Emdeon Member Management offers 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.
Flexible, customizable products
Emdeon Real-Time
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). 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 Patient Responsibility EstimatorSM
Emdeon Patient Responsibility EstimatorSM is an innovative tool that improves payer-provider relationships by offering providers reliable, convenient, real-time estimates of patients’ out-of-pocket responsibility. Helping providers collect or establish payment at the point-of-service improves member and provider satisfaction and helps payers achieve positive brand association.
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 Medicare Crossover
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.
Emdeon Provider Web ConnectSM
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. Provider WebConnect is developed and managed by Emdeon and can be embedded in payers existing web pages.
Emdeon CareComm
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.
Pre-care messaging enhances care by delivering personalized information that enriches the physician-patient interaction. In addition to promoting healthy lifestyles within a health plan’s population and provider network, CareComm facilitates cost avoidance by promoting adherence to evidence-based clinical best practices and encouraging preventive care over more costly reactive care.
