In order to support the recommendations provided through the analysis process, Ecom has developed an integrated suite of claims management services that provide compelling administrative efficiency and operational cost savings. These services include:
EDI Intake
| o | Ecom manages the connectivity to clearinghouses and other trading partners handling electronic claims. |
| o | Ecom translates claim files to the required formats required by PPO networks, and clearinghouses in HIPAA compliant EDI standards. |
| o | Ecom utilizes eligibility files from the client and determines the correct PPO network for repricing. |
| o | Ecom manages primary PPO network selections, secondary and travel networks, bill negotiation and other cost containment service vendors selected by the client. |
| o | Ecom PPO Advisors provides comprehensive PPO / repricing solutions for approximately 100 different nationally recognized PPO networks. Regardless of the repricing methodology, all claims are returned to you in your companys specific format. |
| o | Ecom automates the movement of all claims from the client to the PPO and other cost containment partners and back. |
| o | Ecom provides self-service tracking of all claims submitted to Ecom for repricing. |
| o | Ecom offers standard and ad-hoc reporting via Client Web Tools. |
| o | Ecom provides 1 invoice for all applicable PPO access fees. |
| o | Ecom's experienced team recommends optimal claims workflow based on each clients claim processes |
By providing a complete transactional workflow capability to handle all aspects of PPO claim management, Ecom streamlines the administrative processes for the clients, therefore improving administrative costs and improving operational efficiency for each customer. Further, Ecom has allowed the client to focus on their core business of delivering and managing healthcare to its members.
