The Lifecycle of a Claim
What is End-to-End Risk Mitigation?
With our unique Intelligent Healthcare Network, Emdeon takes advantage of savings opportunities at every stage of the claim lifecycle.
Scroll down to follow the claim and see for yourself!
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Emdeon Coding Advisor
MultiPayer Analytics and a sequenced process that benchmarks provider billing, educates providers and monitors future billing, in the Pre-submission stage of the lifecycle, to reduce unnecessary costs from inappropriate billing.
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Pre-Payment
By closely monitoring and identifying aberrant claims through code edits, the application of investigative rules and multi-payer analytics, and early detection of anomalies, payers can detect outliers and combat costs prior to issuing payment
Here the claim is marked as 'Not Flagged' or 'Flagged'. Please choose which path you would like to explore.
Insurance Company / Payer
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Insurance Company / Payer
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Post-Pay Audit & Post-Pay Recovery
When claims are incorrectly paid, clinical reviews, additional analysis and investigation help recoup dollars lost to improper payments.
After a claim is paid, it may be audited and verified or flagged. A claim may also be flagged for investigation. Please choose which path you would like to explore.
Congratulations, your claim has completed its lifecycle!
Try another path
Are you mitigating risk at every stage of the lifecycle?
Emdeon’s Intelligent Healthcare Network provides unique insights to help you make the most informed decisions available.
Let Emdeon help you avoid lost profits, reduce administrative time and cost, find lost dollars, capture new savings and maintain a strong provider network.
Find out more about our Payment Integrity solutions:
Pre-Submission Post-Submission Post-Payment
Resources:
1Department of Health and Human Services, Office of Inspector General, Coding Trends of Medicare Evaluation and Management Services, Daniel R. Levinson, May 2012
http://oig.hhs.gov/oei/reports/oei-04-10-00180.pdf
2Testimony of Louis Saccoccio, CEO, National Health Care Anti-Fraud Association before the U.S. House Committee on Ways and Means Subcommittee on Oversight, March 24, 2015
http://waysandmeans.house.gov/uploadedfiles/2015_03_24_oversight_louis_saccoccio_testimony.pdf
3Annual Report of the Departments of Health and Human Services and Justice, Health Care Fraud and Abuse Control Program FY 2014
https://oig.hhs.gov/publications/docs/hcfac/FY2014-hcfac.pdf
Please choose one of three corrective options:
Congratulations, your claim has completed its lifecycle!
Try another path
Are you mitigating risk at every stage of the lifecycle?
Emdeon’s Intelligent Healthcare Network provides unique insights to help you make the most informed decisions available.
Let Emdeon help you avoid lost profits, reduce administrative time and cost, find lost dollars, capture new savings and maintain a strong provider network.
Find out more about our Payment Integrity solutions:
Pre-Submission Post-Submission Post-Payment
Resources:
1Department of Health and Human Services, Office of Inspector General, Coding Trends of Medicare Evaluation and Management Services, Daniel R. Levinson, May 2012
http://oig.hhs.gov/oei/reports/oei-04-10-00180.pdf
2Testimony of Louis Saccoccio, CEO, National Health Care Anti-Fraud Association before the U.S. House Committee on Ways and Means Subcommittee on Oversight, March 24, 2015
http://waysandmeans.house.gov/uploadedfiles/2015_03_24_oversight_louis_saccoccio_testimony.pdf
3Annual Report of the Departments of Health and Human Services and Justice, Health Care Fraud and Abuse Control Program FY 2014
https://oig.hhs.gov/publications/docs/hcfac/FY2014-hcfac.pdf
Congratulations, your claim has completed its lifecycle!
Try another path
Are you mitigating risk at every stage of the lifecycle?
Emdeon’s Intelligent Healthcare Network provides unique insights to help you make the most informed decisions available.
Let Emdeon help you avoid lost profits, reduce administrative time and cost, find lost dollars, capture new savings and maintain a strong provider network.
Find out more about our Payment Integrity solutions:
Pre-Submission Post-Submission Post-Payment
Resources:
1Department of Health and Human Services, Office of Inspector General, Coding Trends of Medicare Evaluation and Management Services, Daniel R. Levinson, May 2012
http://oig.hhs.gov/oei/reports/oei-04-10-00180.pdf
2Testimony of Louis Saccoccio, CEO, National Health Care Anti-Fraud Association before the U.S. House Committee on Ways and Means Subcommittee on Oversight, March 24, 2015
http://waysandmeans.house.gov/uploadedfiles/2015_03_24_oversight_louis_saccoccio_testimony.pdf
3Annual Report of the Departments of Health and Human Services and Justice, Health Care Fraud and Abuse Control Program FY 2014
https://oig.hhs.gov/publications/docs/hcfac/FY2014-hcfac.pdf
Congratulations, your claim has completed its lifecycle!
Try another path
Are you mitigating risk at every stage of the lifecycle?
Emdeon’s Intelligent Healthcare Network provides unique insights to help you make the most informed decisions available.
Let Emdeon help you avoid lost profits, reduce administrative time and cost, find lost dollars, capture new savings and maintain a strong provider network.
Find out more about our Payment Integrity solutions:
Pre-Submission Post-Submission Post-Payment
Resources:
1Department of Health and Human Services, Office of Inspector General, Coding Trends of Medicare Evaluation and Management Services, Daniel R. Levinson, May 2012
http://oig.hhs.gov/oei/reports/oei-04-10-00180.pdf
2Testimony of Louis Saccoccio, CEO, National Health Care Anti-Fraud Association before the U.S. House Committee on Ways and Means Subcommittee on Oversight, March 24, 2015
http://waysandmeans.house.gov/uploadedfiles/2015_03_24_oversight_louis_saccoccio_testimony.pdf
3Annual Report of the Departments of Health and Human Services and Justice, Health Care Fraud and Abuse Control Program FY 2014
https://oig.hhs.gov/publications/docs/hcfac/FY2014-hcfac.pdf
Insurance Company / Payer
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Insurance Company / Payer
Insurance Company / Payer
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Post-Pay Audit & Post-Pay Recovery
When claims are incorrectly paid, clinical reviews, additional analysis and investigation help recoup dollars lost to improper payments.
After a claim is paid, it may be audited and verified or flagged. A claim may also be flagged for investigation. Please choose which path you would like to explore.
Congratulations, your claim has completed its lifecycle!
Try another path
Are you mitigating risk at every stage of the lifecycle?
Emdeon’s Intelligent Healthcare Network provides unique insights to help you make the most informed decisions available.
Let Emdeon help you avoid lost profits, reduce administrative time and cost, find lost dollars, capture new savings and maintain a strong provider network.
Find out more about our Payment Integrity solutions:
Pre-Submission Post-Submission Post-Payment
Resources:
1Department of Health and Human Services, Office of Inspector General, Coding Trends of Medicare Evaluation and Management Services, Daniel R. Levinson, May 2012
http://oig.hhs.gov/oei/reports/oei-04-10-00180.pdf
2Testimony of Louis Saccoccio, CEO, National Health Care Anti-Fraud Association before the U.S. House Committee on Ways and Means Subcommittee on Oversight, March 24, 2015
http://waysandmeans.house.gov/uploadedfiles/2015_03_24_oversight_louis_saccoccio_testimony.pdf
3Annual Report of the Departments of Health and Human Services and Justice, Health Care Fraud and Abuse Control Program FY 2014
https://oig.hhs.gov/publications/docs/hcfac/FY2014-hcfac.pdf
Please choose one of three corrective options:
Congratulations, your claim has completed its lifecycle!
Try another path
Are you mitigating risk at every stage of the lifecycle?
Emdeon’s Intelligent Healthcare Network provides unique insights to help you make the most informed decisions available.
Let Emdeon help you avoid lost profits, reduce administrative time and cost, find lost dollars, capture new savings and maintain a strong provider network.
Find out more about our Payment Integrity solutions:
Pre-Submission Post-Submission Post-Payment
Resources:
1Department of Health and Human Services, Office of Inspector General, Coding Trends of Medicare Evaluation and Management Services, Daniel R. Levinson, May 2012
http://oig.hhs.gov/oei/reports/oei-04-10-00180.pdf
2Testimony of Louis Saccoccio, CEO, National Health Care Anti-Fraud Association before the U.S. House Committee on Ways and Means Subcommittee on Oversight, March 24, 2015
http://waysandmeans.house.gov/uploadedfiles/2015_03_24_oversight_louis_saccoccio_testimony.pdf
3Annual Report of the Departments of Health and Human Services and Justice, Health Care Fraud and Abuse Control Program FY 2014
https://oig.hhs.gov/publications/docs/hcfac/FY2014-hcfac.pdf
Congratulations, your claim has completed its lifecycle!
Try another path
Are you mitigating risk at every stage of the lifecycle?
Emdeon’s Intelligent Healthcare Network provides unique insights to help you make the most informed decisions available.
Let Emdeon help you avoid lost profits, reduce administrative time and cost, find lost dollars, capture new savings and maintain a strong provider network.
Find out more about our Payment Integrity solutions:
Pre-Submission Post-Submission Post-Payment
Resources:
1Department of Health and Human Services, Office of Inspector General, Coding Trends of Medicare Evaluation and Management Services, Daniel R. Levinson, May 2012
http://oig.hhs.gov/oei/reports/oei-04-10-00180.pdf
2Testimony of Louis Saccoccio, CEO, National Health Care Anti-Fraud Association before the U.S. House Committee on Ways and Means Subcommittee on Oversight, March 24, 2015
http://waysandmeans.house.gov/uploadedfiles/2015_03_24_oversight_louis_saccoccio_testimony.pdf
3Annual Report of the Departments of Health and Human Services and Justice, Health Care Fraud and Abuse Control Program FY 2014
https://oig.hhs.gov/publications/docs/hcfac/FY2014-hcfac.pdf
Congratulations, your claim has completed its lifecycle!
Try another path
Are you mitigating risk at every stage of the lifecycle?
Emdeon’s Intelligent Healthcare Network provides unique insights to help you make the most informed decisions available.
Let Emdeon help you avoid lost profits, reduce administrative time and cost, find lost dollars, capture new savings and maintain a strong provider network.
Find out more about our Payment Integrity solutions:
Pre-Submission Post-Submission Post-Payment
Resources:
1Department of Health and Human Services, Office of Inspector General, Coding Trends of Medicare Evaluation and Management Services, Daniel R. Levinson, May 2012
http://oig.hhs.gov/oei/reports/oei-04-10-00180.pdf
2Testimony of Louis Saccoccio, CEO, National Health Care Anti-Fraud Association before the U.S. House Committee on Ways and Means Subcommittee on Oversight, March 24, 2015
http://waysandmeans.house.gov/uploadedfiles/2015_03_24_oversight_louis_saccoccio_testimony.pdf
3Annual Report of the Departments of Health and Human Services and Justice, Health Care Fraud and Abuse Control Program FY 2014
https://oig.hhs.gov/publications/docs/hcfac/FY2014-hcfac.pdf