property of emdeon dental 1 electronic transactions.. more than just claims! april 28, 2010 emdeon...

Property of Emdeon Dental 1

Electronic Transactions.. More Than Just Claims!

April 28, 2010

EMDEON PRESENTS


WHO IS EMDEON?

We are the leading provider of technology and information solutions that simplify the business of healthcare by facilitating intelligent

communications among healthcare payers, providers, pharmacies, labs, hospitals and patients.

1100 Payers(Medical/Dental Payers)

Medical/Dental Software Vendors

Medical, Pharmacy, Lab, Hospital

340,000 Providers (Physicians/Dentists)


What Emdeon Dental Does

Emdeon connects 83,000 dentists

using 140 different practice management software vendors

to over 400 insurance companies


How Does All of This Work?

Emdeon would like to help you

simplify the business of healthcare

and make the best

choices for your office.


• Electronic attachments

• Real time eligibility inquiries/response

» Yes or No and sometimes includes benefit data

• Real time claim status inquiries/response

» Check the status and track your claims

• ERA – electronic remittance advice

» ‘electronic’ EOB

» Integrated and post-able to patient record

• EFT – electronic funds transfer

» Direct deposit from the payer

• Real time claims and more!

» What the future holds – coming soon!

Today’s Discussion


Electronic Claims

• Average=$0.50 per claim with seconds of staff time to submit

• 3% - 5% rejection rates*

• ‘Certified Receipts’ Reports allow easy follow-up for tracking

• Read Your Daily Reports!

Paper Claims

• Higher costs - paper claims can take several minutes to submit

• ~30% rejection rate*

• No acknowledgement that claim was ever received

• Longer turnaround time for rejection notification

A Reminder:EClaims Can Improve Your ‘Bottom Line’

And Make Your Day Easier

*National Dental EDI Council Payer Survey


Electronic Transactions Make It Easier!

• Check eligibility/benefits while patients are in your office

• Send your claims and attachments electronically

• Track your electronic claims all the way through

• Check claim status without calling the payer

• Receive an electronic EOB / payment information (ERA)

• Get paid electronically via Electronic Funds Transfer (EFT)

• Send an electronic statement when insurance pays


NPI Needed for Electronic Transactions

• Type 1 – Individual

• Type 2 – Corporate

• NPI is needed for ALL electronic transactions

• Notify the payers of your NPI

• Check with your software vendor for instructions on how to enter into your system

• Check with your payers if you have claim issues


Electronic Attachments


Important to remember:

Claims must be processed according to consultant review within plan guidelines

• Due to the nature and costs of some procedures, payers will require attachments for review.

• Processing a paper claim with an attachment slows settlement.

• Remembering documentation guidelines for each payer is a challenge for dental offices. This typically results in sending unnecessary attachments.

Many payers say that only a small percentage

of the attachments they receive

are actually required or used for claim review!

X-rays, perio charts, narratives, and EOB’sWhat About Attachments?


How Does It Work?

• Built into desktop software– ID number is automatically generated by

your desktop software. This number tells the payer which attachment belongs with which claim.

• ‘Stand alone’ software– National Electronic Attachment


Where Do Attachments Go?

• Insurance company checks daily or is notified• Attachment ID will be in the ‘remarks’ field• >200 plans available – check website often

Dental OfficePMS

Software

Aetna

Anthem

Horizon

MetLife

ElectronicClaims

InternetAttachmentRepository

ElectronicAttachments


What Do You Need?

Among other things, you will need:

• Internet Service Provider

• Send your claims electronically

• The ability to digitize attachments

– Digital radiography

– Scanner with transparency adapter and adequate flatbed area for historical film and paper documentation

• Electronic attachment software


Real Time Patient Information Available

Telephone/VRU:Automated response services

Payer websiteswww

Internet web portals‘Dental Provider Services’ /Emdeon

Office desktop software

Built into your desktop softwareUsing your desktop software powered by Emdeon


The Advantages of Real-Time Transactions

In simple terms, “real time” means asking a question and receiving an answer within a few seconds – much like having a normal conversation with a particular payer or clearinghouse.

• Fewer phone calls to payers

• Higher claim acceptance rate

• More knowledgeable front office staff

– Increase patient trust

– Improve patient services

• Faster patient payment (response from payer is immediate - while patient is in your office)

– Increased cash flow

• More quality time for your patients


Real Time Eligibility and Benefit Information

Is the patient eligible? For what services?

Eligibility tells you if a patient is eligible for coverage, may give other information on benefits, deductible and maximums, may give frequencies and utilization

• Dental Provider Services (DPS) web portal by Emdeon

• “Integrated” or built in your practice management system (click a button from a patient record to automatically check patient eligibility)


ONE Web Portal - Many Payers Emdeon’s Dental Provider Services (DPS)

Benefits of ONE web portal:

• Consistent look and feel, regardless of payer

• Available to anyone who has internet access

• “One stop shop” – multiple payers, one site

• Claim status and claim tracking available

• Eligibility and benefits transactions available

www.emdeondental.com


Example:frequencies,deductibles,coverage on endo, periooral surgeryand sealants,age limitations


Real Time Claim Status/Tracking

Where is my claim-what happened to it?

Claim status tells you where a particular claim is within the payer’s processing system (if sent electronically).

• Dental Provider Services (DPS) by Emdeon for all of your claims sent electronically

• “Integrated” or built into your practice management system (click on a button from the patient record to automatically check the status of a specific claim)


Detailed Tracking and payment info


Electronic Remittance Advice‘ERA’

“Electronic EOB’s” are delivered:

• Internet web portals– Emdeon’s ‘DPS’ (print only)

• Some payer websites (print only)

• “Integrated” or built into your practice management system (click on a button to automatically post to patient record)


ERA Displayed via Web Portal


ERA Display (Built-in Desktop Software)


Printed Electronic Remittance Advice (‘electronic EOB’)displayed and printed from website or desktop software


Electronic Funds Transfer‘EFT’

‘Direct Deposit’ from payer to you

• Receive payments quicker from the payer• Unique deposit/entry on bank statement• May continue to receive EOB’s online via payer

website or via fax (specific to each payer) or Emdeon’s DPS

• Sign up is quick and easy – done directly with each payer (check payer websites for info)

Watch for more information from Emdeon!


Real Time Claims

The future is coming . . .

The delivery of an electronic claim from your office to a payer with a corresponding adjudication response from the payer, delivered back to you during the same telecommunication session – roundtrip in seconds . . .

Emdeon is currently working with payers and software vendors

to bring this to your office very soon!


Questions For Our Panel ??

AetnaTom Rabbe1-800-451-7715 Customer [email protected]

Anthemwww.anthem.com/edi (select your state for contact info)

Horizon BCBS NJShirley Antoine973.466.6181www.horizon-bcbsnj.com/providers/dental.html

MetLifeAnn M. [email protected](315) 792-5961

Emdeon Dental – 888.416.0673 option [email protected]

property of emdeon dental 1 electronic transactions.. more than just claims! april 28, 2010 emdeon...

Documents

property of emdeon dental

electronic claims average

emdeon presents

electronic statement

dental offices

electronic transactions

payer real time claims

electronic funds transfer