Emdeon Third-Party Liability Analysis

Leveraging the industry's most comprehensive payer network and a history of partnering with commercial and government payers, Emdeon Third-Party Liability (TPL) Analysis manages the process of identifying, validating and verifying coordination of benefit opportunities. By recognizing overlaps in coverage, Third-Party Liability Analysis helps recover overpaid claim dollars, redirects payments to responsible parties and limits future overpayments.

Our fully automated solutions provide tools to intelligently manage enrollment and claim processing by seamlessly integrating address, income and third-party benefit verification. Direct integration at these stages of the benefit cycle enables long-term cost avoidance because it improves data quality and consistency. It also allows us to pre-screen members for need, qualification and other coverage, while providing employees an easy-to-use system.

Implementing a complete best-practices model makes it possible to identify waste, fraud and inappropriate member benefits before claims are submitted or paid. This proactive approach can help payers avoid less effective and lengthy back-end recoupment practices, which can translate into more efficient healthcare, less expensive benefits and overall savings.

Features

• Smart Scan™ Analytics that help reduce false positives
• Online access and file monitoring
• Real-time transactions to validate TPL leads
• Batch file processing for TPL discovery
• Flexible pricing models
• Customized reporting and monitoring
• Daily, monthly, quarterly, bi-annual and event-triggered processing
• Conducts analysis retroactively or prospectively

Benefits

• Cost-effective, results-driven product suite
• Helps recover claims and maximize cost avoidance
• Fast, easy claim tracking
• Saves time by eliminating labor-intensive claim report monitoring
• Quickly identifies claim rejection reasons
• Helps improve claim acceptance rates