Clearinghouses and TPAs

Clearinghouses (CH), and Third Party Administrators (TPAs) play a vital role in helping payers and providers in their daily healthcare transactions thereby improving the quality of care, and lowering the cost of U.S. healthcare.

Providers, payers and patients are benefited from their timely transactions, effective clinical and administrative information processing, sending and receiving of information such as claims status, eligibility verification, and electronic remittance advice.

Services

emids provides following services to CH and TPAs:

• Application development and maintenance
  Development and maintenance of claims platform, medical coding, billing and transcription applications, utilization management and accounting applications
• Data management
  Data migration, integrations, and extraction, transformation, and loading for healthcare data from CH and TPAs applications. emids has proven experience in managing huge clinical and administrative data repositories
• QA and testing
  emids' offering on QA and testing provides a comprehensive suite of tools and test cases for CH and TPA applications, and data testing
• BPO
  emids BPO services to CH and TPAs manage increased volumes of over payment analysis, member and provider enrollment, eligibility verification, healthcare claims administration, provider and member management, CMS validation, charge capture, medical coding and transcription, provider license verification  and fraud & abuse management
• Building of HIPAA EDI capability to claims administration, provider and member management applications

Solutions

emids' solutions to CH and TPAs:

• Claims management
  emids healthcare expertise enabled us to provide revenue cycle management, health insurance claims processing, overpayment analysis and QA automation to CH, TPAs - systems and applications. However, the claims management solution is classified under consulting, technology and operations
• Interoperability
  emids' with its in-depth knowledge of interoperable standards such as HL7, DICOM, HIPAA, ICD, IHE, LOINC, SNOMED and NCPDP SCRIPT, can help CH and TPAs – applications and systems to achieve these standards with perfection. Our interoperability solution is lined along consulting, developing and testing, maintenance and support, and training
• Mobility
  emids' mobility solution enables CH and TPAs to provide physicians and payers to have readily available information in their mobile devices. We have a solution set for integration with iPad, iPhone, Blackberry, and Android Smart Phones
• HIPAA 5010 transition and business testing
  emids provides HIPAA 4010 to 5010 transition and business testing solution to CH and TPAs. The solution is classified into: impact assessment services, remediation planning and implementation and HIPAA 5010 testing services includes independent testing and validation. emids HIPAA business testing framework can help entities in different areas including gateways testing, claim systems testing, trading partners testing and validation edits. 
• ICD-10 transition
  emids' ICD-10 transition solution can assist CH and TPAs to adapt new coding standards. emids' streamlined transition solution include: consulting and impact assessment services, remediation, planning and assessment, and ICD 10 testing services

Benefits

• Readymade use cases, templates and test cases for:
  • HIPAA 5010 and ICD 10, enables quicker compliance
  • Mobility capability building, accelerates development
  • Seamless integration, ensures interoperability
• Automation in CH and TPA's processes and systems
• Our in-depth understanding of data models and tools accelerates the development process
• Easier adoption of newer technology, leading to better patient experience

Case studies

• ETL and BI services for claims data analysis for a leading RCM organization
• Build, test, and operate an automated erroneous claims detection system for a US top-3 insurance processor
• Automated testing process for radiology necessity verification for a radiology benefit management company
• Managed QA for a leader in radiology management
• Utilization management services for a radiology benefits management provider
• Overpayment analysis, eligibility verification and consulting for leading RCM service provider

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