Provider Advantages
HC MedNet’s applications and services provide numerous cost-effective features that enhance your organization’s revenue streams. Our offerings include:

• Internet-Based Claims Adjudication
  
• Real-Time Claim Edits
  
• On-Line Claims Correction
  
• Common Input Format
  
• Standardized Web-Based Payer Responses
  
• Access to Historical Response Information
  
• HIPAA-Compliant Transactions and Code Sets
  
• Pro-Active Monitoring of Claims Responses
  
  

Real-Time Claim Edits
All HC MedNet applications operate instantly! Upon receipt, all claims are immediately validated for completeness and forwarded to the PPO and/or Payer. The results of such “real-time” processing are immediately available on the HC MedNet site. HC MedNet reprices claims submitted to our site as appropriate, and delivers them to the payer. The details of the Payer’s acceptance or rejection are promptly posted for your secure inquiry on our site. This allows the Provider organization to immediately resolve issues and resubmit claims through our On-Line Claim Correction Module.

On-Line Claim Correction
HC MedNet’s Claims Management System processes, validates and delivers Provider claims to the PPO and/or Payer. If the claim fails either HC MedNet’s validations or the payer’s, the Provider has the ability to make corrections directly on-line and resubmit the claim using our Claim Editor. Our Claim Editor accommodates all fields in the HIPAA X12 837 transaction. Never has it been so easy to quickly correct and resubmit claims!

Common Input Format
All HC MedNet subscribers have the advantage of being able to submit claims batches to us in any format, regardless of Payer requirements. For example, we accept standard formats, such as the NSF and HIPAA 837, as well as Print File and custom/proprietary formats that only HC MedNet can accommodate. We reformat the claim data according to each Payer’s individual requirements to assure that it is readily accepted and processed.

Standardized Web-Based Payer Response
HC MedNet converts all claim-related responses received from Payers for easy on-line Provider review. Our Providers are no longer burdened with sifting through reams of paper documentation from Payers to correct claims errors. Furthermore, eliminating the need to decipher volumes of dissimilar Payer reports relieves demands on our Providers’ staff. Your time is money, and HC MedNet’s common format response product presents our clients with unparalleled ease of use!

Access to Historical Response Information
HC MedNet stores all responses received from PPOs, Payers and other intermediaries in each client’s claim process. These responses are available instantaneously for your review through our private, secure web site. Providers are able to search for data on specific claims based upon Patient name, Payer name, Provider, Date of Service, and more. This feature has proved invaluable to our Provider clients’ responsiveness to their Patients.

HIPAA-compliant transactions and code sets
HC MedNet’s extensive development and implementation efforts related to HIPAA standards and regulations have afforded our Provider clients the advantage of submitting their claims in any format to produce the HIPAA-compliant transaction. Because our product converts claims information received in non-standard formats to the ANSI standard, our Provider clients achieve HIPAA compliance in all transactions and code sets involved in the claims process. Furthermore, HC MedNet can also accept ancillary transactions such as inquiries and responses regarding eligibility and remittance advice.Proactive Monitoring of Claims’ Status
Our commitment is to provide a conduit supporting the cleanest claims, the most expeditious processing, and the most user-friendly analysis capabilities in the industry. We are constantly and proactively monitoring claim submissions and responses from the Payer community. We pride ourselves in ascertaining and diagnosing issues facing individual claims. This combination of monitoring and feedback assessment efforts serves to prevent recurrence of simple errors, and reduce outstanding accounts receivable.