elligence Electronic Transactions Partners
Electronic claims submission helps providers and payers maintain a flow of vital information by enabling the transmission of claims and managed care transactions. That means no more filling out paperwork by hand, waiting for the post office to deliver claims or spending time holding on the phone.
Electronic claims submission, also called Electronic Data Interchange (EDI), connects providers and payers and other health care partners using computers, modems and ordinary phone lines. It allows you to send and receive vital health care information electronically. Information is sent from your practice management system to a clearinghouse network where it is verified for accuracy and then sent straight through to the payer's computer.
There are several reasons why we recommend that health care providers work with a clearinghouse for electronic claims submission:
- A clearinghouse is connected with many more payers that we could ever connect with directly. Most major clearinghouses are connected with more than 500 commercial and government payers around the country.
- A clearinghouse is able to take the information generated by your practice management program, and translate it into the specific format required by the payer.
- A clearinghouse allows the health care provider to submit all their electronic claims in one batch, rather than a separate batch for each payer.
- Clearinghouses eliminate the need for office staff to prepare claims manually or re-key repetitive transaction information. No paper forms, envelopes or stamps are required.
Claims submitted electronically are processed quickly, efficiently and more accurately. According to Emdeon, a recent study of health care providers, sponsored by the State of New Jersey, showed the tremendous savings available when using EDI:
- Physicians save an average of $1.50 or 35 percent per claim by using EDI instead of paper.
- Physicians report 21% fewer rejected initial claims and 20% fewer rejected follow-up claims.
- Physicians save an average of 30 days in collecting accounts receivable for electronic claims or 52 percent improvement in cash flow vs. paper claims.
- In addition, the study found physicians using EDI improved their efficiency, productivity and data accuracy through improved payment turnaround time, reduced rejected claims and improved patient relations.
Gateway EDI’s claim tools and products are designed to simplify daily operations, increase office efficiency, and decrease rejection rates. All of our tools are created to meet or exceed HIPAA requirements.
Gateway EDI customer service representatives have an average of 11 years in the health care industry, so they understand your daily challenges. Our experts are always ready to answer your calls real time. We also have a track record of 92% instant resolution. We make you our priority, so you can make patients your priority.
For more information about Gateway EDI, please call (800) 969-3666 or visit our web site at www.gatewayedi.com.
emdeon (Formerly WebMD/Envoy)
Emdeon is the largest electronic clearinghouse for commercial claims. They offer a variety of health care-related data services including eligibility and referral inquiries, rosters and encounter information for the managed care industry. Through the strength and breadth of Emdeon's network that links providers, EDI service vendors, and payers, the company's combined transaction volume is rapidly approaching one billion transactions per year.
- http://www.emdeon.com
- http://direct.medifax.com/webmd/payerlist.asp?db=era (Payer list)
- Toll-Free: (800) 366-5716
Electronic Statement Processing - ExpressBill
To provide a more complete electronic billing solution, you can use elligence to outsource your statement processing.
ExpressBill -- part of the emdeon family of services -- will process, print and mail the statements to patients. This will significantly decrease the overhead associated with billing patients.
Typically, statements are processed electronically like this:
- elligence generates a batch of statements, and creates a file on your hard drive.
- You transmit the file to the statements processing service bureau using a modem and communications software.
- The service bureau will send an acknowledgement report, indicating they have received your batch, the number of statements included, etc.
- The file is processed, data is double-checked, and addresses are bar-coded.
- Your statements are printed.
- Undeliverable addresses are separated & corrected.
- Statements are folded, inserted and sorted per US Postal Service specifications, and are mailed out.
- You receive a report of corrected addresses.
- Payment is made by the patient to your office.
McKesson
McKesson processes over 148 million claims annually with a total value of $24 billion. Over 34 million remittances per year are processed by McKesson, and in excess of 21 million eligibility requests processed annually. The Transaction Solutions Hub processes financial and administrative transactions for more than 11,000+ healthcare groups.
Constant communication is maintained with over 1,500 payers to ensure formatting accuracy and compliance. Updates and edits posted regularly on www.transactions.mckhboc.com. More than 144 million patient statements are printed and mailed by McKesson annually.
- Founded in 1833, with annual revenues of more than $80 billion
- Professional (HCFA 1500) and Institutional (UB-92) connections for electronic claims to virtually all Medicare, Medicaid and BC/BS Payers - nationwide.
- Per Transaction as well as Per Provider Billing Options for both Claims and Remittance
- Eligibility checking via a stand-alone internet-based program
- FTP Transfers - in other words, internet transfers of files, as opposed to modem transfers.
- Electronic Statements
McKesson can be used together with emdeon to diversify your electronic claims between two major clearinghouses.