La Jolla, Calif./Phoenix, Ariz. -- September 27, 2004 - Two industry leaders, VestaCare, Inc. and Eldorado Computing, Inc. (ECI), announce their partnership to offer an advanced claims auto-adjudication solution to healthcare payers today at the Self-Insurance Institute of America´s (SIIA) National Conference in Miami, Fla.
According to the terms of the agreement, VestaCare, a leader in providing claims processing automation and system integration solutions, and ECI, a nationally recognized provider of health benefits management solutions, will offer an integrated claims processing solution to ECI''s healthcare payer clients. The comprehensive system combines VestaCare´s fully automated pre-processing with ECI´s HEALTHpac auto-adjudication engine to enable maximum auto-adjudication rates for ECI clients. Both parties agree to support a standardized implementation process and data exchange method utilizing the HIPAA-compliant X12 837 4010 EDI format.
VestaCare''s technology leverages double-key data conversion, real-time eligibility testing, PPO routing and re-pricing, and an intelligent claim loading solution that allows complex human decision-making steps to be captured and fully automated, eliminating manual intervention in over 70% of the claims payment process.
"In combining these capabilities with the added flexibility to apply any desired PPO to a payers'' group requirement, the VestaCare-ECI solution ensures the most effective medical cost management and claims processing solution available for the healthcare payer industry," said Tom Brekka, CEO of VestaCare.
According to ECI´s CEO, Zane Bell, "The joint expertise of the two companies allow ECI clients to attain the industry´s highest auto-adjudication rates, increase flexibility in PPO choices, and streamline medical cost management - all of which result in improved productivity and reduced administration costs."
About Eldorado Computing, Inc.
Based in Phoenix Ariz., Eldorado Computing, Inc. is a recognized leader in providing integrated software and ASP solutions for health benefits management. The company serves hundreds of third-party administrators (TPAs), health plans, employers and self-insured organizations. Together, Eldorado Computing´s customers manage five million insured lives and handle 35 million claims annually. For more information, contact 602-604-3100 or visit www.eldocomp.com.
About Vestacare
Based in La Jolla, Calif., VestaCare, Inc. is rapidly becoming recognized as "Masters of Process Automation and System Integration" for the health insurance industry. The company''s proprietary LegacyWerks technology combined with its fully automated Transaction Router and specialized EDI tools enables VestaCare to create the optimal business process outsourcing solutions for all Payer requirements.
VestaCare''s EDI Receiver solution automate electronic connections with trading partners, as well as verifies, translates and corrects claim formats to ensure continued HIPAA EDI compliance through all processing steps. VestaCare´s Data Transcription service provides 99.96 percent accuracy on a field-basis, representing a 10 times improvement in accuracy over conventional OCR and keying approaches. VestaCare''s Eligibility process is real-time and fully integrated with the Payer''s claims system, eliminating extra IT support required with other outsourced solutions. VestaCare''s PPO routing/repricing solution provides complete management of the repricing process, including automatic routing of claims to over 30 PPOs and Trading Partners, and full monitoring to ensure immediate turn-around of 100% of all claims. VestaCare''s intelligent claim loading solution fully automates the entry and pre-processing of claims with the Payer''s claims system, including providing full provider matching, revenue code matching, revenue code bundling, claim value adjustment and presetting claims for auto-adjudication.