Nashville, U.S.A. — On October 30, Emdeon, a provider of revenue and payment cycle management and clinical information exchange solutions, announced the launch of Emdeon EDGE, an integrated, technology-enabled solution that includes complete payment integrity and cost containment services designed to help detect improper healthcare claims and prevent inaccurate payments.

Emdeon has built a leading payment integrity and cost containment solution by acquiring three market leaders – The Sentinel Group, EquiClaim and TC³ Health – and integrating them with Emdeon’s vast healthcare network. By combining the best of these companies’ recognized leadership in fraud, waste and abuse technology, investigation expertise, cost management services and comprehensive audit and recovery services, Emdeon is able to offer healthcare payers one complete solution to help ensure accurate claim payments throughout the adjudication lifecycle.

Healthcare fraud, waste and abuse in the United States continues to be an increasing problem with industry estimates placing the cost upwards of $200 billion a year. In fact, a joint letter from the secretary of Health and Human Services and the U.S. attorney general issued in September 2012 emphasized to healthcare trade organizations the need to ensure accurate and proper healthcare claims, and stated that attempts to “game the system” will not be tolerated.

“Healthcare payers can benefit from Emdeon’s multi-payer data analytics that drive insights that cannot be gained from single payer data,” said Terry Cameron, senior vice president of payment integrity for Emdeon. “This capability can help detect improper claims and prevent lost dollars that otherwise may be missed. Additionally, Emdeon combines the analysis from that same data with knowledge and expertise to create more efficient payment integrity processes and more savings opportunities.”

Emdeon EDGE easily integrates within the existing claim adjudication workflow and provides multi-layered protection that offers both prospective and retrospective claims review, as well as in- and out-of-network claims management.  By leveraging Emdeon’s claims data and network, these services enable superior detection of fraud, waste and abuse and the reduction of costly errors and time-consuming manual processes. As a result, payers can increase efficiencies, maximize returns and have confidence that their healthcare payments will be correct.

Emdeon EDGE is a comprehensive payment integrity solution that includes the following four suites: Emdeon EDGE Fraud, Waste & Abuse Protection Suite, Emdeon EDGE Integrated Repricing Suite, Emdeon EDGE Audit & Recovery Suite and Emdeon EDGE Analytics Suite, each with a broad set of features for maximum benefit. Healthcare payers can purchase these services together for the most extensive protection or individually to fit their needs.

Image Courtesy : Mercy Health / Foter / CC BY-NC-ND

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