Use the formats, forget the fees!

Hybrid Direct + Clearinghouse can save you money

• SolAce EMC is a tool, it is not a clearinghouse in itself. By purchasing this tool you gain the ultimate control over your billing processes. We like to think that it puts the clearinghouse right in your office!
  
• Our goal is to provide direct connection support for any payer who receives claims directly. We make this easy and very cost-effective for payers by supporting common technical protocols and infrastructure like Internet Secure FTP, and by providing our open source EDI messaging solution for free. We make it easy for claim submitters by providing unified trading partner communications features so you have one easy-to-use mechanism for communicating with payers and clearinghouses.
  
• We have partnered with THIN and other clearinghouses to bring you access to commercial payers for no or low per-claim fees. Commercial payers refers to payers who do not usually accept claims directly, so you get the best of both worlds by using a product that supports both direct and clearinghouse submission. We also support CareVu, WebMD, EDI Healthcare, BCBS Arizona, and a couple of other clearinghouses out of the box, but recommend THIN due to its synergy with SolAce of providing you with the lowest cost channel for your electronic claims.
  
• SolAce EMC is an all-in-one HIPAA compliance tool. As payers add support for additional features and transaction sets SolAce EMC will expand to support those features.
  
• You are not limited to the number of payers you can access with your copy of SolAce, nor is there an extra charge for additional payer links.
  
• In summary, with SolAce EMC there are no per-claim or per-provider charges for the large majority of payers who accept electronic claims.
  
• While our goal is to provide you with zero per-claim potential, there may be additional fees from the clearinghouse to your organization. This is the case if you utilize the clearinghouse's print-and-mail service for submission of claims to non-electronic payers, or if you submit to government plans via the clearinghouse instead of submitting directly. You may also have to pay long-distance or Internet access charges to utilize the direct transmission mechanisms that are included with SolAce EMC. These fees are third-party to Ivertex and we are not involved with these charges. SolAce will try to estimate clearinghouse fees for claims to non-free payers, and display them on the screen for you, but we can make no warranty as to the accuracy of its estimates because we have no control over these third-party charges.
  
• We will constantly expand our payer links as we find payers who want to get off the tollway and get on the freeway.
  

Enrollment & Testing

Payers that allow direct transmission require you to enroll with their EDI (Electronic Data Interchange) department. Once enrolled you will be able to transmit of claims directly to their system, and their system should send back acknowledgments and acceptance/exception reports. See our Enrollment & Testing document if you are interested in what is involved.

An interesting twist in HIPAA...

HIPAA mandates standard transaction formats for payers and providers, and grants clearinghouses exception to convert from non-standard to standard, or vice versa, but not from non-standard to non-standard transaction formats.

What this means is that every payer will have the capability to process HIPAA compliant transactions, as clearinghouses will cater to non-standard formats from the mass provider market.

So the question is, why doesn't everyone just speak the same language. After all, isn't that what HIPAA was designed for? Your payer can process HIPAA transactions by this time or they are non-compliant with federal regulations, so if they aren't letting you send directly you should have a talk with them.

Certified Direct Links

SolAce has several automatic transmission modules to send/receive direct with Medicare, Medicaid, BCBS, or other payers that allow direct communications. If we haven't produced the automated transmission module for a payer that you submit to, we will develop it while you are being enrolled with them. SolAce can transmit even without an automated transmission module, but we don't like to leave you with a manual process. There is never an extra charge to you for access to all our direct payer links.

Commercial Payers

SolAce EMC's commercial claims features provides our customers with access to over 1,100 payers who accept electronic claims. This is achieved by transmitting the claims to a traditional clearinghouse which aggregates claim volume for payers.

Commercial payers have traditionally only received claims from clearinghouses because they prefer not to invest in infrastructure necessary to accomodate the mass provider market. Instead, they pay the clearinghouse to handle this function for them, typically anywhere from $0.25 to $0.50 per claim.

SolAce EMC leverages the clearinghouse network by transmitting your claims to a clearinghouse that can accept these commercial claims for free. The clearinghouse can also accept claims for non-electronic (paper-only) payers for a very reasonable per-claim charge to print-and-mail the claims for you. This means you can use one common interface to do all your billing.

There are also around 100 payers that are non-participating that the clearinghouse charges 15 cents per claim for. These match up closely to the direct connects that SolAce can provide, so you can choose between paying the 15 cents and sending all claims to one destination, or establish a direct connection and enjoy no charges and a direct channel to the payer.