Emdeon’s Claim Management services offer the expertise of an organization with nearly two decades of experience in the healthcare claims processing industry.  Emdeon leads the industry in clearinghouse and eServices solutions for automated EDI workflow that decreases electronic claims receipt and pre-processing cost, reduces phone calls from providers and improves your auto-adjudication rate. Our secure transmission mechanisms and HIPAA translations and formats offer you the best and most reliable connectivity services available so that claims are processed correctly. Our nationwide electronic network reach allows us to connect to any system for all payer-to-provider HIPAA-mandated transactions. 

Emdeon also offers a host of integrated imaging and data capture solutions that support a unified payment stream. We’re the only provider of both industry-leading software automation and business process outsourcing solutions.

Flexible, customizable products

Emdeon Transform™
Emdeon Transform is a high-volume imaging, data capture and transaction/forms processing software capable of scanning any form, claim or document to enable electronic transaction processing.  With technology-leading image processing, Transform reduces manual keying and increases overall data quality while reducing mailroom and data-entry costs.  By automating claim data capture, Transform increases auto-adjudication rates, improves efficiency, lowers costs and shortens the time between claim receipt and adjudication.

Emdeon Paper-to-EDI Conversion
Through state-of-the-art mailroom operations and industry leading scanning and data capture technology, Emdeon Paper-to-EDI Conversion allows payers to streamline their organization and focus on core business competencies by outsourcing mailroom operations, scanning, imaging and data capture to Emdeon. 

Uniting mailroom functions with world-class scanning and imaging tools, Emdeon Paper-to-EDI Conversion reduces payers’ administrative expenses by automating claim intake, eliminating capital investments in equipment and technology and enhancing data quality.  Validation and editing tools improve data accuracy, decrease claim fall-out and improve first-pass rates.

Emdeon Claims Connection
Emdeon Claims Connection is a direct connectivity service for claims transactions. Claims Connection provides Emdeon network connection via the HIPAA-standard ASC X12N 4010 format – supporting claims and encounter submission (837).  Claims Connection also supports alternative technology platforms and format options so you can select the best solution for your needs.

Emdeon Real-Time
Emdeon Real-Time  provides Emdeon network connection via the HIPAA-standard ASC X12N 4010 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).  Emdeon Real-Time also supports alternative technology platforms and format options so you can select the best solution for your needs.

Emdeon Hosted Real-Time
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.  Emdeon Hosted Real-Time functions as a data-hosting resource on behalf of payer organizations, eliminating payers’ need for expensive upgrades in systems and technology.

Emdeon Hosted Real-Time enables sophisticated inquiry and response transactions including:

Real-time eligibility and claim information

• Patient eligibility status
• Primary Care Physician name
• Claim status

Real-time benefit information

• Copay amount
• Deductible amount/unmet amount
• Coinsurance level
• Out of Pocket
• Coverage limitations and exclusions
• Benefit coverage
  

Emdeon Electronic Remittance Advice
Emdeon Electronic Remittance Advice provides Emdeon network connection via the HIPAA-standard ASC X12N 4010 format – supporting electronic remittance advice (835).  Emdeon Remittance Advice also supports alternative technology platforms and format options so you can select the best solution for your needs.

Emdeon Advanced Claiming
Emdeon Advanced Claiming improves the efficiency of the payment settlement cycle and lowers processing cost-per-claim by providing intelligent routing between payers, PPOs and other business partners, and applying client-specific pre-adjudication services to all claims.

The seamless integration into existing claim flows and the application of intelligent, rules-based pre-adjudication and routing logic results in higher first-pass rates, reductions in manual handling, and significant financial savings from streamlined administration.  For customers with multiple adjudication systems, Advanced Claiming will redirect the pre-processed claims to multiple service locations.

Emdeon Vision for Claim Management
Emdeon Vision for Claim Management is a web-based application that offers payers end-to-end, claim-level views into the claim filing process from claim submission to Emdeon through delivery to the payer organization.   With Emdeon Vision, payers have the ability to perform claim searches, verify claim status and generate a variety of claim trending and summary reports. 

With user-defined search criteria, payers are able to research claim information quickly and easily to resolve provider inquiries completely.  Emdeon Vision’s twelve-month claim history enables payers to perform tracking and summary functions to analyze numerous aspects of claim data and gain deeper insight into the claim lifecycle.

Emdeon Managed Gateway
Emdeon Managed Gateway provides payers with a single-vendor solution for the entire claim lifecycle from pre-adjudication to post-adjudication, including: mailroom outsourcing, document scanning, data capture, enhanced edits, eligibility verification, claim-routing and document retrieval.  The bundled solutions of Emdeon’s Managed Gateway provide higher EDI penetration, increased auto-adjudication rates, as well as data validation and editing on all claims, with greater savings than per-transaction rates.  The elimination of managing multiple vendor relationships results in even further savings.

Emdeon Third-Party Liability Analysis
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.

With the most connections to government and commercial payers in the industry, Emdeon is expertly poised with existing infrastructure to streamline the process of information exchange and interpretation.  Emdeon Third-Party Liability Analysis helps Medicaid plans recover revenue and overcome associated challenges, as well as helps commercial payers comply with DHHS legislation.

Emdeon Accelerated Growth Program for Claims
Emdeon Accelerated Growth Program for Claims impacts payers’ bottom lines by increasing EDI transactions, improving auto-adjudication rates and moving payer organizations and the industry closer to paperless administration.  Specific and measurable growth plans designed by Emdeon help payers capitalize on EDI opportunities to increase electronic adoption and utilization among providers. 

Leveraging our extensive provider reach with our analysis of your organization’s electronic and paper claim volumes, Emdeon identifies EDI opportunities and customizes a growth program to increase electronic utilization among connected, submitting providers and conversion to electronic for paper-only submitting providers.  Our dedicated team of EDI consultants is equipped to perform provider and vendor outreach initiatives including direct sales, mail and telemarketing campaigns to grow your EDI, or provide growth plans and training to your existing staff to administer growth initiatives.