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Payer
Connection Solutions for Healthplans & TPA’s
Today,
receiving insurance claims electronically represents one of the many known cost
saving measures available to insurance companies. While the industry has spent
years perfecting electronic solutions, the majority of claims continue to be
transmitted by paper with no electronic feedback loop for handling problem
claims.
Tomorrow,
the industry has the opportunity to leverage HIPAA as a means to realize the
promised benefits of standard transactions. This includes not only claim
submission, but, pre-determination of benefits, claim status tracking, and
electronic reimbursement. These benefits are dependent on a physician's office
being connected to this electronic environment.
Payer Connection’s understanding of the process has captured hundreds of
organizations wanting to adopt our vision and strategy for HIPAA
implementation.
Payer Connection has uniquely brought together the technology and administrative
healthcare industry expertise to apply electronic transactions for automating
critical business areas such as:
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Claim
Submission
Secure electronic claim transmissions with translation from legacy formats to
HIPAA standards for Professional, Dental, and Institutional formats.
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Business-Based
Claim Editing
Reducing the number of claims delivered in error by implementing Payer specific
rules and edits, user defined code crosswalks, and a user intervention workflow
application to correct pended claims before and after submission.
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Automated
Claim Status Tracking
Delivers updated claim status information for tracking and managing Payer
requests for additional information, providing faster notification of rejects
for non-eligible patients, and resubmission processing to correct pended
claims.
Payer
Connection works closely with Payers to develop a targeted effort directed
towards transitioning their physician networks to the standard formats. We base
our success on the ability to achieve higher utilization of transactions while
reducing call volumes for benefit questions, pended claims, and requests for
additional information. Our integrated transaction approach eliminates Payer
concerns over typical pricing packages and delivers a measurable return on
investment. The benefits are:
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Customized
Payer Edits
Receive cleaner claims with real-time business edits that achieve higher
electronic adjudication, with on-line correction and response to your requests
for additional information.
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Flat Rate
Pricing
Create predictable expense and tracking of value created by utilization of
electronic transactions without risking volatile fees that add additional
administrative overhead.
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Reduce
Administrative Costs
Communicate electronically with your providers on pended claims that need
additional information for processing, lowering your costs for mailing
requests.
Payer
Connection packages its services to fit the need of the organizations we serve,
big or small. For large Payers who have already invested and are satisfied with
their front-end capture and handling of electronic claims, we provide immediate
value by delivering claims from our existing client base. For small and even
large Payers who cannot justify the expense or have not realized the benefits
of outsourcing part of the trading partner process, Payer Connection delivers
the following services.
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HIPAA EDI
Hub
Provides the capability of sending/receiving HIPAA EDI transactions with your
trading partners. Handles receipt of transactions, creation and delivery of
functional acknowledgements, and reformats data to the specification of
internal legacy systems. By building custom business rules, problem claims can
be handled before they get stuck in the mix of other claims.
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Co/Full-Branded
Services
Payer Connections communication technology integrates seamlessly into any Web
Intranet or E-Commerce site. We provide the complete set of management tools
with your logo and color scheme displayed prominently in the surrounding frame.
This Branded effort is a strategic and powerful way to achieve not only HIPAA
transaction compliance, but a truly functional system to be used by internal
staff as well as external Trading Partners.
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Full
Integration
Some Payers may prefer to fully customize the Payer Connection EDI Hub. We
deliver the framework to build a proprietary healthcare dashboard. The
framework provides the system architecture, data model, role-based and
privilege based security, and an extensive knowledge base to achieve your
branding strategy and business needs.
Call
us to discuss your needs today.
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