Electronic Universal Claim

Electronic Universal Claim

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  Electronic Universal ClaimNetwork Contact: Eleanor Pickron [email_address] 510-423-6672 (home) 510-943-7342 (cell) Electronic Universal Claim (EUC) Receive all claims Apply insurer edits Pay claims or forward to insurer MEDICAL PROVIDERS INSURERS C L A I M A N T S
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  Electronic Claims FilingHistory '“Virtual” Single Payer' 1994 Insurer Proposal In 1994, insurers promised, through the Workgroup on EDI (WEDI) to Facilitate claims filing as 'one face' to providers Streamline the claims filing/payment process Control the spread of claims data The US Needs A Single Electronic Medical Claims Network An essential first step Creates clarity, goodwill Provides secure one-stop integration Not administrator-driven; must be included in reconciliation
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  Electronic Universal Claim(EUC) Network Medical Providers Claimants ACH Payments Government Insurers Private Insurers ClaimsData ClaimsData Claims EUC Network Payments Payments
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  EUC Network: ElectronicClearinghouse An Electronic Clearinghouse that serves all parties Time of filing: Validates/verifies claims In process: Clearinghouse function Tracks claim status Applies Workflow edits Provides online realtime status reporting Post-claim: Creates effective business intelligence Keeps all records in X12 standard for security Maintains transaction history Uses history to evaluate new claims
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  EUC Network Featuresand Benefits Service Features Open Source Computing Provides browser input for one-at-a-time filing Free modular integration for provider multiple filing Fully HIPAA-compliant X12 standards ACH Payments Using X12 835 & 820 with 824 Product Benefits Flexible framework supports any set of legislation edits Immediate public, measurable improvement in service delivery
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  Claimant, Provider, InsurerONLY Purpose~End Unneeded Spread of Claimant Data Streamline claims processing and payments Eliminate non-provider, non-insurer claims handling Eliminate claim processor business function One Face to the Provider and Claimant Single industry network streamlines compliance Quick implementation of reform legislation Supports exchanges, Medicare, Medicaid, Tricare, Military, etc. Integrate provider service bundling, other new features, benefits
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  How Does EUCWork? Providers or claimants create claims Single claim filing templates for Office or browser software Multiple filing systems supported by free modular connections Electronic Universal Claim (EUC) Services Pre-edits: Claimant validation required Approved: authorized via ACH and X12 835 Suspended or denied: Notified to all parties via X12 824 Insurers accept claims electronically Payment, denial or suspension required in 72 hours. Denied and suspended claims adjusted by each insurer w/return to EUC for final settlement.
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  EUC Technical FeaturesCloud Computing & Full Integration All parties to any transaction linked into system EUC responsible for linking to provider systems Insurers responsible for linking to EUC Claimants can use their own or public systems Security & Fraud Prevention All parties to any transaction must participate Nationwide systemic view deters scams Validation by both provider and patient Cross-check for payment history Use of business intelligence edits
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  How Do WeGet EUC? Incorporate EUC Network All healthcare legislation needs this implementation arm Reduces costs Participant-neutral Improves accountability Electronic Universal Claims Project The Works Progress Administration (WPA) of the Great Recession Integration using 25,000 Open Source Programmers Create integration for providers and public places Initiate, Track, Pay All Claims Electronically
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  EUC Network: NextSteps Create initial project (3 months) Initial design creation Test project with 3 insurers Reform legislation requirements to define edits Roll out initial pilot (6 months) Mandatory participation schedule ' 'Lessons learned' feedback loop for continuous process improvement Roll out staged full implementation Maximum of one year
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  How to Startthe EUC Network Create 30 day project plan and application Use ARRA funds Build developer teams Integration specifications QA and integration testing requirements Use scrum methodology Select VAN or network Address failed claims process Create advanced edits and tracking