EDI product robotically processes EDI 837 claims transactions, drastically reducing processing costs and claim turnaround time.
April 5, 2007
DALLAS - While the concept of "Robotic Adjudication" may sound futuristic, Eagle Innovations has been robotically adjudicating EDI healthcare claims for the past ten years. "What we've been doing with our e-Claims product was revolutionary years ago, and it still is today," offers Sean Hansen, national sales and product director for Eagle Innovations. "We haven't found an EDI product out there that does what e-Claims does, and it's time the world knew about it. 'Robotic Adjudication' is the much needed missing link between human adjudication and auto-adjudication. Health plans and third-party administrators are in a constant struggle to decrease the amount of labor and cost associated with processing a claim. Before e-Claims Now, if a claim couldn't be auto-adjudicated, the only option was to manually process it. That's not true anymore."
The question is whether or not e-Claims really does, in fact, "robotically" adjudicate claims.
"You bet it does," says Dan Kirkwood, president and founder of Eagle. "E-Claims Now, which works alongside an existing adjudication system, learns how to make adjudication decisions just like your claims examiners do today. Computerized adjudicators log into your system and begin adjudicating claims according to your business rules. They can look up data in other information systems, or on other screens, make corrections or decisions, and process the EDI claim. It all happens in a fraction of the time - and cost - it would take for a human to do the same thing."
Hansen sounds off in more detail about how e-Claims Now is designed to assist health plans and TPAs reduce expenses and streamline claims processing. "E-Claims Now is a comprehensive EDI solution for handling inbound claims, from receipt to pre-adjudication, and on through to adjudication. It's important to remember that it works with existing adjudication systems, so if you're looking to improve your auto-adjudication capabilities without spending millions on a new system, e-Claims Now is perfect. It warehouses and normalizes inbound claims, and then it scrubs them to move them cleanly into your adjudication system without having to send problem batches to a programmer to figure out. The claims that your system can auto-adjudicate are allowed through; the ones it can't are redirected to either specific human queues or robotic agents, depending upon what intervention is needed to finalize adjudication."
Licenses for Eagle's e-Claims Now product have been purchased by many major clearinghouses and healthcare entities including Emdeon (formerly Envoy), Siemens (formerly SMS) and numerous healthcare payors throughout the U.S.
Eagle Innovations, Inc., has been in business for 20 years, and the company has implemented thousands of solutions in hundreds of healthcare organizations throughout the U.S. and Canada. Eagle's claims solutions process tens of thousands of claims daily including paper and EDI HCFA, UB92, and dental claims. More information about e-Claims Now is available at 'http://www.eagleinnovations.com/eclaims'.
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