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Orem, UT, United States, 2008/06/04 - KLAS addresses the question of whether an ambulatory EDI claims clearinghouse is simply a commodity, while researching the successes and struggles healthcare providers experienced when working with their clearinghouse service vendors.
The ambulatory clearinghouse market has advanced in recent history due to both regulatory changes and industry innovations. Because of significant merger and acquisition activity, the vendor landscape has evolved and given vendors the opportunity to enhance their offerings by incorporating many value-added services. On the provider side, EDI volumes are rising and the demand for eligibility information is high; at the same time, many providers are trying to reduce their overall EDI costs.
As a result of the market changes, clearinghouse service is no longer simply a mechanism to get paid. It has the potential to be a revenue cycle management system that streamlines processes to the point that some providers report not only operational efficiencies, but increased revenue as well. Clearinghouses are clearly no longer a simple commodity offering. More choices are available that ever before.
Most of the time providers reported that practice management (PM) vendors would allow the provider to select a clearinghouse from a list of preferred vendors. While choice is important, it does not always guarantee success. Not having a choice may provide an advantage with a good marriage between the PM vendor, the clearinghouse, and the payer.
One benefit exciting providers is the ability to edit and reprocess rejected claims online which leads to faster throughput. A challenge could result in dual entry, if the online edits were not integrated back to the PM system. The potential benefit for clearinghouse services to make secondary claims automatic also energized providers.
In this report, healthcare providers share their insights and experiences with their clearinghouse service firms. Scores showed a definite correlation between a vendor’s overall performance score and their functional strength ratings. Vendors included in the research are Availity, Emdeon Business Solutions, Gateway EDI, Ingenix ENS, Misys Payerpath, Navicure, RelayHealth, The Consult ECP, and ZirMed.
For more information about the clearinghouse service report, additional KLAS reports, or to access KLAS data, please visit the KLAS research website.
KLAS is a research firm specializing in monitoring and reporting the performance of healthcare vendors. KLAS’ mission is to improve delivery, by independently measuring vendor performance for the benefit of our healthcare provider partners, consultants, investors, and vendors. Working together with executives from over 4500 hospitals and over 2500 clinics, KLAS delivers timely reports, trends, and statistics, which provide a solid overview of vendor performance in the industry. KLAS measures performance of software, professional services, and medical equipment vendors.
All KLAS data and reports are © 2008 KLAS Enterprises, LLC. All rights reserved.