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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 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.
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
- 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
- Identifies and rejects duplicate claim submissions
- Automated, efficient routing between payers and PPOs for re-pricing
Benefits
- Improves 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
- Improves first-pass results
