NASHVILLE, Tenn., May 13, 2011 /PRNewswire/ -- Emdeon Inc. (NYSE: EM), a leading provider of healthcare revenue and payment
"Claims audits can have a significant negative financial impact on our pharmacy customers," said Mark Lyle, senior vice president for pharmacy services for Emdeon. "Through Emdeon Audit Advantage, we are adding further value to our pharmacy network by helping our pharmacy customers mitigate audit risks and related financial implications."
As government audits continue to rise, more and more pharmacies are finding it increasingly important to identify both prescriber eligibility and patient coverage before prescriptions are filled and claims are submitted to payers for processing. Without these checks, pharmacies can run the risk of having to contend with time-consuming audits and the subsequent penalties, fines and recoupment payments that may follow.
The Emdeon Audit Advantage suite is comprised of both prescriber eligibility and primary coverage alerts. These solutions enable pharmacies to perform enhanced prescriber eligibility and primary coverage checks, in real-time at the point of sale, within standard workflows and existing pharmacy management systems. Each real-time alert is designed to provide extended protection beyond the robust, audit-focused core edits already offered by Emdeon's claims editing service, Emdeon EditŪ.
The Emdeon Audit Advantage prescriber eligibility alert helps pharmacies reduce the audit risks and financial penalties associated with submitting prescriptions written by prescribers who do not have prescribing authority. These alerts can also help reduce administrative costs by decreasing the amount of time retail pharmacy personnel spend researching prescribers' information. By accessing current federal and state prescriber data, which is updated weekly, this advanced validation component provides real-time checks of prescriber information for each submitted pharmacy claim related to licensure, status, sanctions and DEA prescriptive authority. Rejected claims return compliance notifications with clear messaging that identifies the reason for rejection. In addition, the prescriber eligibility alert features near real-time analytics with reports that identify claims that are denied due to prescriber eligibility issues and includes the reason the claim was denied. The report may then be sorted by store, denial frequency and prescriber.
The Emdeon Audit Advantage primary coverage alert checks primary state Medicaid claims to determine if other patient coverage is available. Potential matches are returned in real-time for pharmacies to further evaluate if the claim is being billed correctly to Medicaid or if the claim should be submitted to a commercial or other payer.
Emdeon Audit Advantage is available to retail pharmacies nationwide. For more information about this or other Emdeon pharmacy solutions, please contact us at 877-707-0024 or online at www.emdeon.com/auditadvantage/.
Emdeon is a leading provider of revenue and payment cycle management and clinical information exchange 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 and clinical information exchange processes. For more information, visit www.emdeon.com.
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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.
SOURCE Emdeon Inc.
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