StrataCare’s eBilling Enterprise Solution is a suite of products and services designed to facilitate clients who are required by state jurisdictions to accept and process electronic bills. The first state to mandate eBilling is Texas beginning in January, 2008, Minnesota in January, 2009, California in the draft regulation stage and other states to follow.
The Texas Electronic Billing and Reimbursement (eBill) mandate requires, with some exceptions, providers to submit electronic workers’ compensation bills and attachments to payers beginning in January 2008. According to the mandate, healthcare providers in the state of Texas will be required to submit medical claims in a HIPAA adopted ANSI 837(or other mutually agreed upon) format to payers. Payers in turn, will have to return Electronic Remittance Advice (ERA) in a HIPAA adopted ANSI 835 (or other mutually agreed upon) format. The ERA will provide an electronic explanation of payments, payment reductions and denials of medical claims submitted to the payer. Similar requirements are expected in other states as they begin to adopt eBilling statutes.
StrataCare’s e-billing solution will provide complete workflow technology from receiving electronic bills with online approval/denial capability, to the most accurate bill review in the industry and complementary Electronic Funds Transfer (EFT) should a client desire this payment solution.
StrataCare’s eBilling Enterprise Solution will utilize StrataCare’s Clearinghouse Partner, MedAvant Healthcare Solutions, for receiving the electronic bills and attachments from providers and transmitting the documents to StrataCare for re-pricing through our StrataWare bill review application.
Adjusters or processors then access StrataCare’s ImageManager Module where the electronic bills and any related attachments will be viewable as standard TIFF images for adjuster or processor approval or denial. Upon bill completion, payment and EOR data are transmitted to the Payer’s claim system for traditional check and EOR issuance. Payer‘s desiring a more robust solution can elect to utilize our complementary Electronic Funds Transfer (EFT) Partner for electronic finds and EOR transmissions.
Upon payment to the provider Post Payment data is transmitted to StrataWare and combined with EOR data and transmitted back to the Clearinghouse Partner who then transmits the Electronic Remittance Advice (ERA) back to the provider.
Key Features & Benefits
- Compliance Ready - StrataCare’s eBilling Enterprise Solution will meet Texas’ and all future jurisdictionally mandated eBilling statutes.
- Clearinghouse Services - Fully HIPAA compliant clearinghouse services are provided by MedAvant Healthcare Solutions, the nation’s leading provider of real-time claims processing and business intelligence solutions, including receiving electronic bills from providers and secure transmission of bill and attachment data to StrataWare software and transmission of Electronic Remittance Advice (ERA) back to the provider. All in HIPAA adopted ANSI 4010A1 or alternative mutually agreed upon formats. MedAvant does this through its real-time processing platform, PhoenixSM.
- ImageManager™- Adjusters have online access for approval or denial of electronic bills and any related attachments that are viewable in a standard TIFF image for easy reading.
- StrataWare.Net™ - Electronic bills are re-priced through our highly accurate and fully automated rules-driven bill review with maximum PPO penetration without human intervention. Bills and related attachments requiring special handling such as high level hospital or surgery review can be automatically routed via a client-specific configuration to the appropriate user through StrataWare's existing robust routing capability.
- State Reporting - StrataWare captures all required medical bill and payment data for submission to jurisdictions requiring state reporting.
