News | November 9, 2011

OptumInsight Launches Smart Clearinghouse To Boost Billing Accuracy, Reduce Administrative Costs For Hospitals And Physician Practices

  • Claims integrity services embedded within Netwerkes EDI automate key claims management processes
  • Unique integration between Netwerkes EDI and Epic Practice Management Systems streamlines workflow
  • Advanced capabilities reduce errors, increase first-pass claims payment rates and improve productivity

OptumInsight recently launched new capabilities for its Netwerkes electronic data interchange (EDI) service, creating a smart clearinghouse that will help hospitals and physician practices – and particularly those using Epic Practice Management Systems – increase billing accuracy and productivity, reduce administrative costs and ensure timely receipt of payments from health plans.

When physician practices or hospitals send medical claims to health plans, the Netwerkes service now automatically reviews and validates diagnosis and procedure codes, alerts users to potential errors and provides easy-to-use editing tools for correcting mistakes. Netwerkes also reviews claims and received payments to alert users to potential inconsistencies with the contractual terms negotiated with health plans.

OptumInsight and Epic have integrated the Netwerkes service with Epic Practice Management Systems claim administration and clinical information workflows, creating a unique set of advanced, productivity-enhancing capabilities for hospitals and physician practices that use Epic. For example, seamless communications between the two systems enables users to submit, track and manage eligibility checks, claims submissions and payments within Epic, rather than transfer files and toggle between separate applications. Additional features that build on the longstanding relationship between OptumInsight and Epic include:

  • Claim Error Reports, which map claims with errors to Epic's proprietary codes and automatically routes them to defined Epic work queues for corrections, eliminating delays and reducing the potential for human error
  • Submit Date Reports that provide a time-stamped report notifying users precisely when a health plan receives a medical claim, improving claim aging accuracy
  • Accepted/Rejected Claims Reports delivered in Epic's proprietary file format, saving time and improving accuracy because files are automatically reconciled within the practice management system
  • Remittance Management that automatically matches and routes remittance notifications to the appropriate billing system, ensuring payments are received by and posted to the appropriate Epic or legacy billing system
  • More Health Plan Eligibility Verification Options enable users save time by verifying an individual's coverage under health insurance for same-day visits in real-time; or, to prepare several patient files in advance of upcoming appointments in one transmission. Both methods transfer files in Epic's proprietary format, ensuring consistency and accuracy throughout the billing process.

"Netwerkes provides a ‘smart clearinghouse' from which physician practices, hospitals, labs, health plans, pharmacies and government agencies, can send and receive data, and helps to simplify and improve the accuracy of billions of health information transactions that occur across the health care system," said Tom Boehning, senior vice president at OptumInsight. "Further, integrating the Netwerkes clearinghouse more tightly with Epic, and embedding claims integrity services into the EDI workflow enable our clients to get optimal value from their investment in these systems."

Boehning said hospitals and physician practices that use Netwerkes in combination with Epic enjoy higher first-pass payment rates and increase payment accuracy because the system provides immediate notification of claims coding accuracy prior to submission to payers and automatically identifies contractual underpayments received from health plans.

About OptumInsight
OptumInsight provides health information, technology and consulting services. Commercial health plans, physicians, hospitals, life sciences companies, government agencies and other organizations that comprise the health care system depend on OptumInsight solutions and insights to improve their performance. OptumInsight is part of Optum, a leading information and technology-enabled health services company dedicated to making the health system work better for everyone. For more information, visit or

SOURCE: OptumInsight