Alliance combines Emdeon's workflow, healthcare payer connectivity and provider reach with Enclarity's leading provider database and analytics to help eliminate unnecessary rework and waste
NASHVILLE, Tenn., May 4 /PRNewswire-FirstCall/ -- Emdeon Inc. (NYSE: EM), a leading provider of healthcare revenue and payment cycle management solutions, today announced a strategic alliance with Enclarity, Inc., a leading healthcare information solutions company delivering more accurate, timely and comprehensive data on healthcare providers. Through the strategic alliance agreement, Emdeon will be able to offer its 1,200 healthcare payer customers access to more accurate provider data through a new in-stream solution. This solution will be designed to help identify errors during the transaction workflow at the claim level with pre-adjudication detection of incorrect provider data.
Incorrect provider data is currently one of the most significant challenges for healthcare payers, resulting in a reported $26 billion in unnecessary claims-processing costs annually.(1) Enclarity's Master Provider Referential Database integrates thousands of data sources and advanced analytics to maintain over 140 million records on more than 6.5 million healthcare providers nationally. Meanwhile, Emdeon processes over five billion healthcare transactions annually and its network reaches 1,200 payers, 500,000 providers, 5,000 hospitals, 81,000 dentists and 55,000 pharmacies.
"The lack of comprehensive and accurate provider information is one of the largest problems facing healthcare payers today and one of the primary reasons that claims fall out of the auto-adjudication process," said Gary Stuart, executive vice president for payer services for Emdeon.
Stuart continued, "Inaccurate provider data creates a number of problems for payers, such as paying in-network provider claims as out-of-network and mailing provider payments to the incorrect address. Through this relationship, Emdeon intends to develop in-stream products with Enclarity that will address this problem early in the claims transaction workflow, helping to reduce the costs that payers incur when manually adjudicating claims."
Efficient processing of healthcare claims requires accurate data on provider demographics such as rendering and billing address, hospital affiliations, license status and basic contact information. According to Enclarity's research, this information is in a constant state of flux with 2% to 2.5% of provider demographic data changing each month. Furthermore, approximately 20% of claims processed fall out of auto-adjudication due to provider data issues and require manual intervention to be fully processed. Enclarity's research also indicates that manual intervention typically consumes 20 to 40 minutes of additional investigation and costs the payer an incremental $8 to $15 per affected claim. By correcting this data in-stream when the claim is filed, not only does the payer potentially save time and money, but the provider can also be notified of their incorrect or incomplete data and resolve the issue for future claims.
In connection with the strategic alliance, Emdeon made a minority equity investment in Enclarity to fund, in part, the development and implementation of the in-stream solution and several additional projects to help drive healthcare efficiency. For example, in the area of fraud and abuse prevention, Emdeon is considering using Enclarity's data to isolate transactions filed under deceased, retired or sanctioned provider identification numbers. Likewise, in Emdeon's pharmacy services division, Enclarity's data could be utilized to enable verification of prescriber information.
"We continue to integrate intelligent solutions within Emdeon's network to increase the value for our customers," said George Lazenby, chief executive officer for Emdeon. "Our alliance with Enclarity complements our central position in the healthcare transaction workflow with access to more accurate provider data. It is another example of our commitment to increasing healthcare efficiency."
Enclarity chief executive officer, Sean Downs said of the alliance, "Enclarity has made great strides in becoming the standard for health plans seeking better provider data quality. Through Emdeon's broad payer connectivity and central position in the healthcare transaction workflow, this strategic alliance provides Enclarity a tremendous opportunity to extend and continue to commercialize our ProviderPoint product. We are also excited about the many other ways we can work together to make healthcare transactions more efficient with better provider data."
Emdeon is a leading provider of revenue and payment cycle management solutions, connecting payers, providers and patients in the U.S. healthcare system. Emdeon's product and service offerings integrate and automate key business and administrative functions of its payer and provider customers throughout the patient encounter. Through the use of Emdeon's comprehensive suite of products and services, which are designed to easily integrate with existing technology infrastructures, customers are able to improve efficiency, reduce costs, increase cash flow and more efficiently manage the complex revenue and payment cycle process. For more information, visit www.emdeon.com.
Enclarity® solves healthcare's provider information problem. The company delivers correct, current and comprehensive provider information solutions by blending thousands of data sources, advanced analytics and healthcare expertise. As a result, its clients improve results in many areas, including claims processing, provider directories, regulatory compliance and market analysis. Named one of the Top 100 private technology companies in North America by Red Herring magazine and awarded the Global Healthcare Information Technology Excellence Award by Frost & Sullivan, Enclarity is headquartered in Aliso Viejo, Calif. For more information, visit www.enclarity.com.
Statements made in this press release that express Emdeon's or management's intentions, plans, beliefs, expectations or predictions of future events are forward-looking statements, which Emdeon intends to be covered by the safe harbor provisions for forward-looking statements contained in the Private Securities Litigation Reform Act of 1995. These statements often include words such as "may," "will," "should," "believe," "expect," "anticipate," "intend," "plan," "estimate" or similar expressions. Forward-looking statements may include information concerning Emdeon's possible or assumed future results of operations, including descriptions of Emdeon's revenues, profitability and outlook and its overall business strategy. You should not place undue reliance on these statements because they are subject to numerous uncertainties and factors relating to Emdeon's operations and business environment, all of which are difficult to predict and many of which are beyond Emdeon's control. Although Emdeon believes that these forward-looking statements are based on reasonable assumptions, you should be aware that many factors could affect Emdeon's actual financial results or results of operations and could cause actual results to differ materially from those in the forward-looking statements, including the risks discussed in the "Risk Factors" and "Management's Discussion and Analysis of Financial Condition and Results of Operations" sections and elsewhere in Emdeon's Annual Report on Form 10-K for the year ended December 31, 2009, as well as Emdeon's periodic and other reports, filed with the Securities and Exchange Commission.
You should keep in mind that any forward-looking statement made by Emdeon herein, or elsewhere, speaks only as of the date on which made. Emdeon expressly disclaims any intent, obligation or undertaking to update or revise any forward-looking statements made herein to reflect any change in Emdeon's expectations with regard thereto or any change in events, conditions or circumstances on which any such statements are based.
(1) Thomson Gale Report 2007
SOURCE Emdeon Inc.