Our EDI Evaluations are Organized Accordingly:
- What clearinghouses say about themselves
- How well they cover the basics (See Our Core Rating Criteria)
- Services provided
- Answers to the tough questions (Responses to our ‘Gauntlet’ Billing Manager’s Survey)
- Real user’s actual experience
“Thank you for the wonderful service you provide. It’s become the
cornerstone of our marketing effort and we see great results from it.”
UNDERSTANDING OUR RATING CRITERIA
We evaluate clearinghouses on how well they help practices improve the following core medical billing tasks:
- Estimate and Collect Patient Payments Upfront
- Process and Track All Claims
- Manage Payer Payments
- Follow-up on Patient Balances
- Interface with the practice’s Practice Management (PM) System
- Help a practice improve it’s overall patient billing efficiency
- It’s reputation among current and prior users regarding support and service quality
RUN THE GAUNTLET: OUR EDI SURVEY CHALLENGE
1. Call Wait Times: — How long do I have to wait to speak with someone in support?
2. Payer List w/ Direct Connections: — Do you have direct connectivity to the payers I need to send claims to? (Direct payer connectivity mean less reliance on other clearinghouses, less future problems, and higher customer satisfaction.)
3. Knowledgeable Support: — How knowledgeable is your staff regarding payer rules, claims errors, and Practice Management (PM) Systems?
4. Patient Payments: — How well does your service help me estimate patient responsibility to determine the patient portion in advance so that our Front Office staff can collect patient payments at the time of appointment.
5. PM Interface: — Does your EDI system integrate with my PM system (or vice-versa) so that eligibility can be checked automatically from our patient scheduler? Is your support staff knowledgeable enough about my PM to assist me in using your EDI system.
6. Claim Scrubbing & Validation: — What are your rejection rates? To high, means too many payer denials. Too low means too many claim rejections at the clearinghouse level –in our experience +-3% is just about right.
7. Missing Claims: — My payer does not show as having received my claims. I don’t want to wait 2-3 weeks to find this out. How do I tell in minutes if I have missing claims on your system?
8. Claim Dashboard: — How well does your service help me manage unattended claims, rejections, and denials. Does it report back errors merely as numeric codes or as understandable explanations. Does your service report back to my PM with error messages, with ERA’s, with alerts on slow payments and potential cash-flow issues, such as excessive unpaid claim days?
9. Real Time RCM Reporting — Revenue Cycle Management (RCM): — How long do I have to wait to detect blocked cash-flow, or lost or unattended claims? Do you offer Proactive Revenue Controls? How well does your system proactively/continuously monitor key performance indicators (KPIs) that enable us to act in real-time to address revenue leakage before it significantly impacts our cash-flow?
10. Productivity Analytics : — How well does your service and technology give us insight into financial and operational performance across our organization against similar provider benchmarks?