Emdeon

Emdeon is a leading provider of revenue and payment cycle solutions that connect payers, providers and patients to integrate and automate key business and administrative functions throughout the patient encounter. Through the use of Emdeon's comprehensive suite of products and services, its customers are able to improve efficiency, reduce costs, increase cash flow and more efficiently manage the complex revenue and payment cycle process.

Emdeon also provides Coordination of Benefits (COB) and Third Party Liability (TPL) services to State Medicaid Agencies and other public entities and is a sub-contractor to primary TPL/COB vendors in 38 States. Emdeon processes 15,000,000 real-time validations annually for both retrospective recoupment and prospective cost avoidance, generating billions of dollars in Medicaid savings nationwide. Its network of national insurance eligibility and roster information determines other coverage and assists Medicaid Agencies with recoupment and cost avoidance strategies to recover or avoid claims where Medicaid is secondary. Medicaid Management Information Systems (MMIS) TPL Segments are updated with coverage detail to allow providers to bill payers appropriately.

The combination of historic roster searching and real-time data access is more effective than other recovery and cost avoidance techniques that rely upon periodic batch updates provided by commercial insurers. Emdeon uses real-time eligibility transactions to ensure that verified polices are placed in the State TPL file for immediate cost avoidance. The enhanced pre-claim benefit information allows Medicaid to avoid paying claims for which they are not responsible.

Through partnership with major credit bureaus and data vendors Emdeon can also determine current income, family size and address information, allowing the provider to identify recipients who may no longer be eligible for Medicaid.

Results

• Emdeon’s experience with 38 state Medicaid agencies suggests savings potential of up to 5% of the total Medicaid spend through enhanced COB and TPL transactions.
• In large states, even a single percentage point reduction in the Medicaid spend can put millions of dollars back into state coffers.

***Submitted by Susanne Powell, Director, Corporate Communications, Emdeon, spowell@emdeon.com  

Published: January 26, 2009