Our business is about making sure that electronic healthcare transactions are delivered quickly and accurately, and that the responses are returned in a timely manner to the customers who need them.”
Simplifying the Business of Healthcare
“Using BusinessObjects, we’re able to deliver the data multiple ways to multiple customers with multiple security models – quickly and effectively. This enables us to focus on the organization of the information itself, which is a much smarter use of our resources,” explains Boerger of this innovative solution. “Whether it’s medical claims, dental claims, electronic remittances, real-time insurance eligibility requests, or Health Insurance Portability and Accountability Act (HIPAA)-based transaction sets, Emdeon Vision makes life easier for payers and providers alike,” writes Business Objects.
To learn more about Emdeon’s Business Intelligence Excellence Award and how Emdeon can simplify your healthcare business, call us today at 877.EMDEON.6 (877.363.3666) or visit us online at www.emdeon.com.
