Program Integrity Solutions
Emdeon Program Integrity Solutions help you identify, process and accurately pay only valid healthcare claims efficiently while reducing healthcare dollars lost to fraud, abuse and waste. This suite offers comprehensive solutions that easily integrate with your existing claims workflow. These solutions can be tailored to meet your immediate needs but also adapt as your organization changes and grows. With its unparalleled repository of claims data, Emdeon has the ability to streamline the information exchange and interpretation enabling detection of aberrant claims that currently may go unseen resulting in significant savings for your business.
Emdeon's innovative solution set offers the most complete healthcare fraud, abuse and waste solution available today. Our product suite empowers government entities of all sizes to intelligently automate processes that previously required a significant investment in human resources and IT infrastructure. When no longer forced to only manage suspect or irregular claims using a retrospective pay-and-chase model, organizations are more productive and efficient. Emdeon can help you be confident that when you pay a claim, it's a payment worth making.
Want to increase your claims efficiency? Let the healthcare efficiency experts review your business and apply our knowledge to your bottom line.
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Emdeon Fraud Prevention Services helps remove unnecessary costs from healthcare by identifying claim aberrancies and catching potentially fraudulent, abusive or wasteful claims early in the claim lifecycle, even pre-adjudication.
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Emdeon Clinical Integrity for Claims offers government entities flexible, transparent claims edits that leverage more than 16 million rules based on protocols from the American Medical Association, Centers for Medicare and Medicaid Services and other industry sources.
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With Emdeon Fraud Investigative Services, government entities can combine retrospective claims analysis and prospective fraud detection techniques.
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Leveraging the industry's most comprehensive payer connectivity with a history of partnering with government payers, Emdeon Third-Party Liability Analysis seamlessly manages the process of mapping Medicaid claim data to commercial payers' eligibility rosters.
