Emdeon Provides Single Portal Claims Tracking and Benefit Information

From the Desk of the “EDI Guy”...
by Alan Feldman
Reprinted with permission from Insurance Solutions Newsletter--888-825-0298.

Emdeon, the largest dental clearinghouse in the United States, is literally changing the way dental offices do business. Administrative staff no longer needs to spend hours each day trying to obtain eligibility and benefit information in order to collect accurate co-payments at the time of service. Instead of spending hours surfing individual carrier websites or navigating phone systems, Emdeon now offers a single portal solution for accessing benefit information and claims tracking.

Who is Emdeon?
In the early 1980’s there was a clearinghouse named NEIC (National Electronic Information Corporation). In 1995, the name changed from NEIC to Envoy. Envoy then became Healtheon, which then became WebMD. As of August 2005, the largest clearinghouse in the United States is now called Emdeon.

The evolution of the name also reflects the evolution of services Emdeon now provides to the dental community. The new services will be enormously beneficial to dental practices already sending electronic transactions and should inspire paper-driven dental practices to finally start using electronic claims.

How is Emdeon able to offer these services?

• The majority of dentistry’s electronic transactions already pass through Emdeon in some way. Emdeon currently processes approximately 90 million electronic claims and transactions annually.

• Emdeon provides clearinghouse services for over 140 dental software vendors, including major national vendors.

• Emdeon has connections to over 300 dental insurance carriers. By utilizing Emdeon, your dental claims reach dental carriers faster, resulting in faster reimbursement.

Emdeon now provides dental claim tracking and claim status
If your office has an Internet connection, you can access Emdeon’s new service, Emdeon DPS (Dental Provider Services).

Imagine “FedEx Style” tracking for all of your electronic dental claims. As long as Emdeon has had some role in the transmission of your practice’s dental claims, you will be able to immediately find out where your claims are and exactly what is happening with them. Your dental practice will be able to track all your claims up to the point at which they are paid. And the good news is that the claim status and tracking feature is currently free.

Tracking is not available through the Emdeon DPS tracking system if a claim is transmitted directly to the insurance carrier; therefore, if you submit claims using your practice management software, it is important to know how your software vendor routes your claims. Assuming Emdeon is involved in processing your dental claims (which is typically the case), Emdeon DPS will allow you to search for claims by:

• Patient
• Insurance Carrier
• Category
• Claims transmitted
• Claims accepted
• Claims rejected

Emdeon DPS also displays:

• The date your electronic claims were sent
• Whether or not all of your dental claims were accepted by a specific carrier
• All relevant information received from the insurance carrier
• The real-time status of your dental claims and payment information (if the carrier has the necessary technology)
• The following information (if the carrier has the necessary technology):
  • The payment amount
  • The check date and number
  • A line item breakdown of the claim

According to Jay Baker, vice president of dental marketing for Emdeon, “There are many places on the Internet for dental offices to gather information. Many insurance carriers have excellent websites for dental offices to use; however, dental offices do not want to march around from website to website looking for information.” When asked what sets Emdeon DPS apart from other means of gathering information, Baker stated, “Simply put—it is one-stop shopping. Why should staff in a dental practice spend valuable time going from one website to another with different security protocols for each when Emdeon DPS offers it all on one website?”

Emdeon DPS addresses many of the concerns expressed by dental practices that have resisted electronic claims. And while it is generally easier and more convenient for dental practices to submit electronic claims through their dental software vendor, claims can be sent directly to Emdeon and then passed along to insurance carriers. If having the ability to track the status of dental claims over a single website inspires you to finally break the paper habit, contact Emdeon or your dental software vendor for information on how to get started sending electronic claims.

Emdeon now provides eligibility and benefit information
Dental practices have been desperate for an efficient way to access real-time eligibility and comprehensive benefit information, and Emdeon realized it had the capacity to solve the problem. As such, Emdeon DPS also provides one-stop access to eligibility and benefit information. You no longer have to navigate the maze of options over carrier phone systems in hopes of finally speaking to a human being who may or may not provide accurate information.

Emdeon’s eligibility feature eliminates long calls by providing you access to real-time eligibility and plan benefit information from multiple carriers using a single portal.

Benefit information typically includes plan maximums, deductibles, co-insurance percentages, frequency limitations, etc. According to Emdeon, some payers even allow you to check benefits for a specific procedure code. In just seconds, you can receive the same information that seems to take forever while waiting on hold to contact a customer service representative.

The patient’s eligibility and benefits are displayed on your computer in an easy-to-read format that can be printed and shared with your patient. If there is a discrepancy between the benefits listed and the actual payment received, the patient will readily see that your office is not the source of the problem.

The Cost
While the Emdeon DPS claim status and tracking features are currently free to dental practices, there is a small monthly fee for the eligibility and plan design feature due to the significant amount of information that needs to be coordinated.

The Final Hurdle
The technology has arrived and Emdeon has responded to the dental industry’s cry for administrative simplification; however, the last hurdle is to get more carriers and dentists to utilize the technology. Emdeon DPS has made major strides in connecting providers to payers. When it comes to electronic eligibility and benefit information, the challenge has always been getting more dental carriers to provide more information when provider usage is low and getting more providers to access the system when insurance participation is low. It is best described with the cliche, “Which came first, the chicken or the egg?” The more dental providers use Emdeon DPS, the more insurance carriers will be enticed to provide more plan and payment information back to the dental providers.

A list of carriers currently providing claim status, eligibility, and detailed benefit information through Emdeon DPS is available on Emdeon’s website at www.emdeon.com. Among others, the list includes Aetna, Ameritas, CIGNA, Great West Healthcare, MetLife, Principal Mutual Life, and most state Medicaid programs. If you have additional questions about the Emdeon DPS product, call 1-888-416-0673, Option 2, to speak with an Emdeon Dental Representative, visit the Emdeon Dental website at: www.emdeondental.com, or send an email to Emdeon at dentalproducts@emdeon.com.

Let them know that Emdeon DPS is exactly what dentistry has needed. The more emails they receive, the easier it will be for Emdeon to persuade all carriers to give providers access to eligibility and comprehensive benefit information. The more information carriers provide over Emdeon DPS, the more efficient you will be. Increased efficiency leads to increased profits. What are you waiting for?