- Fraud, Waste and Abuse
Transform Unnecessary Costs Into Strategic Opportunities
- Payment Integrity Brochure
- Payment Integrity White Paper — Advantages of Pre-Payment
- Payment Integrity White Paper — New Perspectives on Payment Integrity
- George Lazenby's chapter in 'Stop Paying the Crooks.'
- BNA Healthcare Fraud Report'
- "Driving Change in Payers' Fraud, Waste and Abuse Recovery Efforts"
Emdeon EDGETM Payment Integrity Solutions
America's vision of healthcare in the 21st Century did not accommodate a scope of wasteful overpayments that has been estimated at $700 billion per year. However, today, healthcare delivery in America has a new vision. One that bestows the power to reign in fraud, waste and abuse, overpayments, and excessive costs. Consider what it means to truly gain an edge. To manage costs proactively. To gain new insights into your claims data. To stop profit leaks and improve your bottom line.
Consider a partner who has the edge on today's best practices for payment integrity and claims cost management. A national data repository that is unmatched. Innovative technology that drives analytics to help give you unprecedented vision. Consider Emdeon EDGE.
Payment Integrity. Cost Management.
Emdeon has built one of the most complete suites of payment integrity services by acquiring three market leaders — The Sentinel Group, EquiClaim and TC3 Health — and integrating them with Emdeon's market leading healthcare network, data and analytics. The Sentinel Group's fraud, waste and abuse technology and investigation expertise, paired with TC3's recognized leadership in integrated fraud, waste and abuse and cost management services, along with EquiClaim's comprehensive portfolio of audit and recovery services, makes Emdeon the one partner you need to help protect you from improper claims payments.
Achieve superior claims cost containment and the payment integrity your business needs - how you want it, when you want it. With Emdeon EDGE, when you pay a claim, you can trust it is a claim worth paying.
Emdeon EDGE solutions easily integrate within your existing claims workflow, from pre-payment to post-payment, and provide multi-layered protection that offers both prospective and retrospective claims review, as well as in and out-of-network claims management.
Expertise On Your Side.
Emdeon's team of statisticians and analysts, investigators, auditors and thought leaders is comprised of industry veterans including medical directors, pharmacists, registered nurses, certified claim coders, and data analysts. Together we've uncovered millions of dollars in overpayments for our clients. Our Emdeon EDGE experts are ready to uncover and recover your overpayments.
Want to reduce your exposure to invalid claims payments and improve your profit margins? Let the healthcare efficiency experts review your business and apply our knowledge to your bottom line.Contact Us
Emdeon EDGE helps you:
- Avoid lost profits from paying invalid claims by detecting, investigating and preventing payment of those claims
- Reduce administrative time and cost by processing and accurately paying valid claims quickly and easily
- Capture new savings with insights into emerging schemes that single payer data typically cannot predict by leveraging exclusive multi-payer data and proprietary analytics tools
- Find lost dollars by auditing and recovering improper payments
- Maintain a strong provider network with clear and engaged provider communication
Help prevent unnecessary costs that drain your profits by identifying invalid claims and catching potentially fraudulent, wasteful or abusive claims up front. From pre-payment to post-payment, Emdeon EDGE provides multiple layers of protection.
Recover overpayments caused by inaccurate contract repricing, improper coding and misapplied reimbursement methods through a combination of expert audit and coding staff supported by extensive pharmacy and clinical expertise.
Expanding your profit margin requires strong networks and keeping your providers happy. Gain all the advantages of a single-source repricing solution for managing both in and out-of-network claims nationwide.
Combining built-in rules and advanced analytics with information and predictive models that are constantly refreshed from our multi-payer data analysis and expert analytics team, Emdeon EDGE recognizes and fights improper payments before they impact your bottom line. A robust and powerful analytics package offers unique insights that help you identify and understand cost drivers and facilitate better decision making.