Medical Network Solutions
Network solutions for providers and payers who want to leverage our vast nationwide connectivity to streamline engagement, reduce costs, and improve claims processing and eligibility verification efficiencies.
Our Eligibility and Benefits Verification Network connects payers and providers, communicating critical coverage information directly to your practice.
Self-service provider tools include eligibility inquiries (270 / 271) and referral authorizations and notifications (278).
We offer hosted data solutions for both eligibility and referral authorizations.
Our claims management solutions eliminate manual processes and improve submission accuracy, helping you create efficiencies, reduce the number of rejected claims, and shorten your adjudication timeline.
Electronic attachments save paper and help to ensure compliance.
Claim status tools provide visibility from submission to payment, enabling self-service.
Electronic Remittance Advice saves you the trouble of printing and mailing remits, enabling streamlined efficiency.
Lower transactional costs, fewer support calls, and higher clean claim rates help to reduce waste and improve efficiency in healthcare administration.
Our Advanced Claim Management product provides edits for member/provider-based claim rejections, data enhancement, and clinical and administrative coding rules.
Claims can be routed to re-pricing networks (PPOs) and other entities.