Presentation on theme: "Property of Emdeon Dental 1 Electronic Transactions.. More Than Just Claims! April 28, 2010 EMDEON PRESENTS."— Presentation transcript:
Property of Emdeon Dental 1 Electronic Transactions.. More Than Just Claims! April 28, 2010 EMDEON PRESENTS
Property of Emdeon Dental 2 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)
Property of Emdeon Dental 3 What Emdeon Dental Does Emdeon connects 83,000 dentists using 140 different practice management software vendors to over 400 insurance companies
Property of Emdeon Dental 4 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.
Property of Emdeon Dental 5 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
Property of Emdeon Dental 6 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
Property of Emdeon Dental 7 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
Property of Emdeon Dental 8 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
Property of Emdeon Dental 9 Electronic Attachments
Property of Emdeon Dental 10 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’s What About Attachments?
Property of Emdeon Dental 11 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
Property of Emdeon Dental 12 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 Office PMS Software Aetna Anthem Horizon MetLife Electronic Claims Internet Attachment Repository Electronic Attachments
Property of Emdeon Dental 13 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
Property of Emdeon Dental 14 Real Time Patient Information Available Telephone/VRU: Automated response services Payer websites www Internet web portals ‘Dental Provider Services’ /Emdeon Office desktop software Built into your desktop software Using your desktop software powered by Emdeon
Property of Emdeon Dental 15 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
Property of Emdeon Dental 16 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)
Property of Emdeon Dental 17 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
Property of Emdeon Dental 20 Example: frequencies, deductibles, coverage on endo, perio oral surgery and sealants, age limitations
Property of Emdeon Dental 21 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)
Property of Emdeon Dental 25 Detailed Tracking and payment info
Property of Emdeon Dental 26 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)
Property of Emdeon Dental 27 ERA Displayed via Web Portal
Property of Emdeon Dental 28 ERA Display (Built-in Desktop Software)
Property of Emdeon Dental 29 ERA Display (Built-in Desktop Software)
Property of Emdeon Dental 30 ERA Display (Built-in Desktop Software)
Property of Emdeon Dental 31 Printed Electronic Remittance Advice (‘electronic EOB’) displayed and printed from website or desktop software
Property of Emdeon Dental 32 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!
Property of Emdeon Dental 33 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!
Property of Emdeon Dental 34 Questions For Our Panel ?? Aetna Tom Rabbe 1-800-451-7715 Customer Service RabbeTR@aetna.com www.AetnaDental.com Anthem www.anthem.com/edi (select your state for contact info) Horizon BCBS NJ Shirley Antoine 973.466.6181 www.horizon-bcbsnj.com/providers/dental.html MetLife Ann M. Burnett firstname.lastname@example.org (315) 792-5961 Emdeon Dental – 888.416.0673 option 2 KCamp@Emdeon.com www.emdeondental.com