Welcome to Secure EDI

Secure EDI is a technology company dedicated to increasing the efficiency and reducing the cost of the nation´s healthcare delivery system. The company creates seamless connections among providers and payers for the sharing and analysis of management information and the secure, on-line processing of claim and payment transactions. Secure EDI´s comprehensive suite of services supports continual process improvements in the evolving healthcare informatics landscape.

What are the benefits of Secure EDI Services?

Secure EDI provides the software and services needed to assure efficient, reliable and secure electronic networks among the providers of healthcare services and the private insurance companies and government programs that insure millions of lives. The company brings state-of-the-art electronic solutions that include eligibility verification, real time adjudication of claims, electronic funds transfer and informatics. The total Secure EDI solutions platform results in increased efficiency and reduced operating costs.

Information technology innovations from Secure EDI also assure access to the management information needed for short and long-term decision making by healthcare providers and payers. Through advanced data mining technology, real time dashboard reporting and information transparency, Secure EDI encourages strategic collaborations and mutually beneficial partnerships throughout the healthcare industry.

What is the background of Secure EDI?

Secure EDI traces its roots to Inmediata Health Group, a healthcare information technology company that has been the leader in the automation of healthcare transactions in Puerto Rico for the past decade, serving more than 4.5 million people covered by 15,000 providers. Based on Inmediata´s success in Puerto Rico, Secure EDI is expanding in North America by reaching out to the full range of private and government healthcare payers, including a number of leading international companies served by Inmediata in Puerto Rico.

What is Secure EDI´s approach to serving payers?

A distinctive feature of Secure EDI´s service to payers is its ability to enhance current systems and procedures in a logical progression of improvements. Rather than requiring the wholesale replacement of legacy systems, Secure EDI works with payers to identify areas for enhancement and then applies modular elements of software and services to those specific areas.

For example, Secure EDI´s data mining and dashboard reporting capabilities provide management with trend and exceptions data needed to make both tactical and strategic decisions. This analytical tool can be overlaid upon most legacy systems. Another example of Secure EDI´s flexibility is its claims entry interface for providers. This interface can operate as a standalone feature or can be integrated into a physician or dentist´s practice management system for a comprehensive approach.

What are the primary benefits that Secure EDI offers to payers?

Services and systems from Secure EDI provide a broad range of measurable benefits and a positive return on investment for payers. These benefits include continued migration from paper to electronic claims processing, ability to process more claims volume without an increase in personnel, reduced operating costs, lower overall information technology costs, reduced errors, enhanced through-put, reduction in pended claims and assurance of full compliance with HIPAA and other regulations in a constantly changing environment.

The most important strategic benefit that Secure EDI offers is the way in which it sets the stage for redefining relationships among payers and healthcare providers. Secure EDI forms the essential framework for mutually beneficial, long-term partnerships with providers by creating a secure, reliable and efficient e-solutions platform. This multi-faceted connection encourages collaboration, sharing of resources and, ultimately, information transparency.

Providers are assured of prompt, accurate payment for services from payers that can obtain electronically all of the information they need to verify coverage and assure full HIPAA compliance. The seamless, easy-to-operate interconnection that Secure EDI establishes between providers and payers automates all aspects of e-transactions, eliminating potential areas of conflict. The result is a system that provides mission critical services that everyone can rely on day in and day out.

Equally important, systems from Secure EDI take automated financial transactions processing to an entirely new level through analytical tools. Data mining, dashboard reporting and custom reporting capabilities encourage providers and payers to track and trend important data in a manner that leads to product, service and systems improvements. Millions of pieces of data are organized so that providers and payers can extract the critical information they need for effective management. Ultimately, this capability creates a system-wide transparency that builds trust and engenders long-term partnerships.

What are the primary benefits that Secure EDI offers to healthcare and dental providers?

The environment for healthcare and dental providers is increasingly complex today with continual changes, many of which are related to relationships with payers. Payment plans are constantly changing, with increased financial responsibility being shifted to patients. Providers must have the ability to interface with literally hundreds of different payers while assuring prompt, efficient and compassionate service to patients.

Secure EDI supports healthcare and dental providers in many ways. On-line verification of coverage allows a practice to determine financial responsibility as soon as a patient checks in at the front desk. From there, Secure EDI technology provides for electronic adjudication of claims and prompt payments, including electronic funds transfer. In addition, Secure EDI systems enable practices to automate the process of reconciliation of claims and payments.

Additionally, Secure EDI systems are designed to integrate seamlessly with existing practice management systems. These features assure that a practice can keep up-to-date on changes in plans and terms without disruptive system changes. This integration feature provides practice managers with a rich resource of information that can be used to trend data, identify issues and respond pro-actively.

Most importantly, systems and services from Secure EDI support mutually beneficial relationships between providers and payers in support of quality, efficient patient care. By automating financial and transaction areas and by providing data mining, Secure EDI is pioneering the way for increased efficiency and higher levels of quality.

Is Secure EDI a clearinghouse?

Clearinghouse is a core strength of Secure EDI, but it is just one aspect of its services. While many payers select Secure EDI because of its ability to assure compliance with stringent HIPAA clearinghouse regulations, these payers soon recognize that the clearinghouse function is only one of many services offered. Information analytics, secure provider interfaces, coverage verification and efficient adjudication of claims are only a few of the other support services that position Secure EDI as a trusted resource for all aspects of e-transactions.

What is Secure EDI´s philosophy concerning partnerships in the healthcare industry?

Secure EDI recognizes that the complexity of the healthcare environment requires the ability to form seamless, win-win partnerships with a wide variety of organizations healthcare plans, hospital networks, physicians, dentists, allied health professionals, professional practice managers and systems and services companies. Secure EDI is well positioned to become a highly sought after partner in the healthcare industry.

What services does Secure EDI provide?

Secure EDI provides an electronic platform which results in an end-to-end solution. It supports all aspects of electronic transactions and claim processing systems, from the time a patient walks into a provider’s office until a payment is made and the claim reconciled at the provider level.

All of Secure EDI services feature real-time response, ease of use, self-directed tutorial training, integration with clearinghouse functions, quick data access, compatibility with most practice management systems, single entry point for up to 400 health plans and support for comprehensive analytic and management information tools. Payers and providers can elect to implement an end-to-end solution from Secure EDI or integrate selected functions with legacy systems.

Below is a brief summary of the suite of services from Secure EDI:

• Real-time eligibility Instant verification of patient eligibility and coverage under more than 400 different health plans by accessing the Secure EDI HIPAA clearinghouse. Determines financial responsibility before services are provided.

• Real-time claim status Access to current claim status for all claims in process, as well as archived claims. Speeds access to information and eliminates the need for lengthy telephone calls to payers.

• Real-time attachments Support for HIPAA 275 transactions to instantly alert providers when a claim has been pended until further information can be uploaded to an image archive. Reduces hold time and expenses for pended items, while automating access to additional information in digital form.

• Electronic claims gateway Entry point for electronic claim submission to the HIPAA clearinghouse with multiple options for entry, editing and processing. Enhances operational efficiency, increases data accuracy and encourages migration to a total on-line claim submission environment.

• Real-time Claim Adjudication Calculation of each patient´s payment responsibility at the time of service and subsequent support for the adjudication of the claim based on each health plan’s specific rules and edits. Payments to providers are expedited while patients access all benefits, including Consumer Directed Health (CDH) plans, without delay or additional paperwork.

• Claim Tracking Permanently archived claims that can be tracked instantly on-line by patient, service line or other criteria. Enhances patient service while offering providers instant access to information for input into practice management systems.

• Proprietary Reports Medicare and Medicaid fiscal intermediary proprietary reports supported in the format provided by the intermediary. Enables providers to receive reports in familiar formats and assures that providers and intermediaries are working from common templates.

• Electronic Remittance Advice/payment file management and reconciliation Automated matching of electronic funds transfer (EFT) with each claim paid for ease of reconciliation by providers, including clear definitions of covered services and procedures. Eliminates the time consuming claim and payment reconciliation process commonly associated with EFT and automatically generates an explanation of benefits.

• Provider office business analytics Analytical tools that providers can use to produce robust analytical reports related to practice financials, marketing and other purposes, including management of multi-provider and multi-office practices. Converts detailed raw data into actionable management information for providers.

• Consumer directed health interoperability Ability to integrate consumer directed health plans into payer plans in determining a patient´s overall financial responsibility at the time of service. Supports the growing application of consumer directed plans and assures a higher level of sophistication and customer service in electronic transactions.

• Product and service tutorials Easy-to-use tutorials available in both English and Spanish. Assures rapid orientation of new employees and full utilization of functions and capabilities to maintain high levels of provider office efficiency.

• Secure payer access dashboard Capability for providers and payers to have full access to the Secure EDI HIPAA clearinghouse. Results in a new level of transparency between providers and payers, fostering a culture of partnership, trust and collaboration.

• Private branded solutions Option for payers to brand Secure EDI software and services as their own within provider offices. Positions the payer as a true business partner, providing high levels of sophisticated operational support including options for Secure EDI clients and technology partners.

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