Emdeon Advanced Claiming identifies the most efficient path for healthcare claims to be delivered to the final claim adjudicator.
Emdeon pre-adjudication services apply predefined payer or PPO business logic to all targeted incoming claims originated by EDI or paper-based processes. By hosting and automatically updating payer and provider data, Advanced Claiming can execute a wide range of business rules at a group or member level as claims are processed by Emdeon. Advanced Claiming customers typically experience a higher first-pass rate, reducing manual intervention in the claim re-pricing and/or adjudication process, significantly lowering processing cost-per-claim. For customers with multiple adjudication systems, pre-processed claims can be re-directed to appropriate service location.
Emdeon claim routing service links specific data on claims to member eligibility within a group, group coverage to a PPO, procedure codes, dollar amounts, and/or provider’s participation in a PPO network. Claims are automatically routed to the appropriate PPO or payer for processing in a format specific to the re-pricing or adjudication system without manual intervention. Once re-priced by the PPO, claims are then delivered to the payer through Advanced Claiming. |
