Product Comparison

If you're new to the medical billing arena, you might find our product comparison useful in making your decision on which electronic claim transaction solution is right for you.  In general, the HIPAA regulations mandate that all providers of service with 10 or more full-time employees submit their claims electronically.  Read the regulations to determine how you are impacted.

Attributes	SolAce EMC	Clearinghouses	"Free" Packages from Payers	Web Portals	Other Direct Claim Packages
Cash Flow Impact
No Double Entry
Reduced Claim Error Rate
Cost
Existing System Integration
Specialty Fields Supported
Payers Supported

SolAce EMC
SolAce is a unique and affordable solution that lets you send claims directly to payers without the per-claim or per-provider charges.  It integrates seamlessly with your existing practice management system, or can be used as a stand alone product.  SolAce provides automated transmission of HIPAA compliant transactions to avoid double entry of claim information.

Most importantly, SolAce's specialized edit checks improve your claim acceptance rates from a typical 50-55% to 90% or more which, when combined with direct submission, can dramatically improve your cash flow.  Because SolAce is a desktop application that resides in your office, you have complete control over your billing.  Solace is a single source solution for medical claim transactions which supports dozens of fields that are not on standard forms but are required for specialties

Clearinghouses
Clearinghouses are services that provide software for you to install in your office that enables you the convenience of transmitting to a central point.  From that point all the sorting and routing of your claims are handled by the clearinghouse.  The prices vary, but most clearinghouses are moving to a monthly, per-provider fee of $45 to $100.

Many clearinghouses offer additional services for additional cost, such as statements, eligibility and enrollment and claim status checks.  Most will also bundle a third party web portal solution for an additional fee (see Web Portals below).  Total cost can add up quickly and there are also incidental fees for certain services, so be sure to understand the contract well.  A per-claim charge option may be available but can be costly based on volume.  Since the clearinghouse submits your claim data "as is", there is no added improvement to claim rejection or denial rates or the related cash flow.

Free Packages from Payers
Several payers, especially the government contracted ones, distribute software to providers for free or a $25 charge.  This software is designed to encourage everyone to use electronic claims submissions, because it saves the payer $3 or more per claim by not having to handle a paper claim.

The Medicaid fiscal agent ACS distributes a product named ACE$, while Blue Cross/Blue Shield distributes ProClaim and AcClaim, and many Medicare regions distribute PC-ACE Pro 32.  These products provide data entry of claims and generation of the file that you need to transmit, however this requires double entry of claim information (PC-ACE Pro 32 does offer some import capabilities for those who are tech savvy.)  Potential use of multiple applications (one for each payer) and the payer submission requirements are not always simple which can easily result in denied claims.  Transmission instructions vary by region also.  Some may require you to use Dial-up Networking and connect to an FTP server, while others have bulletin board systems (BBS) that you dial into to upload your claims and download your acknowledgments and other transactions.  Although "free", this option can be very time consuming and complicated for providers.

Note: The regulatory mandate for the government funded payers to provide inexpensive claim submission software expires in October 2003 at which time certain payers may no longer support these products or maintain the current pricing.

Web Portals
Web portals are web sites that allow you to enter claims and perform a variety of other functions.  These portals are sometimes provided by the payer, and others are serviced by clearinghouse partner companies.  Prices start around $50 per month per provider, or are sometimes based on your volume, and can range up into the hundreds depending on what features you want.  Watch out for hidden fees and additional per-claims costs.

Some of the portals have edits to catch data entry errors but with others, submitting claims that get rejected or denied is very possible.  In addition to being a double entry solution, entering information via a web browser can be challenging due to potential technical problems.  Data can be lost (which you will be responsible for keeping a copy of) and connection problems can be time consuming and stressful.  The capabilities provided can be robust, including support for numerous transaction types including eligibility, claim status, etc.

Other Direct Claims Packages
Software packages that can send claims directly to certain payers are available from a variety of locations.  These other direct solutions usually only support a limited number of payers which can result in the need to purchase and/or use multiple products or services.The biggest difference from SolAce is the price.

Most other direct solutions are at the high-end, sold as add-ons with practice management systems to enable direct electronic claims submission right in your existing software.  These add-ons provide you with complete control over your billing and eliminate the per-claim and per-provider charges that a clearinghouse option would have.  However, like clearinghouses, the add-ons submit claim information "as is" which does not provide the same level of improved quality of claims or cash flow as SolAce which can just as easily integrate with the existing accounting system (i.e. a third party add-on).

Next Steps
As you can see, there are a variety of options that you can use to achieve HIPAA compliance and increase cash flow by submitting claims electronically.  Our advice is to decide which options fit your needs (i.e. most cost effective, easy to implement/use) and then contact the vendors of each to determine pricing, support options, contract details, and future pricing expectations (upgrades, etc.)

Please contact us regarding SolAce or if we can assist you in your analysis or comparison of these options.