Claims Management

Claim Edits

ET&T clients achieve their Revenue Cycle Management goals through the use of the ET&T claim management software, e^X12. This HIPAA compliant, browser-based application that is compatible with any Practice Management or Hospital Information System. It securely transmits primary, secondary and tertiary claims, allowing ET&T clients to manage claims from the point of submission through adjudication. Clients have the ability to efficiently correct claim errors and edit as needed. Clients may also request custom edits, giving them the flexibility to meet the specialized needs of their organization. e^X12 is a customizable environment, enabling clients to meet their specific workflow and business environment needs.

Scrubbers

ET&T simplifies claim management processes by offering custom coding, or scrubbers. These scrubbers eliminate repetitive errors or constant conditions, thus reducing the manual effort involved in managing claims. Scrubbers also significantly reduce the number of erred claims, improving first-pass rates and reducing claim denials.  

Payer Edits

ET&T provides a robust suite of transactional edits to ensure clients achieve high first-pass rates. The ET&T editing suite includes validation of transactions against the following policies and standards:

 

• HIPAA Levels 1-7
• CCI
• NCCI
• Medicare NCD & LCD
• Custom payer edits; such as duplicate claims checking

ET&T also monitors payer rejection reports to identify additional edits that can improve revenue cycle processes.

Clearinghouse

ET&T has connectivity to nearly 2,000 health insurance carriers and trading partners. To ensure the most rapid transmission route possible, ET&T continually pursues exclusive arrangements and direct connectivity with payers most predominantly used by clients. Transactions are transmitted daily and all transactions are reconciled to ensure they have successfully reached their destination.

ERA

ET&T clients are able to receive Electronic Remittance Advice (ERA) from a variety of payers. ERA provides payment information much more rapidly than traditional paper alternatives. Clients can download, post, view and/or print payment information available within the transaction. These features allow clients to select the most efficient ERA process for their organization. ET&T clients may also use ERA payment information to rapidly bill secondary claims and track denials. 

Secondary Claims

ET&T provides a secondary billing solution that allows clients to choose which option is the most efficient for their business office. Using e^X12, clients may coordinate benefits by entering, uploading, or auto-posting electronic

remittance files to create secondary claims. At the click of a button, these options enable ET&T clients to bill secondary insurance carriers electronically and take advantage of the full editing suite that your primary claims receive. ET&T’s secondary billing solution enables clients to experience increased efficiency and improved revenue cycle performance with accelerated payments, resulting in reduced A/R days.