Popular Solutions
Member Eligibility Management
Emdeon Member Eligibility Management services offer a unique upstream approach for efficient management and utilization of member eligibility data that achieves downstream administrative and medical cost savings. Our suite of member information-driven solutions helps payers strengthen provider self-service, improve member care management, increase auto-adjudication rates, comply with government benefit reporting mandates and facilitate HIPAA and CORE compliance.
Eligibility, authorizations, claim status and other related inquiries are often viewed as just another communication requirement for interaction with providers. Emdeon changes that through our ability to take your member information and not only enable real-time transactions through both direct connections and hosted solutions, but also capitalize on our broad solution set to enable efficiencies in downstream healthcare costs by addressing upstream challenges, deploying more solutions with one benefit data set, faster, with minimal risk and greater return on investment.
As always, our nationwide electronic network reach allows us to connect to any system for all payer-to-provider HIPAA-mandated transactions, but the value goes far beyond facilitating traditional pre-care inquiries. By reinventing the approach to member eligibility data management, Emdeon enables you to not only serve your provider networks in the best way possible, we are helping improve member health, facilitate regulatory compliance, increase revenue and reduce costs.
Want to better manage your member eligibility data? Let the healthcare efficiency experts review your business and apply our knowledge to your bottom line.
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Emdeon Real-Time provides Emdeon network connection via the HIPAA-standard ASC X12N format, supporting eligibility inquiry and response (270/271), claims status (276/277), find provider (274), healthcare services review request and response (278 x 094), healthcare services review inquiry and response (278 x 059) and claim financial inquiry (277/835).
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Emdeon Hosted Real-Time offers payer organizations the functionality for real-time healthcare transaction exchange in HIPAA compliant formats and enables real-time eligibility and benefits inquiry and response capability.
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The Emdeon Patient Responsibility Estimator® is an innovative tool that improves payer-provider relationships by offering providers reliable, convenient, real-time estimates of patients' out-of-pocket responsibility.
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Provider WebConnectSM offers payers their own internet-based portal that enables their submitting providers to login and submit batch claims, perform real-time eligibility and benefit verification, referrals, pre-certifications, authorizations and claim status inquiries, with no hardware or software requirements.
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Emdeon Third-Party Liability Analysis seamlessly manages the process of mapping Medicaid claim data to commercial payers' eligibility rosters. By identifying commercial payers with primary COB responsibility, Emdeon Third-Party Liability Analysis helps Medicaid recover overpaid claim dollars and limit future overpayments.
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Processing more than 35 million Medicare Crossover transactions annually, Emdeon offers guidance and resources that help payers simplify Medicare Crossover claim processing. Emdeon's existing payer connectivity to GHI eliminates payer requirements for implementing individual connectivity and workflows. Emdeon Medicare Crossover offers payers accelerated COBA readiness, minimized implementation costs and increased claim acceptance rates.
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Emdeon CareComm is a care communication tool for improving healthcare decision-making. It enables health plans to engage their provider network through pre-care messaging that leverages a real-time eligibility connection, as well as engage their member population post-care through print messaging. CareComm helps convey important patient health history and analytics at the right point in time to improve the health of your member population.
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Payer News: Emdeon Connection
The Emdeon Connection eNewsletter provides information to our government and commercial payer audience.
Emdeon Acquires EquiClaim to Expand its Payment Integrity Solutions Offering
We are excited to announce Emdeon has acquired EquiClaim, a leading provider of post-payment healthcare claims audit and recovery services for commercial and government payers, from MultiPlan.
Pre-Payment Fraud Detection and its Impact on the Bottom Line: A New Payment Integrity White Paper
The phrase, "An ounce of prevention is worth a pound of cure" aptly applies to a movement within the healthcare payment industry: Fraud, waste and abuse (FWA) prevention.
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