Process efficiencies ultimately allow doctors more time to provide quality care. How that transaction is processed within the individual organization is its choice. This requirement has already allowed members to achieve significant improvements in the speed and uniformity of many core administrative processes. This private network provides a secure and high-speed connection for sending and receiving patient data. There are no per-transaction fees.
All members pay the same monthly membership fee regardless of how many transactions they exchange.
Analysis shows that a large number of denied claims are due to invalid member information and that eligibility verification often is not performed. In addition to member payer activities, a pilot project with Medicaid is under way. Early tests show positive results with response time of under 5 seconds for eligibility verification. Once the pilot is proven successful, access to Medicaid data will be available to the entire consortium. Referral Authorization - Unlike eligibility, referral authorizations are a requirement for specialty visits, and often primary care physicians must deal with a cumbersome and fragmented process.