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The Modern
Medical
EDI Network
Members increasingly are in charge of their own healthcare journey, including payments.
Can Your Medical EDI Network Meet Future Healthcare Challenges?
Change Healthcare (Nasdaq: CHNG) is a leading healthcare technology company focused on insights, innovation, and accelerating the transformation of the U.S. healthcare system through the power of the Change Healthcare Platform. We provide data and analytics-driven solutions to improve clinical, financial, administrative, and patient engagement outcomes in the U.S. healthcare system.
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Ten Things to Ask Your Medical Network Vendor
Why EDI Is Still Going Strong After 55 Years
Ten Questions to Help You Pressure-Test Your Medical EDI Network
YES: Congratulations! Your vendor provides claims process solutions that help you reduce the administrative burden and costs.
Does your medical EDI network vendor provide pre-adjudication services?
Our Medical Network Provides a Full Range of Capabilities
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Why EDI?
Payer Challenges
Ten Questions
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Here are some facts you may not know about a technology you probably use every day.
EDI was developed for the U.S. transportation industry in the 1960s to enable thorough and accurate communication between multiple companies communications systems.
Today, almost all industries, including healthcare, rely on EDI for the fast and efficient exchange of business documents.
After more than 50 years, companies still rely on EDI for mission-critical applications. In fact, demand for EDI has never been higher.
The most recent estimates for the healthcare industry suggest that the EDI market will be worth $5.9 billion by 2025, an annual growth rate of 9.4%.
Question: How do you know if your EDI and clearinghouse capable of solving these challenges?
Not all EDI systems are created equal
A modern medical EDI network consolidates and manages all inbound and outbound transactions, optimizes application workflows, and provides access and connections to value-added capabilities.
A modern medical EDI network is the platform that enables you to run innovative solutions to help tackle today's biggest healthcare challenges.
Click on the numbers below to see the questions.
Payer Connectivity Service
An advanced claims management solution that helps payers improve first-pass auto-adjudication rates, identify the most efficient claims processing path, and reduce costs.
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What do you think about your current EDI network?
Change Healthcare can help you create a modern medical EDI network with our innovative solutions that help reduce costs, create efficiency, and drive better healthcare outcomes for your members.
Reduce Costs
Create Efficiencies
Improve Health Outcomes
Providers
Payers
Answer
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Are your EDI claims and operations teams fielding lots of calls from providers asking “what happened to my claim?”
YES: You need a more efficient and smarter claiming and remittance solution.
Claiming and Remittance
A claims and remittance solution that allows you to benefit from digital transaction and configurable edits, and uses direct connections for better accuracy and speed.
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Are you confident with the accuracy of your code auditing logic?
YES: Great! You must be using data analytics to optimize claims operations.
Coding Advisor
An analytics- and process-driven claims adjustment solution for payers that identifies billing outliers; helps change provider behavior; and reduces overpayments of low-dollar, high volume claims.
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An analytics-driven risk adjustment solution that gives payers a unique, compliant process that supports diagnosis coding accuracy, streamlines billing workflow, and helps close risk gaps.
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Are you aligned with providers to help ensure appropriate care and resource utilization?
YES: Excellent! You’re working to improve medical utilization and clinical outcomes.
InterQual®
Evidence-based clinical decision support solutions that help payers and providers make clinically appropriate medical utilization decisions.
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Do you accept attachments electronically (as opposed to using paper, mail, or fax)?
YES: Well done! You’re ahead of the curve by reducing administrative overhead with electronic attachments.
Electronic Attachments
A provider-payer data exchange system that helps providers submit documents, such as claims attachments, to payers for medical and workers' compensation claims.
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Can your providers check eligibility and claims status online?
YES: Very good! Your eligibility process provides automated and timely information on demand.
Eligibility API
A real-time solution that provides patient profile and benefits insights at the point of service to help ensure appropriate care delivery, as well as efficient and accurate reimbursement.
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Can you quickly and accurately determine if a member has third party coverage?
YES: Way to go! You have an efficient and money-saving process to accurately determine benefits coverage.
Coordination of Benefits
Helps commercial and government payers reduce costs by revealing accurate eligibility information and undisclosed coverage prior to paying claims.
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Are you able to access clinical patient data quickly, easily, and on demand?
YES: Outstanding! You’re improving patient outcomes and reducing the administrative burden by ensuring you have complete and accurate patient records.
Clinical Data Retrieval
Clinical Data Retrieval: A cloud-based interoperability solution that helps payers quickly and easily retrieve patient records from leading electronic health records (EHRs) systems to more easily increase the volume of patient records you review.
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Are you complying with Health and Human Services’ (HHS) Transparency in Coverage rules?
YES: Superb! You’re have processes in place to adhere to rules and provide transparency for members.
True View™
Helps payers meet cost transparency mandates by giving members digital access to medical procedure prices, and helps them make better decisions that can lead to better financial and health outcomes.
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Does your organization comply with the final CMS Interoperability and Patient Access rule?
YES: Tremendous! You’re helping promote national healthcare system interoperability, mitigating regulatory risk, and helping to ensure quality care.
Interoperability Services
Connected Consumer Health and interoperability solutions that help reduce costs, meet federally mandated requirements, and facilitate innovations that better address value-based payment and improve the consumer experience.
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Not all EDI systems are created equal.
Challenge for payers: The CMS interoperability rule.
Challenge for payers: To provide mechanisms of reimbursement that help providers pivot in this direction.
Providers are moving to value-based care.
Challenge for payers: Build and manage more seamless, automated claims system that integrates with providers' systems.
More integrated workflows in the healthcare industry.
Challenge for payers: Implement efficient payment systems that can save payers and providers time and money.
Cost savings pressures are increasing, leading to industry consolidation.
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A cloud-based interoperability solution that helps payers quickly and easily retrieve patient records from leading Electronic Health Records (EHRs) systems, expedite information procurement, review more records in less time, and drive significant cost savings.
Portal Visibility
Deep insight into transactions to reduce claim submissions
Pre-Adjudication Services
Reject and deny claims early to help lower cost
Payment Integrity
Advanced payment accuracy to drive efficiencies early
Member Engagement
Meet government mandates and enhance member visibility
Health Plan APIs
Hundreds of APIs to interact with third-party vendors
Machine Learning
Increases data insights and analytics
Here are ten questions to help determine if your medical EDI network can address your organization’s current and future challenges.
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Not all EDI systems are created equal.
Can Your EDI Medical Network Meet Future Healthcare Challenges?
10 Questions to Pressure Test Your Medical EDI Network
Today’s modern EDI Medical Network consolidates and manages inbound and outbound transactions, provides optimized application flows, and access to value-added capabilities. Modern EDI networks allow innovative solutions to tackle today’s biggest healthcare challenges.
The Change Healthcare Solution
Payer Connectivity Service is a pre-adjudication platform that includes EDI gateway functionality, an advanced claims management solution for payers that want to improve claim auto-adjudication rates and identify the most efficient path to process claims for a higher first-pass rate and lower costs
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Access tools that report where submitted claims are in the adjudication process.
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NO: You need a pre-adjudication platform that helps you identify and correct claims errors early in the process, and helps avoid costly provider appeals.
NO: Good! Your claims teams have processes in place to reduce
payer-provider abrasion.
NO: You need a better coding system that uses advanced analytics to identify incorrect coding.
Dx Gap Advisor
NO: You need a solution that uses
evidence-based decision support and clinical intelligence to help automate utilization and medical review processes.
NO: You need a system that helps eliminate antiquated processes by automating electronic submission and processing of attachments.
NO: You need solutions that provide on-demand member profiles, as well as benefits/eligibility and claim status information, to improve provider service levels and increase call center capacity.
Claim Status API
NO: You need a Coordination of Benefits solution to help reduce claim payments by quickly and accurately detecting third-party health plan coverage.
NO: You need a clinical data retrieval system that provides digital access to Electronic Health Records.
NO: You need a solution that helps you comply with government transparency mandates and lets members connect to healthcare cost and options resources.
NO: You need a solution that helps you meet federally mandated interoperability regulations.
Modern Medical EDI Network
Learn more at changehealthcare.com
Learn more at changehealthcare.com
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