Payer Solutions
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Products
- Emdeon TransformTM
- Emdeon Paper-to-EDI Conversion
- Emdeon Claims Connection
- Emdeon Electronic Remittance Advice
- Emdeon Advanced Claiming
- Emdeon Clinical Integrity for Claims
- Emdeon Vision for Claim Management
- Emdeon Managed Gateway
- Emdeon Provider WebConnectSM
- Emdeon Claim Attachments
- Emdeon Workers' Compensation & Auto Medical eBills and Attachments
Popular Solutions
Emdeon Advanced Claiming
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 provider data cleansing helps solve one of the biggest problems in healthcare - provider data inaccuracy. Through our database of correct, current and comprehensive information on more than 6.5 million provider records, Emdeon can validate, augment, replace and normalize provider data within a claim to help improve auto-adjudication, increase payment and reporting accuracy and reduce the time spent working pended claims.
Emdeon Claim Routing service links specific data on the claim to member eligibility within a group, group coverage to a PPO, procedure codes, dollar amounts, and/or provider's participation in a PPO network. It also enables Emdeon to determine Capitation Division of Financial Responsibility (DOFR). The claim is 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, the claim is then delivered to the payer through Advanced Claiming.
Want to increase the efficiency of your healthcare claims? Let the healthcare efficiency experts review your business and apply our knowledge to your bottom line.
Contact UsFeatures
- Validates, corrects and replaces provider data
- Flags suspect providers
- Automated, efficient routing between payers and PPOs for re-pricing
- Applies client-specific pre-adjudication business rules to all claims
- Offers provider ID and member ID matching
- Rejects claims older than payer-defined deadlines
- Identifies and rejects duplicate claim submissions
Benefits
- Enhances the efficiency of the payment cycle
- Reduces manual intervention during claim adjudication and re-pricing
- Lowers processing cost-per-claim
- Speeds claim payment settlement cycle
- Increases first-pass results
- Improves payment and reporting accuracy

