Ambulatory EDI Claims Clearinghouse
The life of a provider practice depends on its revenue stream. Aside from the billing solution, the integral piece between the practice and the payer is the clearinghouse service, with a tight relationship between billing and the clearinghouse.
Besides performance, fundamental questions about ambulatory clearinghouse services center around who is out there and if there are significant differences between products. Many providers have been using the same clearinghouse for years and are simply unaware of other EDI claims solutions.
Providers want to know which vendors to look at--what they offer, how they perform, what the solutions cost, and how the healthcare provider organization would benefit from the services. These and other related questions prompted KLAS to conduct this first study on ambulatory clearinghouse services.
Vendors included in the 2008 research are Availity, Emdeon Business Solutions, Gateway EDI, Ingenix ENS, Misys Payerpath, Navicure, RelayHealth, The Consult ECP, and ZirMed.
Contrary to popular thought, KLAS found that there were significant differences between the various vendor offerings. In fact, the quality of payer and practice transactions and the level of customer service vary greatly among vendors when measuring client satisfaction.
As far as performance based on whether or not clients would keep their current clearinghouse, some vendors fared better than others. Eighty percent of participants said they would keep their current clearinghouse services firm. Every vendor except Navicure had at least one respondent say that they would go elsewhere. Ingenix and Availity had the highest percentage of respondents indicate that they would not keep their current vendor.
Most of the time, the practice management (PM) vendor will allow the provider to select a clearinghouse. Seventy percent of providers responding to the study were allowed to choose which clearinghouse they would use. Two of the vendors, Emdeon and Relay Health, bring down the average as most of their customers said that they did not have a choice.
While choice is important, it does not guarantee success. And not having a choice is not always a bad thing as there can be advantages to having a good marriage between the PM system, the clearinghouse, and the payer. Of note for providers who were able to select their clearinghouse service, Emdeon was the most mentioned alternatively considered vendor.
Based on the feedback and perceptions of healthcare providers, KLAS found that clearinghouse services are no longer simple commodity offerings. More choices than ever are now available. Recent market evolutions have given rise to a new generation of clearinghouse vendors with new technology, new functionality, and a new orientation to service.
The ambulatory EDI claims clearinghouse research was conducted to uncover the candid opinions and perceptions of healthcare providers in the industry and offers findings as part of the due diligence process. Additional information is available in the KLAS Database and the full 2008 report.
About KLAS
KLAS is a research firm specializing in monitoring and reporting the performance of healthcare vendors. KLAS’ mission is to improve delivery, by independently measuring vendor performance for the benefit of our healthcare provider partners, consultants, investors, and vendors. Working together with executives from over 4500 hospitals and over 2500 clinics, KLAS delivers timely reports, trends, and statistics, which provide a solid overview of vendor performance in the industry. KLAS measures performance of software, professional services, and medical equipment vendors. For more information, go to www.KLASresearch.com, email marketing@KLASresearch.com, or call 1-800-920-4109 to speak with a KLAS representative.
All KLAS data and reports are © 2008 KLAS Enterprises, LLC. All rights reserved.
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